October 4 is TEN-4 Day
October 4, 2024
Bruises are among the most common injuries that children sustain. But how can we know which bruises were caused by accident, versus bruises that were caused by non accidental trauma or physical abuse?
It is very important that adults can recognize which bruises are concerning for physical abuse because about one third of children who sustain life threatening abusive injuries had preceding minor injuries, often bruises, noticed by an adult. Additionally, child maltreatment is a public health problem with lifelong medical and emotional consequences. Adults who reported physical abuse when they were children were more likely as adults to report chronic physical and mental health conditions.
The clinical decision tool, TEN-4-FACESp was developed by physicians at the Children’s Hospital of Chicago to help identify non accidental injuries. “TEN” refers to bruises on the Torso (T), Ears (E) and Neck (N). The number “4” represents infants 4 months and younger with any bruise, anywhere, as well as children younger than 4 years old with bruising in any of these parts of the body. Additionally, “FACES” refers to injury of the Frenulum (the tissue that runs in a thin line between the lips and gums), Angle of the jaw, Cheeks, Eyelids and Subconjunctivae (the white part of the eyes), all of which are on the face. Finally, “P” represents any unexplained patterned bruising.
This tool is to help highlight areas of a child’s body that are more prone to physical abuse, if there is not a good history or mechanism to explain the injury, and should alert anyone, even if not a medical professional, to worrisome bruising. Adults with regular access to or communication with children who have reason to believe a child has been abused are required to report it to the authorities. Mandatory reporters in Montana include teachers, police officers, and child care providers, but anyone with a reasonable suspicion of abuse may also make a voluntary report. They should follow the below steps if concerning bruising is found on a child:
- Documentation: Take photos of the injuries. Bruises can change and fade quickly, so taking photos early and in different lighting and angles can be helpful to health care providers.
- Medical evaluation: Bring the child to their primary care provider or the local emergency room.
- Report: Suspected cases should be reported to Montana DPHHS Centralized Intake at 1-866-820-5437.
Governor Greg Gianforte has proclaimed October 4th, 2024, in the State of Montana as TEN-4 Day to honor the importance of recognizing concerning bruises and injuries on young children and to emphasize the importance of training adults to recognize, report, and prevent child abuse.
How can you participate for TEN-4 Day? Every day, every adult, everywhere should learn how to identify an injury that is concerning for abuse and then have the injury documented, evaluated and reported. But even more importantly, we need to support our children and their families to prevent these non accidental injuries from occurring at all.
For more information on TEN-4-FACESp, go to faceitabuse.org/ten4rule
