Kids are kids, and sometimes they play in ways that result in minor cuts, scrapes, and bruises. These minor injuries are often found on bony areas of the body like knees, shins, elbows, and foreheads. However, there are other types of bruises that should be a red flag for possible abuse.
For children 4 years of age or younger, bruising in these areas are cause for concern and need to be reported.
TEN-4 is an acronym to build public awareness of how to recognize bruising in young children, encouraging caring adults to watch for bruising on the torso, ears, and neck. Recent research, however, has expanded the clinical definition of concerning bruising, revising the acronym from TEN-4 to TEN-4-FACES-p. We encourage all health professionals to become familiar with the expanded guidelines on what bruising is concerning. Recent research has identified an update to the bruising clinical decision rule (BCDR) to refine the TEN-4 rule to TEN-4-FACES-p for (TEN) torso, ears, neck, (FACES) frenulum, angle of jaw, cheeks (fleshy), eyelids, subconjunctivae (often blood spots on the white of the eye), and (p) for patterned (bite, loop, hand slap, squeeze, grab, and linear marks). The ‘4’ represents any bruising anywhere to an infant through 4 months. The rule applies only to children with bruising who are younger than 4 years. A positive response for any of these components signals a classification of abuse.
Source: Pierce MC, Kaczor K, Lorenz DJ, et al. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Network Open. 2021;4(4): e215832. doi:10.1001/jamanetworkopen.2021.5832
All Kentuckians are mandated reporters. If you believe a child is being abused or neglected, call the Child Protection Hotline 1-877-KYSAFE1 (1-877-597-2331) or file a report online with CHFS. For contact information in other states, please visit our Report It page.
You can report anonymously, but it is very helpful in the investigation to give your name and occupation for follow up if needed.
Be prepared with as much information as you know including: child’s name, address, where they are now, specifics about what was seen, any imminent risks, information about siblings, mother’s name.
Dr. Laura Hancock Jones, general dentist in Western Kentucky, explains the TEN-4 Bruising Rule and di
Ending child abuse is an adult responsibility. This Face It training video will help community members understand the signs of child abuse and neglect and how to report suspected abuse.