A school is assessing a 7-year-old student. The nurse should identify which of the following findings as a potential indicator of physical abuse?

When assessing a school-age child for potential physical abuse, a nurse must differentiate between normal childhood injuries resulting from active play and injuries that suggest a deliberate or non-accidental origin. Non-accidental trauma often appears on fleshy or protected parts of the body, or in patterns that mimic the shape of an object or a forceful grip. The nurse's role is to document these findings objectively and report suspicions to the appropriate authorities according to mandatory reporting laws. Rationale: A. A weight in the 45th percentile is a normal finding for a 7-year-old child. Percentiles between the 5th and 85th are generally considered within the healthy range. While a sudden, drastic drop in weight or being significantly underweight (failure to thrive) can sometimes be a sign of physical neglect or food insecurity, a child at the 45th percentile is maintaining a standard growth curve. B. Abrasions on the knees are very common, expected findings in active school-age children. Known as accidental injuries, these typically occur over bony prominences during play, such as falling while running or biking. Injuries on the knees, shins, elbows, and forehead are generally considered developmentally appropriate and are rarely markers of intentional physical abuse unless they appear in combination with other suspicious patterns. C. Bruising around the wrist is a significant red flag for physical abuse. Bruising in this area often suggests a grab mark or a ligature mark, indicating that the child was forcefully held or restrained. Unlike the knees or shins, the wrists are relatively protected during normal play; therefore, bruising here is considered a non-accidental pattern. D. Missing front deciduous teeth is a normal developmental milestone for a 7-year-old. Most children begin losing their primary teeth and gaining their permanent teeth between the ages of 6 and 12. Although facial or dental trauma (such as a chipped or knocked-out permanent tooth) should be assessed for a possible history of injury, the loss of baby teeth in a 7-year-old is a standard physiological occurrence.