Sentinel injuries and mandatory reporting

TEN-4-FACEsp: torso/ear/neck bruising; any bruising in an infant four months of age or younger (4.99 months in the validation study) — a validated decision rule (TEN-4: torso, ear, neck or any bruising in an infant 4.99 months or younger) improving earlier recognition of the abused child; positive screen needs escalation.^[1]

Threshold and process. Reasonable suspicion, not courtroom proof — treat medical needs, full undressed exam/body map, senior/social work strategy discussion, statutory notification, forensic pathway, safety plan — per local safeguarding pathway; the medical evaluation and interpretation of findings must follow current recommendations.^[2]