A mother sees her 4-year-old boy masturbating. She expresses concern about this to the PMHNP and says she wants to know if he has been sexually abused. What is the most appropriate response?

Choice A reason: Automatically assuming abuse based on masturbation in a 4-year-old is inappropriate and may cause unnecessary alarm. While sexual behavior can be a red flag, it must be assessed in context. This response lacks clinical judgment and violates trauma-informed principles. Choice B reason: While evaluation is important if abuse is suspected, suggesting it is “possible” without further context may reinforce fear unnecessarily. This response is cautious but not the most appropriate initial reassurance. Choice C reason: Masturbation in young children is often a normal part of development. At age 4, exploratory behavior is common and not necessarily indicative of abuse. This response provides reassurance while remaining clinically accurate. Choice D reason: This question may feel accusatory and lacks sensitivity. It could damage rapport and does not reflect a trauma-informed or developmentally appropriate approach.