A young child is being evaluated in the Emergency Department for injuries her mother reports resulted from a fall down the stairs. Which of these findings indicates that physi-cal abuse may be a chronic problem for the child?
a. The mother's description of the child as being ‘clumsy'
b. Several fractures revealed on x-ray in varying degrees of healing
c. Clinging to her mother as she attempted to leave the examining room
d. Struggling with the staff when attempts to obtain a blood specimen were made
ANS: B
Unhealed fractures indicate both numerous injuries and that medical intervention was not sought at the time of injury. Although unkind, the mother's description of the child is not reason to believe chronic abuse has occurred. The remaining options reflect normal behavior, especially if pain or separation is suspected.
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