Filed 12/17/21 In re D.Y. CA2/2

NOT TO BE PUBLISHED IN THE OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

SECOND APPELLATE DISTRICT

DIVISION TWO

In re D.Y., a Person Coming Under the Juvenile C ourt Law. B310206 (Los Angeles County Super. Ct. No. 20CCJP05478A)

LOS ANGELES COUNTY DEPARTMENT OF CHILDREN AND FAMILY SERVICES,

Plaintiff and Respondent,

v.

H.L. and H.Y.,

Defendants and Appellants.

APPEAL S from order s of the Superior Court of Los Angeles County

. Julie Fox Blackshaw

, Judge

. Jurisdictional order

a ffirmed and remaining appeal dismissed

.2 Annie Greenleaf

, under appointment by the Court of Appeal, for Defendant and Appellant H.L

. Megan Turkat

- Schirn , under appointment by the Court of Appeal, for Defendant and Appellant H. Y

. Rodrigo A. Castro

- Silva , County Counsel, Kim Nemoy, Assistant County Counsel, and Jane Kwon

, Principal Deputy County Counsel, for Plaintiff and Respondent.

__________

________________________________

The juvenile court found H.L. (mother) and H.Y. (father) responsible for their infant son D.Y.’s (son) repeated and unexplained bruising. Consequently, the juvenile court exercised
its dependency jurisdiction over son und er Welfare and Institutions Code section 300, subdivisions (a) and (b). 1 The juvenile court removed son from his parents’ custody and, among other things, order ed mother and father to participate in a parenting course. On appeal, mother and father challenge the juvenile court’s jurisdictional finding under s ubdivision (a) of section 300

. Although mother and father do not challenge the juvenile court’s jurisdictional finding under subdivision (b) of section 300

— and, thus, dependency jurisdiction rem ains regardless of our decision
here

— we consider the parents’ appeals because of the
ramifications of the court’s true finding under subdivision (a). Mother and father also appealed the juvenile court’s dispositional
orders . However, subsequent proceedin gs in the juvenile court
have rendered those issues moot , and we do not address them
here

.

1 Undesignated statutory references are to the Welfare and Institutions Code.3 As discussed below, w e conclude substantial evidence supports the juvenile court’s juris dictional finding under section 300, subdivision (a)

. Thus, we affirm.
BACKG ROUND

1

. Events Preceding Petition Son is mother and father’s only child

. Mother and father

are son’s only caregivers , with mother being the primary caregiver . Mother and father were born in Ch i na and ha ve lived in the United States for a number of years. They both speak
Ma n darin and were assisted by Ma n darin language interpreters during the dependency proceedings below

.
a
. Son’s September 2020 Hospital ization In September 2020, when son was five weeks ol d, mother noticed swelling and redness on his left ear. At first, mother

t hought an insect had bitten son’s ear . However, because t he
mark became progressively worse over the course of a few days, mother brought son to an emergency room. The “ER Physician Note” from that visit indicates son was diagnosed with left ear
edema and mother was advised “to try conservative measures
such as ice first before follow

- up with scheduled appointment with pediatrician .” Two days late r , mother brought son to see his pediatrician

, Dr. Eva Chan . Dr. Chan diagnosed son with hemangioma and a
heart murmur. She explained the hemangioma would disappear within five to seven years

. 2 However, because the lesion was on

2 At the adjudication hearing, expert witness es explained the difference between a hem a ngioma and a hematoma , which distinction is central to this case. According to the Departme nt’s expert, a “hemangioma is a benign noncancerous tumor. It’s a result of proliferation of blood vessels .” The expert further4

son’s ear and was growi ng fast, Dr

. Chan referred son to a pediatric dermatolog ist

. ( Dr. Chan also referred son to a pediatric cardiolo gist for his heart murmur. ) Mother stated Dr. Chan told her if she did not want to wait for her insurance

company to process the medical referrals , mother could take son

to Children’s Hospital Los Angeles (hospital) for assessment right away. Mother decided to take son to the hospital later that same day. Hospital records indicate son was admitted “with bruising along the [left] ea r and along the [left] axilla/proximal upper arm ” ( i.e., the armpit area ). Because there was “no mechanism to explain the bruising, ” son was admitted to the hospital for a nonaccidental trauma workup

. Mother stayed with son at the hospital for five days. Hospital notes indicate a consultation was ordered with both “ hematology to rule out bleeding disorders ” and “ENT for the ear hematoma

, ” which it was noted “likely will

explained , “Hemangiomas are very different than hematomas ” in that hemangiomas “ have a very predictable course.

. . . [T] hey tend to proliferate, meaning get bigger, usually within the first three months. Then they will go through a period of either no further growth or very slow growth. It’s usually around nine to twelve months , maybe a little longer. Then they start to inviolate, meaning they start to go away. They can take years before they completely go away.” In contrast, the expert state d a hematoma “ is a collection of blood or a blood clot from injury to the [t]issue.” A hematoma “heals, resolves. The blood reab sorbs

. ” S ignificant deep tissue hematoma s could take weeks to resolve. Similarly, the defense expert testified, “ a hemangioma is

. . . a natural occurring event .

