Kentucky becomes only fourth state to mandate physician training on child abuse

Kentucky and Indiana continue to rank among the worst states in the nation for the number of children who are abused and neglected, according to data from the U.S. Department of Health & Human Services Child Maltreatment 2012 report. In recent years Kentucky has consistently ranked among the worst states in the nation for death rates associated with child abuse and neglect, averaging 29 child deaths each year with another 30 to 60 near-fatalities annually. Indiana has had similar challenges in recent years, averaging 33 child deaths each year from abuse and neglect.

House Bill 157, signed by Gov. Steve Beshear at Norton Children’s Hospital on Tuesday, requires training on the recognition and prevention of pediatric abusive head trauma (also known as shaken baby syndrome) for physicians likely to see children, including pediatricians, radiologists, family practitioners and emergency medicine and urgent care specialists. Starting July 15, 2014, these physicians are required to complete a one-time, one hour course that includes new science not widely taught in medical schools: Bruises in children can be the most overlooked signs of abuse.
The course is available on the Partnership to Eliminate Child Abuse web site,

Kentucky becomes the first state to offer training on bruising patterns, and only the fourth state, after New York, Pennsylvania and California, to mandate child abuse training for physicians, according to the National Conference of State Legislatures. This will complement House Bill 285, which required all other medical professionals, social workers, day care employees and police to undergo similar training.

“We know that of the children who end up in the ‘Just for Kids’ Critical Care Center at Norton Children’s Hospital due to abuse, nearly half have been seen by a medical provider in the two weeks preceding their emergency trip here,” said Stephen Wright, M.D., FAAP, medical director of Norton Children’s Hospital and chair of the Partnership to Eliminate Child Abuse.

“We’re grateful to Governor Beshear, bill sponsor Representative Addia Wuchner and the entire General Assembly for seeing the importance of this training.”

The center of the training is known as the TEN-4 bruising rule, first published by a group of researchers in 2009.
“Infants who are 4 months old and younger should not have any bruising anywhere,” said Justine O’Flynn, R.N., who works in the “Just for Kids” Critical Care Center. “Children ages 4 years and under should not have any bruising on the Torso, Ears or Neck. If your child or a child you know has bruises that fall into these categories, he or she needs to be seen immediately in the emergency department.”

Bruises are often dismissed by parents, caregivers and even medical professionals.
“A small bruise on an infant’s stomach could be a liver laceration that has occurred because the child was punched in the stomach,” said Melissa Currie, M.D., director of the Norton Charities Division of Pediatric Forensic Medicine at the University of Louisville. “Ears do not bruise easily, so when we see a bruise in this location we know to look carefully for additional trauma to the head.”

Normal bruising for toddlers and older children usually occurs on the front of the body and over bony areas such as the forehead, elbows, knees and shins.

As part of the bill signing, Rep. Wuchner was given the “Just for Kids” Champion award; and WLKY-TV and Judge Paula Sherlock, Jefferson Circuit Court, Family Court Division, were given the Child Abuse Prevention Advocate of the Year awards from the Partnership to Eliminate Child Abuse, which is led by Norton Children’s Hospital.

A media tool kit containing additional information, statistics, editorials and public service announcements is located on the Partnership to Eliminate Child Abuse website,

In Kentucky, the number to call to report suspected child abuse is (877) 597-2331. In Indiana, call (800) 800-5556. The Childhelp National Child Abuse Hotline, (800) 422-4453, offers professional crisis counselors who can provide intervention, information and referrals to emergency, social service and support resources. Calls are confidential.

The Child Maltreatment 2012 report is available from the U.S. Department of Health & Human Services Children’s Bureau at


About Norton Children’s Hospital
Licensed for 267 beds and located in the downtown Louisville medical center, Norton Children’s Hospital is the region’s only full-service, free-standing pediatric hospital, and the only hospital in the Louisville area offering a Level I Pediatric Trauma Center. Norton Children’s Hospital provides a complete range of services for children, including pediatric intensive care and one of the nation’s largest Level IV intensive care units for newborns.

Located adjacent to Norton Brownsboro Hospital in northeastern Jefferson County, Norton Children’s Medical Center, Brownsboro is the only pediatric outpatient center of its type in Kentucky, offering 365-days-a-year pediatric emergency services; a full complement of pediatric diagnostic imaging services; cardiology services; a full-service laboratory; and a wide range of pediatric outpatient surgery services. When it opens in 2014, the new Norton Women’s and Norton Children’s Hospital in St. Matthews will offer specialized pediatric emergency services, surgery, inpatient care and an expanded neonatal intensive care unit.

As regional facilities that treat more than 155,000 children each year who seek care regardless of their family’s ability to pay, Norton Children’s Hospital and its sister facilities rely on support from the community. The Children’s Hospital Foundation raises millions of dollars each year to support programs, equipment and facilities, research, advocacy and education at these facilities. The Children’s Hospital Foundation raised $14 million in 2013 to support the mission of Norton Children’s Hospital facilities. For more information, visit