A kindergarten student is frequently violent toward other children. The school nurse notices bruises and burns on the child’s face and arms. Which other symptom would indicate to the nurse that the child might have been physically abused?

Choice A reason: Begging or stealing food or money may suggest neglect or poverty, but it is not specific to physical abuse. While it can be a red flag, it does not directly correlate with the fear response typical of physically abused children. Choice B reason: Shrinking at the approach of adults is a classic behavioral indicator of physical abuse. It reflects fear, hypervigilance, and conditioned avoidance. Children who have been physically abused often anticipate harm and may flinch or withdraw when approached, especially by authority figures. Choice C reason: Developmental delays can result from various factors including neglect, trauma, or medical conditions. While they may co-occur with abuse, they are not definitive indicators of physical abuse alone. Choice D reason: Frequent school absences may suggest neglect or attempts to conceal injuries, but they are not specific enough to confirm physical abuse. Absenteeism could stem from other causes such as illness or family instability.