Case Study

Treating Underlying Pediatric Depression

Daryl, age 8, comes to your office with a severe sore throat, difficulty swallowing, and a fever of 101. During your exam, the third-grader mumbles his answers. “Now baby,” Daryl’s mother says, “Dr. Reveles will help you feel better. I bet she can even figure out why you’re so tired all the time. Do you want me to tell her about your bad dreams, too?”

Daryl shrugs and looks at the floor. His mother continues: “His grandfather died a few months ago. We’re all sad, but it’s been really hard on Daryl.” Daryl’s grandfather had provided daily after-school care for Daryl while his mother worked. Now, Daryl is in an extended care program that doesn’t have any other boys his age. She tells you that Daryl often seems sad and tired, has difficulty sleeping, and has nightmares. “Truth is,” she says, “we both have bad dreams. I guess that’s normal after you lose someone you love.”

portrait of sad, young boy
Patient
Daryl
Sex
Male
Age
8 years

How should you respond?

Swab Daryl’s throat and perform a rapid strep test. When you get the positive results, return to Daryl’s room with a prescription for antibiotics. Encourage Daryl to be more active when he gets well because exercise will give him more energy and help him sleep.

Diagnose and treat Daryl’s strep throat. Ask a few probing questions about the extent of Daryl’s emotional and behavioral symptoms and the family’s adjustment following the loss of his grandfather. Since Daryl does not seem to be in immediate danger and his strep throat needs to heal, schedule a follow-up appointment in one week for additional assessment with a Mood and Feeling Questionnaire and to speak with the mother in more detail.

Diagnose and treat Daryl’s strep throat, then ask the boy to sit in the waiting room while you have a private talk with his mother. Advise her that Daryl may be suffering from depression and recommend that she work with his school to find a social worker who can help him and the rest of the family.

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