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Child Abuse OC medical director looks for telltale signs. By OC FamilyPublished: June, 2007

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The medical director of Orange County's Child Abuse Services Team (CAST) asked a breakfast meeting whether his task force - comprised of law enforcement, social workers, child advocates and medical teams - should err on the side of caution in suspected child-abuse cases, or back off.  "Which is worse," asked Dr. Frederic Bruhn, "overcalling abuse, or undercalling?  "You're damned if you do, both ways."  Dr. Bruhn was the guest speaker at an Orange County Child Abuse Prevention Center (BrightFutures4Kids.org) breakfast meeting. Quoting national statistics, he said that there are about 3 million alleged abuse cases in the U.S. annually; about 12 in 1,000 are confirmed; and that the breakdown goes like this: neglect (60%); physical (18%); sexual (10%); emotional (7%); and other (15%) such as abandonment and drug-endangerment.  "Our job is to diagnose abuse. I can tell the other agencies what I think. A lot of what we see is trauma: Is it accidental or intentional?"  There are some factors that play into suspected abuse. For example, statistically, a child who falls less than 4 feet should not sustain a major injury. So, if a parent of an injured child uses as an excuse that the child fell only a few feet, that's a sign, says Dr. Bruhn. Also, was there a delay in seeking care? In what manner was the bone broken? And, a baby who is only old enough to roll back and forth shouldn't end up badly bruised.  "Everything isn't abuse," said Dr. Bruhn, a pediatrician for 40 years and part of the CAST team for about one year. "But when you work in my job, some days everything seems (so)."  He showed several slides of injured children - most abused, though not all. One image was of a child's seriously bruised buttocks. "If you saw this in an adult, there would be no question, assault. And if you see this in a child, it's no question, it's abuse."

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