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You are a staff member in a before/after school program at a local community center.  When working with a 5-year-old girl in the program, you discover that she has a cast on her foot and that both of her legs and arms are covered in bruises, which are in different phases of healing. The child’s parents tell you that she is sickly and is prone to illnesses and can be very demanding, but you are concerned that someone may be abusing her. When you ask the child what happened, she simply shrugs her shoulders and keeps playing with her dolls. You ask the parents what happened to the child to cause the bruises, and they indicate that she is a clumsy child and keeps falling down. You ask the mother if anyone in the family has ever been tested for osteogenesis imperfecta and Von Willebrand’s disease, which would be a medical explanation for these injuries, or if the father uses alternative medicinal practices, such as cupping. She replies no to both questions.

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