. . a disease process , a diagnostic condition, whereas a hematoma is pretty much a traumatic
event . And in that situation, trauma has to be determined to be either accidental or non

- accidental.”5

need to be evacuated in the OR .” Son was also referred to ophthalmology to rule out a retinal hemorrhage, cardiology
because of his heart murmur , as well as pediatric surgery

. Son had “an extensive hematologic workup that was negative, and imaging that was indeterminate for a vascular malformation
versus hematom a.” The swelling and discoloration of son ’ s left

ear “significantly decreased” during his stay at t he hospital.
When son was discharged a few days later , mother and father were instructed to make follow

- up appointment s with the dermatology clinic , pediatric surgery, and ENT

- O tolaryngology

, as well as to return to Dr. Chan for son’s next scheduled appointment . Son’s diagnosis at discharge was “Left ear hemangioma, unconjugated hyperbilirubinemia [jaundice]

, bilateral axillary [a rmpit] nodes .”
On October 6, 2020 , mother brought son for his next
routine appointment with Dr. Chan, during which son received
scheduled vaccinations and Dr. Chan performed a physical
examination of son. Dr

. Chan did not observe any new bruises or injuri es on son’s body. She noted son had been seen at the hospital and was “ evaluated for the H emangioma , according to mom, Ultrasound and MRI of the head showed normal results
with no abnormalities and was advised to observe with no
intervention.”
b. Son’s O ctober 2020 Hospital ization
A few days later, on October 9, 2020
, mother brought son for his follow

- up visit with the hospital’s dermatology clinic

. The
doctor noted “the lesion [on son’s ear] improved and continue s to decrease in size and there is a small firm nodule suggestive of a resolving auricular hematoma.” Also d uring that appointment, however, an unexplained bruise was seen “spanning his left6

lateral abdominal wall

. ” As a result, the doctor referred son back

to the hos pital , where he was admitted and stayed for two days

. Mother stated she had seen a bruise on son’s torso the day before when she was changing his diaper

. She did not know why
son had a bruise but speculated maybe it was because she had
held him tightly while bathing him. Mother told a hospital social
worker that, the day before, son had a “regular bath” and she did

not see bruising at that time but perhaps she had held him “ too hard

. ” Father indicated he had not seen bruising on son ’s chest
and believed such bruis ing must have occurred at the hospital. However, father had seen a bruise on son’s ear and guessed it might have happened if mother had held son too tightly while bathing him. Father said neither he nor mother harmed son. He
felt no one was “telling him and the mother what is going on with
the child.” After researching on

- l ine, father believed son might
have a blood disease.
Nurses at the hospital reported mother was appropriate
with son during his hospital ization

. The hospital medical team conducted a number of tests to determine a potential cause or causes for son’s bruising

. In addition to a general examination, a pediatric surgeon and an ophthalmology resident doctor examined son

. He also underwent
both an “ x

- ray s keletal survey ” and CT brain scan

. M edical
issues were ruled out as the cause of son’s injuries. Hospital
notes stated

, “ No medical etiology could be identified to explain [son’s] diagnosis.” A ccording to a hospital child abuse team

, son’s bruising was consistent with child abuse

. The attending pediatric emergency medicine physician, Dr. Jeffrey Birnbaum, indicated “strong opposition to [son] being discharged ” from the hospital. Dr. Birnbaum noted his concern s7

included the fact “ that this is [son’s] second presentation for traumatic injury with unclear mechanism. Mother did not seek care for bruising today, it was noted at a follow

- up appointment with dermatology

. ” Dr. Birnbaum also noted that, during son’s first hospital stay, son had an “e xtensive workup ” that was “unremarkable” and “negative.” As a result, Dr. B irnbaum felt hematologic abnormality was unlikely and suspected
nonaccidental trauma

. He noted that although previously there “[w]as concern over a vascular malformation of ear bu t now with findings on abdomen, less likely.” Hospital notes also indicated
son’s “ left ear remain s fuller than his right ear but the hematoma is largely resolved.”
A hospital social worker referred the case to the Los Angeles County Department of Children and Family Services (Department). Soon after the referral was made, a Department social worker spoke with hospital staff as well as with mother
and father . The social worker determined it was in son’s best
interest to be detained and placed in foster care . Mother and
father consent ed and asked that son be placed with A sian Pacific, preferably Chinese, caregivers. The Department detained son and placed him in foster care. The Department reported potential child abuse of son to the Los Angeles County Sheriff’s Department. A s heriff’s deputy responded to the hospital and interviewed Dr. Birnbaum and
mother. Dr. Birnbaum told the deputy “several medical test s had
been conducted on the child and [the doctor] found no evidence of trauma. However, he along with medical staff were concerned
about possible abuse to the child as this was the second time treating the child in the past two weeks for the same [type] of injury.” M other told the deputy she had brought son to the8

hospital for a follow

- up dermatology appointment related to his
ear. She said she informed the doctor of the bruises on son’s

torso . Mother was concerned son may have a blood disease and
she wanted him to undergo medical tests. She further explained she “was sure” the bruising to son’s torso occurred the day before
when she was bathing son and he slipped into the tub causing mother to grip him tightly with both hands. Mother told the deputy “she was upset with medical staff for their accusations of abuse on her child. She further stated she came to the hospital for help regarding the bruising and was in disbelief the medical
staff made accusations of abuse when she was the one who brought the bruises to their attention.” The dep uty reported he saw three bruises on son’s left torso

area , which “ were consistent with [mother’s] explanation on how
her son received them.” The deputy was unable to determine if a
crime had occurred and recommended “follow

