to Worry About Bruises
By Courtney D. Thornburg, MD and Dennis Clements, MD, PhD, MPH.
is a bruise?
bruise is a black-and-blue mark caused by bleeding into the skin
from damaged blood vessels. Many children older than one year of
age develop bruises associated with accidental injury and physical
bruises are not a cause for concern and will go away on their own.
However, bruising can be a sign of an inherited bleeding disorder,
illness, or non-accidental trauma (child abuse).
may be abnormal if they occur spontaneously without explanation,
if they are in other places than the lower legs (unexplained
bruises on the shins are usually normal because children often bump
this area and then forget that they bumped it), if they are larger
than a quarter in size, and if they are lumpy rather than flat.
may also be abnormal if they are larger than expected for the degree
can I take care of my child with normal bruising?
ice (or a bag of frozen vegetables), wrapped in a thin towel, to
the bruised area for 20 to 30 minutes. No other treatment should
acetaminophen for pain. Don't use aspirin or ibuprofen because it
may prolong the bleeding. After 48 hours apply a warm washcloth
three times a day for 10 minutes each time to help the skin reabsorb
clear in about two weeks. They change colors during this time from
black-and blue to green-and-yellow.
causes abnormal bruising?
bruising occurs if there is:
low level of platelets. Platelets are tiny, sticky cells that join
together to plug the hole in wounds. Platelets may be low if they
are not made or if they are broken down too quickly.
A low level of clotting factor. Clotting factors are blood proteins
that interact with the platelets to form a strong clot to cover
the wound as it heals. Clotting factors may be low from birth or
may be low due to infection, medication (blood thinner or long use
of antibiotic), not enough vitamin K or liver problems.
Very weak skin
A major trauma
When is bruising a sign of a bleeding disorder?
disorders may be caused by abnormalities in blood clotting factors
or in platelets.
may be a sign of an inherited bleeding disorder especially if it
is associated with a family history of easy bruising or bleeding,
or with the following symptoms:
red spots called petechiae on the skin (often at areas of pressure
such as the underwear line)
Frequent or prolonged nosebleeds
Excessive bleeding after surgery (such as circumcision)
Excessive bleeding after dental work
Excessive bleeding after injury
Heavy or prolonged menstrual periods. Menstrual periods may be abnormal
if they last more than seven days, include passage of blood clots
larger than one inch, or require changing saturated pads or tampons
more than every two hours.
evaluation for a bleeding tendency includes:
and personal history about bleeding symptoms
of bleeding disorders include:
Clotting factor deficiency (such as hemophilia)
Inherited disorders of low platelets
Acquired disorders of low platelets (immune thrombocytopenic purpura)
Inherited platelet dysfunction (lazy platelets)
is bruising a sign of an underlying illness?
may be a sign of an underlying illness especially if it occurs suddenly
and with other symptoms such as:
Unintended weight loss
Petechiae (pinpoint red spots on the skin)
Enlarged abdomen (due to swelling of spleen or liver)
Bone or facial abnormalities
Large red birthmarks (hemangiomas)
associated with bruising include:
Bone marrow problems
is bruising a sign of child abuse?
may be a sign of child abuse if there are unusually shaped bruises,
bruises in unusual places, bruises in the shape of an object, or
if there are other unexplained injuries.
to do if you are worried about bruising?
your childs primary care physician to talk about how your
child is doing and decide how soon your child needs to be evaluated.
on your childs symptoms your child may be seen in the clinic
or may need to go directly to the emergency room.
childs physician will also decide if your child needs to see
a doctor who specializes in blood disorders or blood clotting.
child develops new bruises and you don't know what caused them.
Your child has bruises around the eyes after a head injury.
On Other Web Sites
these sites for more information:
Courtney D. Thornburg, MD , is a pediatric hematologist at Duke.
Dennis Clements, MD, PhD, MPH, is the chief medical officer of Duke
Children's Hospital. For more information, visit: www.DukeHealth.org
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.