Which behavior should raise suspicion of caregiver abuse towards a child?

Offering unsolicited explanations for abnormal physical exam findings is indeed a behavior that should raise suspicion of caregiver abuse towards a child. This behavior may indicate that the caregiver is attempting to provide justifications for injuries or conditions that appear inconsistent with the child's developmental stage or the explanations provided are overly detailed or implausible. Such unsolicited explanations can be a red flag, suggesting that the caregiver may be trying to deflect attention from potential abuse or neglect, especially if these explanations do not align with the medical history or physical findings observed by the healthcare professional.

In contrast, asking siblings to leave the room during an examination might raise concern, but it could also be a reasonable step to protect the child’s privacy or comfort during a potentially sensitive assessment. Difficulty recalling the last time the child was seen by a physician might suggest neglect in healthcare, but it does not explicitly indicate abuse. Demanding immediate transport to the hospital may stem from a genuine concern for the child’s health and doesn’t inherently signal abuse. Therefore, the unsolicited explanations stand out as a significant indicator of potential caregiver abuse.