- up to determine if any form of child abuse is occurring.”
2

. Petition
On October 14, 2020, the Department filed a three

- count section 300 pe ti tion on behalf of son (petition)

. The petition alleged one count under section 300

, subdivision (a) and two

counts under subdivision (b). The subdivision (a) count was identical to the first subdivision (b) count, which alleg ed son was at risk of serious physical harm because of bruising and swelling on his body that w as “ consistent with non

- accidental trauma.”
Those counts alleged mother’s explanations for how son sustained
his injuries were not consistent with the injuries and father provided no explanation for the injuries. The remaining subdivision (b) count alleged son was at risk of serious physical
harm becaus e parents “ failed to obtain timely necessary medical9

treatment” for son’s injuries. T he petition noted the Department would be relying on section 355.1, subdivision (a) “ to assert that a rebuttable presumption exists finding that the minor is a person
des cribed by ” subdivisions (a) and (b) of section 300. At the detention hearing held a few days later, the juvenile

court no ted it was “sympathetic to the parents ; however, this is a very low burden. Based on the severity of the bruises, further investigatio n needs to take place ; but in light of the allegation, pursuant to [section] 355.1 (a) the rebuttable presumption, the court finds that there is a prima facie case for detaining the child and showing the child is a person described by [section] 300.”
The court ordered son detained from parents and placed in foster

care . Parents were granted monitored visitation with son

. The
court also ordered the Department to have son tested for hemangioma

. 3. Further Investigation The Department continued its investigation and

, in late
November 2020 , filed its jurisdiction and disposition report with
the court. The report indicated that, i n mid

- November 2020, a Department social worker spoke with son’s foster parent, who reported son was doing well. The foste r parent took photographs
of son before and after his monitored visits with mother and
father and no new bruising or marks had appeared. On one occasion, however, mother stated she observed a bruise on son’s
left abdomen during a monitored visit . She sho wed a photograph
of the bruise to a Department social worker, who reported seeing
“a bluish color bruise to the left abdomen area on the picture.”
F oster parent’ s photographs of son taken prior to the monitored visit that same day , however, showed no bruising.10 The social worker also spoke with mother and father. Both mother and father reiterated what they previously had said regarding son’s ear and other markings . They stated Dr. Chan and the hospital had diagnosed son with a left ear hem angioma
and were told it would disappear or get smaller over time.
Neither knew why son had bruising, but believed it was possible
mother had held son too tightly while bathing him. Father thought some of the bruising might have occurred while son was hospital ized i n October. Mother and father denied any abuse of
son and explained they had sought timely medical attention for

son and followed the doctors’ instructions . B oth wanted son back home in their care as soon as possible. Mother and father had enrolled in pa renting classes

. The social worker followed up with the hospital on the juvenile court’s October 2020 order that son be tested for a hemangioma. The hospital responded : “Skin hemangiomas (birthmarks) are typically based on clinical diagnosis with no
addi tional specific studies required. Evaluating [son’s] clinical course since presentation, his ear findings are consistent with a resolving hematoma, with no current evidence of a hemangioma.”
The social worker also communicated with child abuse pediatricia n Dr. Catherine DeRidder , requesting her opinion on
the case. The social worker sent to Dr. DeRidder medical reports
from the hospitals and doctors who had evaluated son . The following day, Dr. DeRidder responded by e

- mail, stating she had
reviewed the documents and believed “ ‘ the PMD physician may just have not known what was going on with the ear and thought that a hemangioma was one possibility but i t seems with the continued bruising and negative work

- up for bleedi ng disorders, that physical abuse is highly likely in this case .’ ” Dr. DeRidder11

also stated son “ ‘does have so many bruises which is the most common finding in physical abuse.’ ”
The social worker communicated with a sheriff’s detective
who had intervie wed mother and father. The detective stated he
did “ not have concern as to physical abuse” and was “waiting for the Department’s investigation outcome.” In addition, the social worker spoke with Dr. Chan , who explained the difference between a hemangioma and a
hematoma. Dr. Chan stated “hemangioma is the accumulation of
blood vessels before .

. . birth” while hematoma “is the accumulation of blood vessel in a certain area of [the] body due to

tra u ma from outside.” Dr. Chan noted although hemangioma
could happen on different parts of the body , it does not cause the body to bruise more easily. She explained bruises from hemangioma last longer than bruises caused by an outside force or trauma, stating hemangioma bruises “would last for several
weeks or 1

– 2 months.” In late December 2020, the Department filed a last minute report with the court indicating mother and father had completed their parenting education program and had continued monitored
visits with son without incident . It was reported mother and father “took care of [son] appropriately during the visits. They fed him, changed his diaper, and played with him. There were no

concerns reported.” In a later report for the court, however, t he Department explained the parenting program parents comple ted did not address the needs of children son’s age but rather taught parenting skills relevant to older children . The Department asked the juvenile court to order parents to complete a 52

- week parenting education program that address e d caring for a young
infant.12 In that same report, the Department also noted mother and father often expressed their desire to have son back in their care

