Which of the following presentations is most suspicious for child maltreatment?
1) A 6-year-old patient who is brought in by the caregiver after they noticed scattered bruising of the patient's shins while getting them dressed for summer camp. The largest bruise is 3-cm, they do not seem to be in a pattern, and there are also a few bruises over their knees and extensor forearms.
2) An 18-month-old patient brought in by their caregiver after being picked up from daycare and noted to have a 2-cm bite mark on their forearm. The daycare provider denied knowing what occurred but did admit to stepping out to change the diaper of another child and, when they returned to the room, the patient and another child were both crying. There are no other lesions present on the body.
3) A 3-month-old with a 7-day history of coughing and fussiness. A chest x-ray shows multiple bilateral posterior rib fractures located near the costovertebral articulations.
4) A 9-year-old who presents for their annual physical examination is noted to have six discrete 4-cm circular bruises on their back with central petechiae. The family recently immigrated from Southeast Asia and, due to a language barrier, are unable