Which presentation should raise suspicion for potential child maltreatment?

The presence of bruising to the left ear of a newborn is particularly concerning and should raise suspicion for potential child maltreatment. In infants, any bruising is atypical and suggests a mechanism of injury that may not be consistent with normal activity or play. Bruising in a newborn is especially alarming because they have very limited mobility and are usually not capable of causing such injuries on their own.

In the context of child maltreatment, any unexplained or suspicious bruising, especially in a newborn, warrants further investigation to rule out abuse. Other scenarios, such as a closed greenstick fracture or a spiral fracture in older children, may be explainable by typical childhood activities, including falls or sports. While bruises in various stages of healing can be concerning, they might still occur due to typical childhood play, especially in toddlers who are active and begin to explore their surroundings.

In contrast, the significant risk from a bruise to a newborn indicates potential maltreatment, making it the most concerning presentation among the options provided.