. They did not know how he got the bruises but they insisted they
never abused him. The Department believed “parents need to learn positive stress and anger management focusing on healthy ways to cope with stress and anger on why [son] was detained from their care, and how this affects them in providing a safe care for [son]. The parents’ stress and anger manag ement remains a concern for [the Department].” The Department asked
the court to order mother and father to participate in individual counseling.
4. Expert Reports Prior to the adjudication hearing, the parties submitted expert reports for the court.

a. D r. Karen Imagawa and Amara McHale, FNP

- C

. The Department submitted a report by Dr. Karen Imagawa and Amara McHale, FNP

- C. This report summarized son’s September and October 2020 hospital izations

, related medical
records , and postdischarge follow

- up appoin tments

. The report
concluded : “Based on [son’s] clinical findings, the extensive (non

revealing) work

- up performed , the progression to complete resolution of the previously noted concerning findings .

. . , and no

recurrence of any of the concerning findings since placement, it appears that: [ ¶ ]

– The ear findings were a traumatic ear hematoma, which subsequently resolved. The left che e k bruise
also resolved . [ ¶ ]

– The axillary [armpit] discoloration and masses
were bruises with underlying hematomas, which subsequently
resolved

. [ ¶ ]

– [Son] also sustained bruising to his trunk, which also progressively resolved.”13 The report also noted that “bruising should not occur with routine daily handling of an otherwise healthy infant ( such as [son]) , and the reported hypothesized cause of the trunk bruising raised by mother does not appear to be an adequate explanation particularly since she notes that the incident was a ‘regular’ bath
and not an incident during which something occurred in which she would have grabbed [son] differently/harder than usual

. Unexplained bruising/injuries in a young infant such as [son] is compatible with non

- accidental/inflicted trauma a s it is unlikely to occur in an infant of [son’s] developmental level w ho at that time was not yet rolling, crawling, pulling to stand or cruising. ” The report explained it was difficult to determine the precise date of son’s injuries based on the color of his bruis es but , “[a]t this time, based on the available information, non

- accidental/inflicted trauma remains a concern and the current leading diagnosis.”
b. Dr. Frederic Bruhn Father submitted a report prepared by Dr. Frederic Bruhn.
Dr. Bruhn was “convinc ed that no substantial evidence exists
that demonstrat es inflicted physical abuse by the parents of [son] .” Dr. Bruhn believed “the current situation has arisen because of a faulty assessment of the child, perhaps due to a language barrier existing in this case and/or by a misrepresentation and miscommunicat ion of the actual medical
records to the C ourt

. ”
As to the marks first noted on son’s left ear and armpits, Dr. Bruhn opined

, “ T he left ear finding was most likely a subcutaneous hemangioma as evidenced by the finding of a complex cystic malformation anter ior to the left ear by
ultrasound examination” and “ultrasound revealed increased vascularity under [ the armpit ] lesions suggesting bilateral14

hemangiomas

. ” As to the later bruis ing on son’s torso, Dr. Bruhn
stated he reviewed color photos provided to him (which were “not identified as to time and person”) and “could not identify any significant bruising .” He noted a “significant discrepancy”
between a report to the court stating bruises on son’s torso were
three to fo ur inches in size and the admitting physician ’s report stating those bruises were three to four centimeters

. Dr. Bruhn
was concerned the se bruises “may have represented another underlying deep hemangioma, rather than a bruise.”
Dr. Bruhn stressed that “mu ltiple studies found no evidence of other abusive injuries (e.g., no fractures, central nervous system bleeds or retinal hemorrhages)” and that the Department had noted mother and father “did not seem to have many of the usual characteristics of child abusers.” He believed “close follow up will probably reveal the underlying diagnosis. ” He “ strongly doubt [ed] that the etiology is inflicted trauma ” and “strongly suggest[ed] that a Geneticist at [the hospital] be
consulted to ru le out whether this child has one of the many deep
vascular hemangiomas that are not described.”
5. Adjudication and Disposition Hearing s The adjudication hearing was held over the course of three days in January 2021 , with the disposition hearing also taking place on the third day

. Among other exhibits, the juvenile court
admitted the two expert reports described above, over 700 pages of hospital records related to son

, as well as medical records from son’s first emergency room visit and his pediatrici an ’s office

. The juvenile court heard testimony from Dr. Imagawa and
Dr. Bruhn , both of whom were qualified to testify as experts in pediatric child abuse . Mother also testified.15 a. Dr. Imagawa’s Testimony Dr. Imagawa testified son initially had marks or discoloration on his head (ear and face) and under his arms, then subsequently also on his torso. She stated that, after son’s first hospital ization in September 2020, he was discharged with “ a diagnosis of a hematoma of the left ear that was resolving and had significantly resolved during the hospitalization.” As to son’s October 2020 hospitalization, Dr. Imagawa testified son “shouldn’t be bruising from just getting a bath or holding him when he’s taking a bath. ” She noted son’s “bruises resolved within seven to ten days after he was in placement. And he has had no further bruising as far as I am aware, no further lesions, no further ear injury, no t hing under his arms. And we have all of
this to documen t that everything was resolved.” Dr. Imagawa opined, “with reasonable certainty,” son had “a hematoma not hemangioma.” Dr. Imagawa explained there

are no specific tests that can be conducted to diagnose either a hematoma or hemangioma. Rather, she explained, such diagnos e s are done by clinical evaluation and a patient’s history. She testified son’s “clinical course is not consistent with
hem angioma” but rather was consistent with a hematoma

