Review Question - QID 210924

A 6-year-old boy is brought in by his mother for a well-visit. She reports that he is going to start kindergarten soon. She is worried that he doesn’t like to play outside with the other kids on the block. When asked, the patient says “I like video games more than running. My big brother plays with me.” His mother states that his teachers reported that he did well in pre-school and participated in group games. The patient is normally a good listener but has become more stubborn about wanting to “do things by himself,” like getting dressed in the morning. The patient has no chronic medical conditions. He is allergic to peanuts. He takes no medications but has an epinephrine auto-injector for his allergy. His brother has asthma and his paternal grandfather died at age 56 of a myocardial infarction. His temperature is 98.7°F (37°C), blood pressure is 110/70 mmHg, pulse is 105/min, respirations are 22/min, and oxygen saturation is 99% on room air. He is in the 50th percentile for height and weight. On physical examination, a grade 2 systolic murmur is heard. When the patient stands up, the murmur decreases. Capillary refill is less than 2 seconds. Which of the following is the most appropriate next step in management?