TEN-4-FACESp

Bruising in Children Under 4

The TEN-4-FACESp bruising rule is a validated medical screening tool used to identify concerning bruises in children under age 4 that may indicate physical abuse. It focuses on specific body regions (TEN-4) and facial areas (FACES), along with patterned bruising (p), to help distinguish abusive injuries from accidental trauma. For Children under 4 years of age, TEN-4-FACESp is a bruising clinical decision rule developed and validated by Dr. Mary Clyde Pierce and colleagues at Stanley Manne Children’s Research Institute at the Children’s Hospital of Chicago.

TEN-4-FACESp is a useful acronym 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”).