A mother brings her 3-month-old boy to the ED for vomiting and irritability. She says that the boy's father told her the baby wouldn’t stop crying and had vomited several times. The mother states the baby had been fine when she left for work that morning. The patient’s medical history is significant for colic and an episode of blood from his mouth 1 month ago. On physical examination, the baby is irritable, his anterior fontanelle is full, and his pupils react bilaterally. The patient continues to vomit several times in the ED and remains irritable and afebrile. You are worried that the vomiting and irritability are signs of abusive head trauma and you consider how to approach brain imaging in this patient. You then wonder whether you should order laboratory tests and assess for other occult injuries with a skeletal survey. Would an ophthalmological examination be indicated in this patient? Finally, you consider how and when to approach the family about a child protective services referral...
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