How to Recognize Child Abuse in Young Children

By: Wee Chua, MD; Kim Kaczor, MS; Madiha Qureshi, MPH; Jill Fraggos, MPH; and Mary Clyde Pierce, MD

We know that physical abuse can be devastating and have long-lasting impacts on children. Nationally, there are at least 115,000 victims of child physical abuse each year, with 6,000 cases in Illinois.  In 2019, cases of physical abuse in children led to at least 700 deaths in the United States and more than 100 children died from physical abuse in the state of Illinois. While these statistics and numbers may be upsetting and startling, there are actionable steps that we can take to help identify children at risk of physical abuse.

Bruising is the most common and most visible sign of physical abuse. In toddlers and pre-school aged children, bruises are not uncommon, however, the location of the bruise can be helpful to distinguish accidental injuries from ones caused by physical abuse.

The bruising clinical decision rule known as TEN-4-FACESp can help recognize when a child is being abused by identifying bruising characteristics shown to distinguish abusive from accidental injuries. The rule is valid in children under 4 years of age.

TEN-4-FACESp represents the following: bruising to the Torso, Ears, or Neck, or any bruising anywhere to an infant 4 months of age or younger, or bruising to the Frenulum (the small fold of tissue between the gum and lip), Angle of the jaw, Cheeks (fleshy part) Eyelids, or Subconjunctivae (the white part of the eyes), and the “p” represents if patterned bruising is present. If any one component is true, this indicates an increased concern for abuse.

Now that we’ve learned about this important tool, how can we help protect children?

If you notice any bruise on a child 4 months and younger or a concerning bruise on a child younger than 4 years, here are the steps that you should take:

  • Document: By taking photos of the injuries. Bruises can change and fade quickly, so taking photos early and in different lighting and angles can be helpful for your health care provider.
  • Medical evaluation: Please bring your child to your Pediatrician, Nurse Practitioner, or the local emergency room.
  • Make a report: Concerning cases can be reported to the Illinois Department of Children & Family Services. You can make report online or by calling the Child Abuse and Neglect Hotline at 800-25-ABUSE (800-252-2873).

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