Non-accidental trauma and neglect (pediatrics) Quiz: Ace Your Exams

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A 9-month-old boy is brought to the emergency department by ambulance for evaluation of a seizure. The patient has been staying with his maternal grandparents for the past week while his parents are out of town. The maternal grandparents witnessed the patient having a generalized tonic-clonic seizure that lasted approximately 8 minutes. Emergency Medical Services (EMS) stopped the seizure with intramuscular midazolam. The patient has been lethargic since this episode. Maternal grandparents state that there has been no recent fever or illness, and no known trauma or dangerous ingestion. Before today’s seizure, the patient was in his usual state of health. He has no significant past medical history, and he takes no medication. The patient has been meeting developmental milestones and vaccinations are up-to-date. Temperature is 37°C (98.6°F), blood pressure is 86/40 mmHg, pulse is 121/min, respiratory rate is 32/min, and oxygen saturation is 98% on room air. On physical examination, the patient appears postictal but moves all extremities freely. Anterior fontanelle is closed. Pupils are equal, round, and reactive to light bilaterally. Cardiopulmonary and abdominal examinations are within normal limits. The patient has evidence of bruising on the right ear and linearly along the right side of the neck. Lab work is obtained, and results are pending. Which of the following is the best next step in management? 

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