10/05/2026
Today is TEN-4 Day, dedicated to raising awareness about child abuse recognition and prevention! 🎗️🎗️
Accidental bumps and scrapes happen, but knowing the clinical red flags can save a child's life. The TEN-4-FACESp rule highlights key areas where bruising on a child under 4 shouldn't be ignored, including the torso, ears, neck, face, and subconjunctivae (eye tissue).
Children under age 4 are at a higher risk of serious physical injury or death as a result of child maltreatment. It is imperative that adults who work with kids or are around kids are educated on the common warning signs of child abuse. One way to remember some of these warning signs is the “TEN-4- FACESp Bruising Rule.”
TEN-4-FACESp is an acronym that is used to help screen children under 4 years of age with bruising to identify when a bruise is more likely to be caused by abuse than accidental injury. TEN-4-FACESp stands for bruising to the Torso, Ears, Neck, Frenulum, Angle of the jaw, Cheeks, Eyelids or Subconjunctivae, “4” represents infants 4 months and younger with any bruise, anywhere, and “p” represents the presence of patterned bruising (“TEN-4-FACESp”).
MO-NACA, in partnership with the Department of Health and Senior Services, oversees the state-funded SAFE-CARE program, coordinating a comprehensive medical response to child abuse and neglect across Missouri. This October 4th, we aim to create discussion and awareness around the TEN-4-FACESp Bruising Rule so the general public understands these signs of abuse, along with the importance of preventing child maltreatment and supporting families.
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.
SAFE-CARE Network Providers are physicians, physician assistants, and nurse practitioners committed to providing quality forensic evaluations to maltreated children in their communities. They encompass a wide range of experience, including urban to rural settings and from small private practices to large children’s hospitals.
Medical Resource Centers are strategically situated at Children’s Mercy Kansas City, St. Louis Children’s Hospital, and SSM Health Cardinal Glennon Children’s Hospital. These centers serve as the foremost authorities in Child Abuse Pediatrics, setting the standard of care for the SAFE-CARE program. Board Certified Child Abuse Pediatricians affiliated with these centers play a pivotal role in providing training, mentorship, and consultation services to ensure the highest quality of expertise within the SAFE-CARE initiative.