. She
stated there was “ no accidental explanat ion to have caused [son’s] ear injury, the bruise on his cheek, the swelling of the temple region, the injuries under his arms.” Dr. Imagawa noted because

son was an infant and not yet mobile

, it was “highly concerning for child abuse” to see marks on suc h areas of the body. She
conclude d “these are consistent with inflicted injuries.” Dr. Imagawa also discussed what she considered deficiencies in Dr. Bruhn’s report. She stated it appear ed Dr.
Bruhn did not have access to all of son’s medical records and16

related photographs . In addition, Dr. Imagawa believed some of Dr. Bruhn’s conclusions were inaccurate. For example, she
testified Dr. Bruhn’s conclusion that the doctors “ could not agree

on a unifying diagnosis ‘hemangioma’ versus ‘hematoma ’ [was] actually not correct. In the records, it indicates this is a
hematoma . And in the discharge summary, it acknowledges that the hematoma had really significantly resolved” and there
remained a “residual hemangioma.” Dr. Imagawa also noted D r

. Bruhn seeme d to emphasize a n opinion by a doctor who assessed

son during his September 2020 hospital ization , which opinion
stated

, “ ‘as of now’ ” nonaccidental trauma “ ‘ ruled out. ’ ” Dr. Imagawa explained, however, t hat opinion predated the significant improvement to son’s ear at discharge from the hospital and its subsequent total resolution.
b. Dr. Bruhn ’s Testimony
Dr. Bruhn testified that “there are certain characteristics of abusive parents” that he considers important but not
determinative. He stated mother and father did not “fit the usual mold of abusing parents.” For example, Dr. Bruhn testified mother “wasn’t trying to hide anythin g from the doctors,” not ing mother brought son to the doctor when she noticed the lesion on his ear getting worse. Concerning son’s first hospitalization in September 2020,
Dr. Bruhn noted one doctor had indicated son might have a “vascular anomaly .” In l ight of that potentiality, Dr. Bruhn
stated a vascular anomaly team should have been consulted but

was not . He believed the vascular anomaly team , had they been consulted, “would have been able to give a reasonable opinion
whether this was a hemangioma or a hematoma [on son’s ear] . I think they could have weighed in on that aspect of the diagnosis

. ”17

Dr. Bruhn also noted there are “ ‘mimics of child abuse’ that are really medical conditions and haven’t been adequately ruled out
in this situation.” He mentioned E hler

- Danlos Syndrome and certain dermatologic conditions as example s

. He stated a test exists to rule out Ehler

- Danlos Syndrome but it had not been
done in this case. Dr. Bruhn was not aware of any tests perf ormed on son during his October 2020 hospitalization that would have ruled out hemangioma. He reiterated he would have consulted with a geneticist and a vascular anomaly team.
Dr. Bruhn em phasized this was a complicated case ; “I can’t tell you what this i s. I don’t know , but I know it’s not a straightforward NAT [nonaccidental trauma] case.” Dr. Bruhn believed son’s ear and armpit markings could be hemangiomas but the markings on son’s torso were “more likely a bruise.” During his testimony, the court a sked Dr. Bruhn to review a November 2020 photograph of son ’s ear. It was unclear whether
Dr. Bruhn had seen the photograph before . After looking at the photograph, Dr. Bruhn noted the discoloration of the ear had disappeared and there were two nodules on the upper portion of
the ear. Because the discoloration had disappeared, Dr. Bruhn
stated the photograph was “a point in favor of this being a hematoma rather than a hemangioma.” The court also asked Dr.
Bruhn to compar e a September 2020 photograph of son’s armpits
with a November 2020 photograph of the same area . I t appeared
the marks there had disappeared

. Dr. Bruhn stated a hemangioma would “probably not ” resolve in that amount of time
but a hematoma “definitely would. ” Similarly, Dr. Bruhn testified, “ If it resolved in a short period of time, that would be more in favor of a hematoma.” Still, he could not rule out a18

hemangioma , noting if a hemangioma were deeper under the skin
it could be difficult to see

.

c. Mother’s Testimony Mother recounted son’s multiple hospital visits and various doctors’ appointments. She explained she followed the doctors’ instructions and always brought son in for his scheduled appointments and sought out medical care even when not
scheduled

. Mother testified neither she nor father intentionally or accidentally hurt son

. Speaking t hrough tears, mother stated,

“ I want to state this solemnly to everybody who is listening, all
the attorneys and Y our H onor, that me and my husband really
love [son], and we are innocent. We want [son] back. [Son] needs us and we need [son].” As to son’s October 2020 hospitalization, m other testified she did not know why son had markings on his torso but “the doctor kept insisting that I must give an explanation as to what gave rise to [son’s] bruises.

