A nurse is assessing a 6-year-old Asian child with injuries sustained after “falling from a bicycle.” The child’s injuries are inconsistent with the provided history. He is brought in by his mother, a physician, who also has resolving facial injuries. When questioned, the mother cannot recall how she received her injuries. Which of the following factors supports the nurse’s suspicion of child abuse?

Child abuse (even suspected cases) in many states must be reported by a healthcare worker. The risk factors include: parental perception of stress, life changes in a family, young age at the birth of the first child, low education level, low income or unemployment, little or no prenatal care, no phone or unlisted number, evidence of harsh discipline, and/or current or past spousal abuse. Therefore, in this scenario, the mother’s injuries along with those of the child raise the suspicion of an abusive situation in the home.