What finding is the most concerning in a physical examination of a child suspected of physical abuse?

Bruising on the neck and cheeks is considered the most concerning finding in a physical examination of a child suspected of physical abuse due to the implications it has for the child's safety and well-being. These areas of the body are not typically injured during normal play activities, and bruising in such locations can be indicative of significant, potentially abusive trauma. Additionally, bruising in these areas is often associated with a higher risk of serious injury, as they can suggest an intention to harm.

Irritability can be a non-specific sign that may arise from various causes, including normal developmental stages or other health issues, making it less specific for detecting abuse. The reticular, light pink rash on the bilateral cheeks could suggest a benign condition like slap cheek syndrome, which is common in children and not indicative of abuse. Weight alone, such as 24 pounds, can be a sign of various health or nutritional issues but does not directly indicate that a child has been abused. Thus, bruising in the neck and cheeks stands out as a strong indicator that warrants immediate concern and investigation in the context of potential physical abuse.