What is the most appropriate next step for a child presenting with suspected child abuse and multiple rib fractures?

When a child presents with multiple rib fractures and there is a suspicion of child abuse, the most appropriate next step is to ensure that a child abuse investigation is initiated. This is critical because the safety and protection of the child are the foremost priorities in such situations.

An immediate referral for an investigation allows trained professionals, such as social workers and law enforcement, to assess the child's environment and potentially identify any abusive situations. This process is vital to protect the child from further harm and to provide any necessary interventions.

While conducting a skeletal survey may be helpful in identifying additional fractures or signs of abuse, it is not a substitute for the immediate action needed to ensure the child's safety. Additionally, though a thorough physical examination is important for assessing the child's current condition, it does not replace the urgency of starting an investigation. Watchful waiting is not appropriate in situations of suspected abuse where there is a risk to the child's safety.