A 6-week-old boy with a history of gastroesophageal reflux presents to the emergency department with bruising and bleeding. He was born full term via normal spontaneous vaginal delivery without complications. His parents had refused vitamin K administration. Since birth, he had been exclusively breastfeeding and growing well, without a recent change in mental status or seizure. Three days ago, the child received craniosacral massage therapy for reflux. The following day, the parents noticed a bruise on his left axilla, bumps with a purplish discoloration on the back of his head, and a few dry facial patches that bled for a day after scratching. There is no history of previous bleeding or family history of bleeding disorders.

On examination, the child is well appearing, and his vital signs and growth parameters are within normal limits. His anterior fontanelle is soft and flat. Findings from the neurologic examination are normal. There are...

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