A 1-year-old boy with coughing for a day; nonproductive cough for four days; left back pain when auscultated; Chest x-ray is provided. Which is the most appropriate next step?

A 1-year-old boy with coughing for a day; nonproductive cough for four days; left back pain when auscultated; Chest x-ray is provided. Which is the most appropriate next step?

• A. Reassure parents
• B. Start antibiotics
• C. Call child protective services
• D. Schedule follow-up

Answer: (C)

When there are signs suggesting possible physical abuse in a young child, reporting to child protective services is required by law. In an infant, back pain and findings on chest imaging can indicate rib fractures or other injuries from trauma that may not be explained by a simple illness or accidental cause. Because safety is the priority, the clinician must escalate to mandated reporting to ensure the child is protected while a formal evaluation is conducted. Reassurance, starting antibiotics without an infection to treat, or simply scheduling follow-up do not address the potential risk to the child and would be inappropriate in this context. Document objective findings and any inconsistent history, and involve pediatrics and social services as part of the next steps.

When there are signs suggesting possible physical abuse in a young child, reporting to child protective services is required by law. In an infant, back pain and findings on chest imaging can indicate rib fractures or other injuries from trauma that may not be explained by a simple illness or accidental cause. Because safety is the priority, the clinician must escalate to mandated reporting to ensure the child is protected while a formal evaluation is conducted. Reassurance, starting antibiotics without an infection to treat, or simply scheduling follow-up do not address the potential risk to the child and would be inappropriate in this context. Document objective findings and any inconsistent history, and involve pediatrics and social services as part of the next steps.