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Two coughing children, each with bruises and highly suspicious test results — clear-cut cases of child abuse? Not necessarily, say our pediatric forensic medicine specialists.

We’ve created a pediatric forensics program that’s making a difference for children, their families and their doctors. It is the only one of its kind in the region, offering our expertise to health care providers before they call child protection and law enforcement professionals.

Child abuse isn’t always easy to recognize, and sometimes what seems like obvious abuse is something altogether different. That can leave doctors unsure how to proceed when a child’s well-being is in question.

Take, for example, two recent cases:

• A 4-month-old baby came to the emergency department with a bad cough. A chest x-ray showed healing rib fractures, which prompted further tests. Those tests revealed bleeding in the brain and other broken bones and confirmed everyone’s suspicions.

  Previously, a potentially lengthy and expensive investigation would have been the next step and the baby might have been returned home in the meantime. Instead, our forensic pediatrician explained her findings to child protection professionals and joined a group meeting with the family. Faced with clear medical evidence, a family member admitted abuse and officials took protective actions before the baby left the safety of the hospital.

• In another case, an immigrant family brought its 7-year-old to the hospital with a cough. The child also had many odd bruises on his back. Our specialist recognized the bruises as the result of “cupping,” an alternative therapy some cultures use to promote healing. Her insight prevented an unnecessary investigation and undue turmoil within the family.

Our forensic pediatricians consult on about four cases each week. The workload is daunting. But their efforts make a difference for us all.