Which pediatric presentation in the emergency department should the nurse follow up for possible abuse and mandatory reporting?

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11ecbb05_cb98_9e05_b433_492b563ab14b_MD0009_00 Infants do not start rolling until age 4 months and normally roll front to back at 5 months. This explanation for the injury does not fit the growth capacity of the child. Because lethargy is present, head injury must be ruled out. (Option B) Congenital dermal melanocytosis (Mongolian spots) are an expected finding. These are seen on the lower back and/or buttock more often in African American, Asian, Hispanic, and Native American infants. Although they can be mistaken for bruising and the size and location should be documented, they are not a concerning finding and usually disappear by school age. Congenital dermal melanocytosis (Option C) A toddler's forehead is the height of many tables. Due to toddlers' lack of coordination, this explanation is plausible in the absence of other concerning findings (eg, child is afraid of caregiver, multiple bruises of various ages over other parts of the body, malnourished). (Option D) Due to the child's short height, this is a credible explanation. A child can pull water down from a higher-level stove top. Burns that are suspicious for abuse include scalds without splash marks; scalds with a clear line of demarcation/immersion ("dunking"); scalds involving the perineum, genitalia, and buttocks; burns on the back (versus the front) of the child; mirror-image burn injury of the extremities; and cigarette burns. Educational objective: Infants begin to roll at age 4-5 months. History that does not match growth and development is a concern for abuse. Burns with splash, bruises from areas typically hit when falling, and Mongolian spots are expected findings.

Which Pediatric Presentation in the Emergency Department Should the Nurse