When assessing a child for an upper extremity fracture, the nurse should know that these fractures most often result from

Hypothyroidismreferstoanunderactivethyroid glandthatdoesnotproduceenoughthyroidhormones. In newborns, this condition is known as congenital hypothyroidism. Thesymptoms mentioned—mottled skin, a large fontanel (soft spot on the baby's head), a largetongue,lethargy, anddifficultyfeeding—arecharacteristic ofhypothyroidism inneonates.

Mottledskincanoccur duetodecreasedcirculationandlow bodytemperatureassociatedwith hypothyroidism. A large fontanel and tongue are common physical features seen ininfants with hypothyroidism. Lethargy and poor feeding are also typical signs of thiscondition.

Hypoglycaemia in (option A) is incorrect because it refers to low blood sugar levels andusuallypresentswithdifferent symptomssuchas jitteriness,tremors,and sweating.

Hypocalcaemia in (option C) is incorrect because it is low calcium levels and can manifestwithsymptoms like muscle cramps, twitching,and seizures.

Phenylketonuria (PKU) in (option D) it is incorrect because it is a metabolic disordercharacterized by the inability to metabolize the amino acid phenylalanine, and it typicallypresentswith differentsymptoms such asintellectual disabilityandamustydoorto theskin.

Therefore, based on the symptoms described, hypothyroidism (B) is the most likely disorderinthisneonate. Itisimportanttoconsultahealthcareprofessionalforaproperdiagnosisandappropriatetreatment.

Upper extremity fractures in children commonly occur as a result of falls. Children are more prone to falls due to their developing motor skills, balance, and coordination. They may fall from playground equipment, bicycles, or simply while running or playing.

While sports injuries (Option A) can also lead to upper extremity fractures, falls are generally the most common cause in children.

Physical abuse (Option B) is an unfortunate possibility in some cases, but it is important to approach the assessment without assuming abuse as the cause without appropriate evidence or disclosure.

Upper extremity fractures resulting from automobile crashes (Option D) are less common in children compared to falls or sports injuries, although they can occur in severe accidents.

It is always important for the nurse to assess the child's history, obtain a detailed account of the injury, and consider any additional signs or indications that may suggest non-accidental trauma if appropriate.