A nurse on a pediatric clinic is collecting data from a school-age child and their parent. Which of the following findings should the nurse identify as an indication of potential maltreatment?

Child maltreatment includes physical abuse, neglect, emotional abuse, and exploitation, and nurses play an important role in early identification and reporting of suspicious findings. Certain injury patterns are more concerning for non-accidental trauma, especially when they are inconsistent with the child’s developmental stage or explanation provided. Symmetrical injuries and burns with clear borders often suggest forced immersion or intentional harm. Prompt recognition helps protect the child and ensures appropriate intervention. Rationale: A. The child expressing a fear of falling in school is not by itself a clear indicator of maltreatment. School-age children may have fears related to injury, bullying, or normal developmental concerns. Without additional physical findings or behavioral signs of abuse, this statement alone does not strongly suggest maltreatment. B. Symmetric burns on the feet are highly suspicious for physical abuse, particularly forced immersion burns such as being placed in hot water. These burns often have clear lines of demarcation and a uniform pattern that differs from accidental splash burns. Such findings require immediate assessment and mandatory reporting for suspected abuse. C. Bruises on the right shin are common in active school-age children and are often related to normal play, sports, or minor accidental injuries. Bruising over bony prominences such as the shins is generally less concerning than bruises in protected areas like the abdomen, back, or inner thighs. This finding alone is not strongly suggestive of abuse. D. Missing a dental cleaning the previous week does not necessarily indicate neglect or maltreatment. Families may miss appointments due to scheduling conflicts, transportation issues, or temporary financial barriers. A single missed preventive visit without a pattern of neglect is not enough to identify maltreatment.