A toddler arrives in the emergency room with a broken arm. A teacher notices bruises on a student's back. A young girl becomes shy around a male relative.

Is it physical or sexual abuse? Is it just the rambunctiousness and clumsiness children are known for? Is the young girl just going through a phase?

Two KU Wichita Pediatrics physicians, Kathy Melhorn and Kerri Weeks, have dedicated their practices and careers to helping answer such questions. Weeks, a clinical associate professor at KU School of Medicine-Wichita, conducts the outpatient Child Maltreatment Clinic that Melhorn began more than two decades ago, providing a clinical evaluation of whether abuse has occurred, while Melhorn, clinical professor, focuses on inpatient assessments and working to improve the system to treat and prevent abuse. 

They work closely with social workers, law enforcement officers, prosecutors and the courts to determine whether children have been abused, to protect them from further abuse and to ensure they receive the care they need. Several years ago, Melhorn was instrumental in helping create the Child Advocacy Center of Sedgwick County, which brought social workers, therapists, the Exploited and Missing Child Unit (a joint Wichita-Sedgwick County law enforcement and Kansas Department for Children and Families unit) and others together under one roof.

"Everything you do in pediatrics is a collaborative approach with other specialties," Melhorn said. With her specialty, "we have the child protective services, law enforcement, the district attorney, the judges, all the people that can really impact the outcome of the child abuse investigation. It's important to communicate well."

"They intersect with every other kind of discipline," said Dr. Brian Pate, chair of the medical school's pediatrics department. "You're not going to find a better example of why we do what we do than a child abuse pediatrician."

What the practice entails

Child abuse and maltreatment became a board-certified specialty in 2009, but both Melhorn and Weeks were working in the field before then.

Melhorn graduated from KU School of Medicine-Wichita and did her pediatrics residency with the school. She saw children "falling through the cracks" but felt that she didn't always have the training to best determine whether abuse occurred. That led to a fellowship at Los Angeles County/USC Medical Center, where she started gaining expertise, and she joined the KU Wichita Pediatrics faculty in 1986.

Weeks completed medical school at KU School of Medicine-Wichita in 2002, and during an internship in Virginia, she met a child abuse expert and, seeing someone so passionate working in that field, it helped steer her toward the specialty. Weeks did her pediatrics residency at Children's Mercy Hospital in Kansas City, Missouri, and followed with a fellowship in child abuse there.

KU Wichita Pediatrics proved a good fit. Weeks could work alongside Melhorn, who began the work within the child abuse medical specialty. "I joined a dedicated and functional team."

"I took over the outpatient abuse clinic," Weeks said. "It has really grown over the years.  We saw about 200 to 250 kids last year in the outpatient clinic, and another 120 inpatient." Patients came from 22 Kansas counties.

"I take patient referrals from other physicians, from law enforcement, the state Department for Children and Families, and the court.  The medical exam is an important piece of the evaluation," Weeks said.

Clinic visits include taking a family history and checking for other medical problems that could mimic abuse, in addition to examining for abuse. There's always the possibility that an abuser could be the one bringing the child to the clinic. "Being able to be diplomatic, objective and communicate well with people - to set your emotions aside - is very important," Weeks said.

"Part of our job is to educate other professionals about child abuse. We are trying to make sure that providers recognize and manage patients appropriately, to give them the care they need," Weeks said.

"The uplifting side of our job is we get to love on these kids. The kids that come to clinic are spoiled rotten," she said, describing the toys, stickers and blankets they shower on patients. 

"I work with a pretty amazing group of nurses," said Weeks. "I have an outlet to process the hard things I see at work. We give each other encouragement, so when we go home we can try to leave it at work. For the most part, it keeps us sane."

"It is hard. I compartmentalize it. You can't think about it all the time," said Melhorn. "I also saw a lot of healthy kids and that helps a lot."

The teaching component

Residents get to see not only how the doctors evaluate and work with abused or potentially abused kids but also see how the system fits together.

"They rotate with us," Weeks said. "Every resident has the chance to see how the multidisciplinary team works together.  We teach in the outpatient clinic and on the floor.  Some of the residents choose to spend a month-long rotation with us."

"I teach medical students," Melhorn said, "and work with residents so they have a basic knowledge of how to work with abuse cases. Residents get to work through the consults with us - they work the cases with us. We take them with us when we testify."

"Every pediatrician has to understand how to find the abused child in the patients they serve," Pate said. "We teach the concept of advocacy in pediatrics. How children are at risk and how the system can mitigate that risk."

Much progress, much work to do

Three decades ago, when Melhorn began working in the field, recognition of child abuse's prevalence and the need for young doctors to learn to recognize abuse were not emphasized.

"When I joined the department in 1986, I asked for a couple hours to talk with medical students," Melhorn said, and was told that wasn't necessary, that abuse wasn't really common, that teaching students about child abuse could just make them "feel bad about pediatrics." Now, decades later, "I don't have to beg and borrow time to teach about this topic."

"We're far better able to handle it," she said of identifying and treating abuse. "Prevention is the side we really need more work on."

The combined academic and community settings of the medical school provide an environment where that work can occur.  "I don't know of any program like this outside an academic setting. You have to have a department to allow you the time to do this. It's critical," Melhorn said.

"This is not lucrative work. The hours that go into it are far beyond what we can bill or be reimbursed for," Weeks said. "The support that we get from KU and the School of Medicine is tremendous."