. . . A fter some time

— they kept pressuring me

— I surm ised that

— I guessed that maybe during a shower, I could have applied just a bit too much pressure on him, that that could cause the bruising. But I don’t know.” Mother
testified some of the Department social workers who spoke with
her at the hospital did not speak Mandarin

. Mother explained
the social workers used a translator through their iPad to communicate with her . Mother believe d “the interpretation provided that day was not up to standard” and indicated the
social workers also complained about it.
d. Rulin g On January 11, 2021, a fter hearing the testimony and argument from counsel, t he juvenile court sustained the subdivision (a) and first subdivision (b) counts of the petition19

(related to nonaccidental trauma) . The court dismissed the remaining subdivisio n (b) count (related to medical neglect)

. The court found son was a person described by section 300.
The court stated, “ The fundamental issue before this court is whether the discoloration of [son’s] ear, armpits, and abdomen

were a result of a congenital hemangioma or a hematoma resulting from inflicted trauma .” The court concluded the marks on son’s body were “ more likely than not ” hematomas. In coming to its conclusion, t he court “found Dr. Imagawa’s opinion to be more cogent, persuasive, an d directly supported by the factual circumstances of this case. Dr. Bruhn’s opinion was more speculative and, upon further questioning at court, did not hold up as plausible.” The court considered Dr. Bruhn’s opinion “less plausible than Dr. Imagawa’s be cause his testimony was inconsistent with statements in his report. In court he testified that [son’s] abdominal discolorations were likely hematoma a n d concluded that perhaps even the ear was a hematoma, as well, once he reviewed the photos showing the b ruises’ re s olution after a couple of weeks.” The court noted both experts agreed on the differences between hematomas and hemangioma s, that
hematomas result f

rom trauma, and that he matomas resolve within weeks whereas hemangiomas take months or longer to
resolve.
The court noted Dr. Bruhn “ spent much of his testimony speculating about possible other causes for [son’s] ear injury, specifically stating that genetic testing would assist in determining whether [son] has Ehler

- Danlos .

. . S yndrome

, which could cause a child to be predisposed to bruising; however

. . . Dr. Bruhn stated that Ehler

- Danlos S y ndrome is a permanent
condition and would continue to cause bruising throughout the20

inflicted child’s life. But that situation doesn’t match the facts before us here. [Son’s] bruising resolved in a couple of weeks, and no further bruising has appeared since he was removed from his

par ents’ care.”
Next

, t he court concluded the hematomas were caused by
nonaccidental trauma. Although the court “found mother to be an attentive and loving parent ” and “appropriately emotional about having her child removed from her care,” the court found it significant mother had failed to provide a reasona ble or credible explanation for son’s injuries. The court stated, “Despite mother’s attentiveness to [son], the evidence shows that the child was seriously injured in her care; therefore, in light of [son ’s] repeated occurrences of unexplained bruising and the absence of any plausible medical or other explanation about ho w these injuries occurred, the court can reach no other conclusion tha n that the parents are responsible for the injuries sustained by [s on] while he was in their care.” As to disposition, the juvenile court removed son from
parents ’ custody and ordered, among other things, parents to participate in an age

- appropriate parenting class as well as to continue with their monitored visitation

. The court emphasized its ruling was not punitive against parents but was in son’s best
interest. The court also ordered the Department to have son
tested for Ehler

- Danlos S y ndrome.
6

. Appeal
Mother and father appealed the juvenile court’s January 11 , 202 1 jurisdictional and disposition al order s

. 7. Post a ppeal Orders
While these appeal s were pending, the juvenile court
returned son to his parents’ custody. As a result , the Department21

filed

, and we granted

, a mo tion to dismiss the appeal s as to the juvenile court’s removal order

. Also while these appeals were pending, mother and father completed the ir court

- ordered parenting program. Thus, the parents’ challenges to the juvenile court’s dispositional orders are moot
, and we do not address them
here.
DISCUSSION Mother and father argue substantial evidence does not support the juvenile court’s exercise of jurisdiction under subdivision (a). As discussed below, although we agree this is not a straightforward case, we are not persuaded by the parents’ arguments and conclude substantial evidence supports the juvenile court’s jurisdictional findings.

1

. Applicable Law
Under section 300, subdivision (a), the juvenile court may assert dependency jurisdiction and declare a child a dependent of the court when “[t] he child has suffered, or there is a substantial risk that the child will suffer, serious physical harm inflicted nonaccidentally upon the child by the child ’ s parent or guardian. For purp oses of this subdivision, a court may find there is a substantial risk of serious future injury based on the manner in which a less serious injury was inflicted, a history of repeated inflictions of injuries on the child or the child ’ s siblings, or a
combi nation of these and other actions by the parent or guardian that indicate the child is at risk of serious physical harm. For purposes of this subdivision, ‘ serious physical harm ’ does not include reasonable and age

- appropriate spanking to the buttocks
if there is no evidence of serious physical injury. ” (§ 300, subd. (a) .)22 Section 355.1

, subdivision (a) creates a rebuttable presumption that certain injuries are nonaccidental in nature.
That section provides, “ Where the court finds, based upon competent professional evidence, that an injury, injuries, or detrimental condition sustained by a minor is of a nature as would ordinarily not be sustained except as the result of the unreasonable or neglectful acts or omissions of either parent, the

guar dian, or other person who has the care or custody of the minor, that finding shall be prima facie evidence that the minor is a person described by subdivision (a), (b), or (d) of Section 300. ” ( § 355.1, subd. (a).) “Once the petitioner establishes a prim a facie case under section 355.1 the burden of producing evidence ‘shifts to the parents the obligation of raising an issue as to the actual cause of the injury or the fitness of the home.’ [Citation.] ‘The effect of a presumption affecting the burden of producing evidence is to require the trier of fact to assume the existence of
the presumed fact unless and until evidence is introduced which would support a finding of its nonexistence, in which case the
trier of fact shall determine the existence or non existence of the presumed fact from the evidence and without regard to the presumption. ’ (Evid. Code, § 604.) ” ( In re D.P. (2014) 225 Cal.App.4th 898, 903

