Christina Howard
UK Healthcare
Kids are kids, sometimes they play in ways that result in minor cuts, scrapes and bruises. Skinned knees and elbows and bruises on shins and foreheads are all part of being an active kid. However, there are other types of bruises that should be a red flag for possible abuse.
(Photo by fiorigianluigi, iStock/Getty Images Plus, via University of Kentucky)
To recognize child abuse, it’s important to remember the TEN-4 rule. Look for bruising on the Torso, Ears and Neck in children ages four and younger. Bruising in these areas is cause for concern and needs to be reported. In babies who are not yet pulling up or taking steps, bruising anywhere is cause for concern.
Every adult in Kentucky is a mandated reporter of child abuse. If you suspect a child is being abused:
• Stay calm and conversational if you notice bruising on a child.
• Document what you see and hear as soon as possible. Include the color, shape, location and size of the bruising.
• Document what the child or parent says, along with any questions you ask. It is OK to ask non-leading questions, such as:
• What happened?
• Where were you when it happened?
• Did an adult see it happen?
• Refrain from asking specific questions or jumping to conclusions. Professionals with appropriate training will handle the investigation.
• Make the report. Contact Child Protective Services by calling 1-877-KYSAFE1 or 1-877-597-2331.
When it comes to child abuse, it is very, very rare for a child to be seriously injured or killed the very first time they are abused. This tends to be an escalation of violence over time, and that’s why it is so important for all of us who care for children to notice those early warning signs so that we can stop that violence before it escalates.
Child abuse occurs in all ethnic, social and economic groups. It can and does happen in every type of family. Bruises are the most missed early warning signs of abuse, but they’re also most easily recognizable if you know what to watch for.
Christina Howard, M.D., is chief of the Division of Pediatric Forensic Medicine at Kentucky Children’s Hospital
