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Original Question

Marty Lagina is an 8 year-old male presenting to his pediatrician with parental complaints of poor attention span and negative outbursts at school and home. The nurse reviews the medical record for Marty and notes that he has been to the office 10 times in the nine months. Each time Marty is sent home with vague symptoms and injuries documented that were the result from “playing too rough with his brother Rick.” The nurse reviews Marty’s support system and sees that he lives with his mother and brother full-time but has overnight visitation with his father every other weekend. Marty states that he does not take any medication and his favorite color is blue. His vitals are Temp- 98.6, Pulse- 95, Respirations- 18 and 02 saturation is 96% on room air. When the nurse enters the room, Marty is laying on the exam table in the fetal position and rocking back and forth. The nurse asks Marty to describe the symptoms he has been experiencing. Marty states that he doesn’t like school and everyone is mean to him. He continued that he tries to pay attention but he is either too sleepy or gets “really bad pain in his head that makes him want to cry.” As Marty was talking, the nurse noticed deep bruising to his neck, just above the scapula and on his upper arms and right leg. When the nurse started to palpate the areas Marty jerked. When asked about the ecchymosis, he began to cry and said that he was wrestling too hard with his brother and got hurt. “My boo boos hurt. Is there a medicine that will make it all better?” he

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