– 904 ; § 355.1, subd. (c). ) Thus, “[w]hile the presumption under section 355.1

‘ disappears upon the i ntroduction of evidence which would support a finding of its nonexistence (Evid. Code, § 604), the trier of fact, here the juvenile court, must still weigh the inferences arising from the [professional ’ s] testimony which gave rise to the presumption agains t the contrary evidence

. . . and resolve the
conflict. [Citation.] ’ [Citation.]

. . . ‘ Where there is more than one inference which can reasonably be deduced from the facts,23

the appellate court is without power to substitute its deductions for those of the trier of fact. ’ ” ( In re D.P.

, supra , 225 Cal.App.4th
at pp. 904

– 905 .)

“ The legislatively declared purpose of these provisions [of the Welfare and Institutions Code] ‘ is to provide maximum safety and protection for children who are currently being physically, sexually, or emotionally abused, being neglected, or being exploited, and to ensure the safety, protection, and physical and
emotional well

- being of children who are at risk of that harm

. ’ (§ 300.2, italics added.) ‘ The court need not w ait until a child is seriously abused or injured to assume jurisdiction and take the steps necessary to protect the child.’ ” ( In re I.J. (2013) 56 Cal.4th 766, 773. ) “ ‘The purpose of dependency proceedings is to prevent risk, not ignore it.’ ” ( Jonath an L. v. Superior Court (2008) 165 Cal.App.4th 1074, 1104.) Courts “need not wait for disaster to strike before asserting jurisdiction.” ( In re K.B. (2021) 59 Cal.App.5th 593, 603.) Moreover , special protection is given to
children like son, who are “ ‘of such tender years that the absence of adequate supervision and care poses an inherent risk to [his or her ] physical health and safety.’ ” ( In re Christopher R. (2014) 225 Cal.App.4th 1210, 1216, 1219 [children under the age of six at the time of the jurisdiction hearing are of “tender years”].)

2

. Standard of Review We review the juvenile court’s jurisdictional findings for
substantial evidence. ( In re I.C. (2018) 4 Cal.5th 869, 8 92 .) “It is well settled that the standard is not satisfied simply by pointing
to ‘ “isolated evidence torn from the context of the whole record.” ’ [Citations.] Rather, the evidence supporting the jurisdictional finding must be considered “ ‘in the light of the whole record ’ ” ‘to
determine whether it discloses substantial evidence

— that is,24

evidence which is reasonable, credible, and of solid value.’ ” ( Ibid. )

“ ‘ “ In making this determination, we draw all reasonable inferences from the evidence to support the f indings and orders of the dependency court; we review the record in the light most favorable to the court’s determinations; and we note that issues of fact and credibility are the province of the trial court. ” ’ ” ( In re
I.J.

, supra , 56 Cal.4th at p. 773.) Under this standard, our review “ ‘begins and ends with a determination as to whether or not there is any substantial evidence, whether or not contradicted, which will support the conclusion of the trier of fact.
All conflicts mus t be resolved in favor of the respondent and all legitimate inferences indulged in to uphold the verdict, if possible. Where there is more than one inference which can reasonably be deduced from the facts, the appellate court is without power to substitut e its deductions for those of the trier of fact.’ ” ( In re David H. (2008) 165 Cal.App.4th 1626, 1633.) “We do not reweigh the evidence, evaluate the credibility of witnesses, or resolve evidentiary conflicts. [Citation.] The judgment will be upheld if it is supported by substantial evidence, even though substantial evidence to the contrary also exists and the trial court might have reached a different result had it believed other evidence.” ( In re Dakota H. (2005) 132 Cal.App.4th 212, 228.)
3

. Justici ability As an initial matter, we note mother and father challenge only the juvenile court’s exercise of jurisdiction under subdivision (a). Mother and father do not challenge the juvenile court’s
exercise of jurisdiction under subdivision (b). Thus, even if we

were to rever se the juvenile court’s subdivision (a) finding, dependency jurisdiction would remain under subdivision (b). I n25

such circumstances, an appeal is subject to dismissal as nonjusticiable. (

In re Drake M. (2012) 211 Cal.App.4th 754, 762

– 7 63.) Nonetheless, in such cases an appellate court may address the merits of the challenged jurisdictional finding when “ the finding (1) serves as the basis for dispositional orders that are also challenged on appeal [citation]; (2) could be prejudicial to the appellant or could potentially impact the current or future dependency proceedings [citations]; or (3) ‘ could have other consequences for [the appellant], beyond jurisdiction

. ’ ” ( Ibid. )
M other and father urge us to consider their appeal because
th e juvenile court’s subdivision (a) finding could harm them beyond jurisdiction. 3 The Department does not argue otherwise

or even address this issue on appeal. We elect to consider the parents’ challenge to the juvenile court’s exercise of jurisdiction

u nder subdivision (a). ( In re Drake M.

