Which pediatric presentation in the ER warrants follow-up for abuse?

In the context of evaluating pediatric presentations in the emergency room for potential abuse, the lethargy of a 2-month-old after falling from a changing table raises significant concern. This concern stems from the age of the infant and the nature of the injury.

Infants, especially those as young as 2 months, are not developmentally capable of rolling or moving independently in a way that would result in such an incident without an external cause. A fall from a changing table can lead to serious injuries, but the lethargy in this scenario suggests that the injury could be more severe or that the infant may have sustained additional trauma. This combination of factors necessitates a thorough investigation for potential abuse, as it may indicate neglect or a more malicious cause of injury.

In contrast, the other scenarios involve injuries that can be more easily explained through common accidents or typical childhood behavior. A 3-month-old with a flat bluish discoloration on the buttock may have a benign condition such as a Mongolian spot, which is not indicative of abuse. The 3-year-old with bruises from running into a table presents a typical playground or home injury that does not raise immediate concerns for abuse. Finally, while burns from boiling water in a 4