An 18-month-old boy has refusal to move his left arm and multiple bruises. What is the appropriate next step?

The situation presented involves an 18-month-old boy who is refusing to move his left arm and has multiple bruises. This raises significant concern for potential child abuse or a serious underlying medical condition, such as an injury that could require immediate attention. In this context, the appropriate next step is to admit the child under the care of a pediatrician.

By admitting the child, medical professionals can conduct a thorough evaluation to rule out fractures, assess for signs of abuse, and ensure that any necessary imaging or laboratory tests are performed. Proper admission allows the child to be observed closely, potentially providing a safer environment to assess his physical and emotional well-being. Additionally, if there is a concern for abuse, the pediatric team can coordinate with child protective services as needed.

While discharging the child with painkillers might provide temporary relief, it does not address the underlying concerns related to his symptoms and could risk further harm if there is a serious injury or abuse. Initiating IV centrism is not relevant in this context, and follow-up in an outpatient setting would not be appropriate given the immediate concerns that need to be addressed. Thus, admitting the child ensures that he receives the comprehensive care required for his condition.