A parent brings a toddler to the pediatric clinic. The nurse observes a number of bruises on the child in various stages of healing. The parent claims the toddler bruises easily
The best action on the part of the pediatrician and the nurse would be to: a. believe the parents and schedule an appointment in 2 weeks
b. report this to child and family services and order a screening battery of bleeding and clotting blood work
c. check with the other parent or another caregiver to see what he or she might be able to add to this history
d. tell the parent that it is clear that he or she is lying and to tell the truth
B
Feedback
A Incorrect: A number of bruises in various stages of healing is a "red flag" indicator for abuse. So the best action to be suspicious of the parent's explanation.
B Correct: Physical abuse indicators include bruises in various stages of healing. The color of the bruises helps determine if the injury occurred as a single episode or over a period of time. Bruises resulting from physical abuse will be various colors, from reddish blue or purple to yellow, brown and fading. To avoid errors in diagnosis, children who present with multiple bruises that do not reflect the use of an object should be reported to child and family services. Screening tests of bleeding and clotting should be ordered to evaluate for a bleeding disorder.
C Incorrect: A number of bruises in various stages of healing is a "red flag" indicator for abuse. So checking with the other parent or another caregiver to see what he or she might be able to add to this history is not the best action.
D Incorrect: This is an inappropriate action. It is important to establish a trusting relationship with the parent so a supportive, nonblaming approach is best.
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