Nu632U14peerresponseTaylor

You see the child pictured above and ask the parents, “How did she get hurt?” They reply that she rolled off a couch.

What additional information would you want to obtain?

I would like to know when the event occurred, how high was the couch, was the child home with another person or the parents, and what were the parents and child doing prior to falling off the couch (sleeping, watching tv, playing, etc)? I would also like to know if the child had taken any medication before falling (I.e. a sedative that could have induced sleep and impacted arousal/alertness).

Is this explanation consistent with the injury? Explain your answer.

While it is possible that the child could have rolled off the couch, it is likely that additional trauma occurred to the childâ€™s eye, as it is swollen almost shut, and the patientâ€™s ear, as it has an additional scratch mark on the external ear. An initial impact would not be strong enough to warrant such bruising without additional force. For example, a study that examined falls in children under 2 years old found that children with falls that were supervised had a smaller prevalence rate of subdural hematoma than the group whose falls were not witnessed (Amagasa, 2020). The witnessed fall group also had no retinal hemorrhage or neurological sequelae (Amagasa, 2020). In conclusion, the witnessed fall group experienced less trauma and severity of injury after short falls, meaning additional blunt force trauma must have been carried out or the child must have fallen from a higher location (Amagasa, 2020).

Is this injury developmentally appropriate?I think the child is developmentally appropriate, as the child appears to be between 18 months and 3 years old. At this time, the child should be walking, attempting to run, walking up and down stairs, beginning to jump and catch balls (Cleveland Clinic, 2023). For this reason, it would be possible for the child to be playing or sleeping on the couch, lose perception of where they are, and fall.
How would you manage this case?

I would manage this case by obtaining a more detailed history from the parents and the child (if the child is of appropriate developmental age). Garzon et al. (2025) recommends getting a history of the event from both parties individually to see if physical abuse suspension is warranted or not. If abuse is suspected, I would contact CPS for further evaluation. I would perform a full physical exam and also order an Xray to ensure no facial fractures have occurred (Garzon et al., 2025).

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