Preschoolers who refuse to be examined. Fearful or spoiled?

Twenty-two children (aged 2 to 5 years) who cried excessively or resisted physical examination during routine office visits initially seemed to be afraid of physicians, but eight were afraid of medical procedures, five had prolonged separation anxiety, six were manipulative, and three were afraid of men because of previous physical abuse by their fathers. Management plans were initiated for each etiological subtype. Five of eight parents whose children were afraid of medical procedures and five of six parents whose children were manipulative returned for counseling. In these cases, 100% (8/8) and 80% (4/5) of the children, respectively, made major improvement. Abused children required referral to mental health centers. Most parents of children with prolonged separation anxiety (three of five) did not consider the overdependent behavior to be a problem and therefore did not comply with treatment recommendations.