, supra , 211 Cal.App.4th at

pp. 762

– 763 ; In re D.P.

, supra , 225 Cal.App.4th at p. 90 2 .)
4

. Substantial evidence supports jurisdiction under section 300, subdivision (a) (physical abuse).
M other and father argue they presented sufficient evidence to rebut the section 355.1 presumption. In particular, they claim Dr. Bruhn’s testimony rebutted the section 355.1 presumption that son’s injuries were nonaccidental and caused by the parents.
P ar ents note Dr. Bruhn “testified that the cause of the marks could be caused by a vascular anomaly or a genetic disease.” In

3 Mother and father also urge us to consider their appeal of the juvenile court’s subdivision (a) jurisdictional finding because that finding served as a basis for the court ’s dispositional orders

, which the parents also appealed . However, as noted above, the appeals from the dispositional orders are now moot and

, therefore, do not constitute grounds for considering their subdivision (a) jurisdictional challenge.26

fact, Dr. Bruhn was not sure what caused the markings on son’s body. He testified

, “I can’t tell you what this is. I don’t know, but I know it’s not a straightforward NAT case.” Assuming this was sufficient to rebut the section 355 .1 presumption, the juvenile

court then was required to weigh the conflicting evidence and
make factual d eterminations. ( In re D.P.

, supra , 225 Cal.App.4th
at pp. 904

– 905.) We conclude substantial evidence supports the juvenile court’s jurisdictional findings. On the one hand, the evidence
included the parents’ apparent love and concern for son, their empha tic denials of intentional harm to son, mother’s suggestion that some of son’s bruising could have resulted from her innocently holding him too tightly during bath time

, and Dr. Bruhn’ s expert speculation that a variety of genetic or
dermatol og ic condition s could have caused son’s markings . On
the other hand , the evidence also included Dr. Imagawa’s expert opinion, as well as other medical doctor s ’ opinions, that son’s repeated presentation s with unexplained markings were highly indicative of physical abuse. Given the fact that no one could definitively state how or why son had the markings he had

, which importantly by all accounts appear to have been hematomas as opposed to hemangiomas, and son clearly was of
“tende r years,” the juvenile court’s subdi vision (a) finding was supported by substantial evidence. We are not persuaded by the parents’ attempt to minimize
the visible markings on son’s body. Parents argue the markings on son’s body do not constitute “serious physical harm” under subdivision (a). We disagree. When a n infant has visible swelling and obvious bruising on multiple areas of his body on more than one occasion

, regardless of whether that infant27

appears to be in pain when those areas are examined, th ose injuries certainly can constitute serious physical harm for purposes of subdivision (a). While we agree with parents that

any unexplained bruise on a child does not necessarily constitute cause for dependency jurisdiction , this case presents more than a single unexplained bruise. Additionall y, Dr. Imagawa reported a healthy infant such as son w ould not sustain bruising from routine daily handling

. Yet here , son , an infant, had repeated unexplained markings which multiple doctors considered highly concerning for child abuse

. As Dr. Bruhn noted , this is not a straightforward case

. There are clearly two conflicting sides to the matter. Nonetheless, we cannot reweigh the facts or assess credibility of
witness es. Those are roles explicitly reserved to the juvenile

court

. ( In re I.J.

, supra , 56 Cal.4th at p. 773; In re David H.

, supra , 165 Cal.App.4th at p. 1633; In re Dakota H.

, supra , 132 Cal.App.4th at p. 228.) Significantly, of the two expert opinions presented, the juvenile court found Dr. Imagawa’s opinion more plausible . The court found Dr. Bruhn’s opinion “more speculative and, upon further questioning at court, [it] did not hold up as plausible.” Despite the competing e vidence, substantial evidence supports the juvenile court’s jurisdictional findings under subdivision (a)

. Finally, a fter briefing had concluded in this appeal, counsel for mother filed a letter alerting the court of new case authority,
In re Cole L. (2021 ) 70 Cal.App.5th 591 ( Cole L. ) , which our colleagues in D ivision S even of the Second District recently
decided

. Mother argu es Cole L. supports the parents’ position
here that the juvenile court’s subdivision (a) jurisdictional finding
must be reversed

. However, Col e L. is factually distinguishable28

from the instant case. In part, t he Cole L. court reversed a finding of dependency jurisdiction under subdivision (a) based on
incidents of parent al domestic violence outside the presence of the subject children

. ( Id. at pp. 602

– 603 .) The court also stated
that “ a finding under section 300, subdivision (a), requires evidence of a risk of physical injury ‘ inflicted nonaccidentally upon the child. ’ An unintended injur y to a bystander child that
results from an intentional act directed at another

— for example, due to an object thrown by one parent at another during an argument

— does not satisfy that statutory requirement .” ( Cole
L.

, supra , at p. 603 .) Cole L. is factual ly distinct and does not change our decision here. DISPOSITION
The juvenile court’s January 11, 2021 jurisdictional order is
affirmed and the remaining appeal from the juvenile court’s dispositional order is dismissed as moot

. NOT TO BE PUBLISHED.

LUI, P. J.
We concur:

ASHMANN

- GERST, J.

HOFFSTADT , J.