What is the most appropriate next step after a pneumonia diagnosis in a child with concerning rib fractures?

Determining the next step after diagnosing pneumonia in a child with concerning rib fractures involves assessing the potential for non-accidental injury. Rib fractures in children, especially those that are concerning or atypical for the child's developmental stage, can be indicative of abuse.

Conducting a skeletal survey is the most appropriate next step because it is a systematic method to evaluate for additional signs of trauma or injury throughout the skeleton. This approach is especially important in cases where there is suspicion of child abuse, as it can reveal previous fractures that may not have been documented or identified, providing a more comprehensive view of the child's situation.

In contrast, initiating bronchodilator therapy is primarily relevant for conditions such as asthma or bronchospasm, which are not directly related to pneumonia or rib fractures. Referring for surgical evaluation may be necessary in cases of significant injuries, but rib fractures alone do not typically require such intervention unless there are complications. Prescribing corticosteroids can be helpful in certain types of pneumonia or inflammatory conditions but does not address the potential concern of underlying abuse indicated by the rib fractures. Thus, approaching the situation with a skeletal survey allows for a thorough investigation into the child's overall safety and well-being.