Bruising In Children: Symptoms, Causes And When To Worry

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Bruising is common among children. Whether it is a toddler taking their first steps or a kindergartener learning to ride a bike, children often bump into things and skid on surfaces, bruising their knees and ankles in the process.

If the bruising is due to minor accidental trauma, it is normal and seldom a cause of worry. Such bruises can be treated at home and tend to fade away in one or two weeks.

However, sudden and suspicious bruising on your child’s body for no apparent reason could be a sign of an underlying medical problem or physical abuse. Read this post to understand the causes of bruising and learn the difference between normal bruising and abnormal bruising in children.

What Is Normal Bruising In Children?

A bruise often leads to bleeding underneath the skin. It is usually caused by a physical impact on the body by an external object. The tissues near the affected area get compressed, damaging the blood vessels and causing them to bleed.

Bruises due to minor accidents are generally small, oval to round in shape with nondistinctive borders, and often seen in areas such as the forehead, knee, shins, elbows, and knees (1).

Here is an image of how a normal bruise looks like.

Image: Shutterstock

If the bruise on your child’s body is caused by falling or skidding, it heals within three to five days. The bruise that appears red on the first day turns purple or blue in a day and gradually turns to yellowish-brown and peels away (2).

However, if you find bruises on your child’s body for no apparent reason, it is a red flag, and such sudden bruises could be due to an underlying medical condition or abuse. Read on to find out the signs of abnormal bruising in children.

Signs Of Abnormal Bruising In Children

If you spot random bruises that appear in unusual locations on your child’s skin, you need to be wary. Here are a few signs of abnormal bruising.

  1. Out-of-proportion bruises from a minor or no impact. For example, a huge bruise for a small bump
  2. Sudden bruises without any history of trauma or accident
  3. Bruises that do not heal even after weeks of occurrence
  4. Family history of bleeding disorders, such as Von Willebrand disease or hemophilia
  5. Bruises on babies who have not yet started crawling
  6. Occurrence of sudden bruises on unusual places, such as the ears, neck, feet, chest, buttocks, abdomen, or genitalia
  7. Large bruises
  8. Frequent nose bleeds or excessive bleeding after a dental procedure or a minor surgery
  9. Clustered or patterned bruises such as handprints, belt marks, or bite marks (1)

If you notice any of the above signs in your child, it is important to know the root cause. The next section covers the various reasons for abnormal bruising.

Causes Of Abnormal Bruising

As your toddler starts taking their first steps, they might trip and bump into many things, leading to bruises, or your child might come home with a new bruise after playing at school. Normal bruises are a part of childhood and are a sign that your child is trying new things.

However, if you see sudden and abnormal bruises on your child’s body, it is best to know the cause behind it. The bruise could be due to any of the reasons given below.

  1. Child abuse: If your child gets unexplained bruises in places such as the upper arms, hands, cheeks, buttocks, and genitalia, and if the bruises look like bite marks, cigarette burns, or belt marks, it might be child abuse (3).

If abuse is ruled out, certain medical conditions might be the cause of the sudden bruising in your child. Below are the names and details of such disorders.

  1. Thrombocytopenia: Thrombocytopenia is a condition in which your blood has a lower than normal platelet count. It could lead to internal bleeding or bleeding underneath your skin or from the surface of your skin. It is often characterized by skin bruises and red, pinpoint, round spots on the skin (petechiae). Corticosteroids, blood or platelet transfusions, and splenectomy are some treatment options available for severe thrombocytopenia ((4).
  1. Von Willebrand disease: This is a common bleeding disorder seen in approximately 1% of children. It occurs due to the lack of or abnormalities in the protein known as von Willebrand factor in the body, causing easy bruising, nose bleeding, oral cavity bleedings, and heavy menstrual periods in the case of adolescent females. Treatments options include antifibrinolytic agents and transfusion with plasma concentrates (5).
  1. Hemophilia A and B: These are bleeding disorders linked to the mutations in genes responsible for the production of coagulation factors VIII and IX. If not managed in early infancy, they can lead to chronic diseases or lifelong disabilities. Children with hemophilia show abnormal bruising or bleeding, bleeding in the joints, bleeding after incisions or losing a tooth, and frequent nosebleeds. Treatment includes infusing commercially prepared clotting factors regularly (6).
  1. Leukemia: This is a common cancer of the blood, wherein the cancerous cells grow in the bone marrow and get circulated into the blood. Bruising and bleeding are some of the common symptoms of leukemia. The bruises appear in unusual places, such as the face, buttocks, ears, chest, and head. These bruises last long and even grow in size. Other leukemia symptoms include fatigue, pale skin, shortness of breath, and loss of appetite (7), (8).
  1. Childhood IgA Vasculitis: Formerly known as Henoch Schonlein Purpura, this blood disorder can occur in children of any age, but the symptoms peak at four to six years. This condition occurs due to abnormalities in immunoglobulin A (IgA), a major antibody that is present in the mucosal secretions and serves as the first line of defense against invasion by pathogens. Symptoms include sudden onset of bruises, purpura, mucosal hemorrhage, and petechiae. Most IgA cases in children improve on their own and do not require any specific treatment (9).
  1. Factors II and V deficiency: Sudden bruising and bleeding disorders occur in children when they are born with deficiencies of coagulation factors prothrombin (FII) and proaccelerin (FV), which serve an important role in blood clotting. The deficiency of these factors in the body is characterized by bleeding gums, nosebleeds, sudden bruises, and prolonged bleeding after an injury. It may be treated through plasma transfusion (10) (11).
  1. Vitamin K deficiency: Bruising and bleeding in children can also occur due to vitamin K deficiency. Vitamin K proteins play an important role in coagulation, bone development, and cardiovascular health (12). Vitamin K transport across the placenta is generally poor in babies, so watch out for symptoms such as bruises around the head and face and bleeding from the nose. According to the National Institute of Health, the dietary intake of Vitamin K for children should be 30mcg–60mcg (13). Treatment options include vitamin K shots or dietary intake.

Apart from the above causes, medicines, such as aspirin, and some antibiotics can also cause bruises in children (14).

When To See The Doctor?

If you notice a recurring pattern of bruises in your children, with no known cause, it is best to consult your pediatrician. Take your child to the doctor if you notice any bleeding disorders or see any of the below signs.

  • Unexplained bruises in a recurring pattern
  • Painless bruises
  • Random bruises without signs of injury
  • Black bruises on the legs or other unusual places

Besides a physical examination, your doctor might prescribe tests, such as a complete blood count, peripheral blood smear, and bleeding time, to determine the functioning of the clotting factors and diagnose bleeding disorders.

Treatment Of Bruises In Children

If the bruises are due to minor trauma, they could be treated at home by applying an ice pack or prescribing over-the-counter medication to reduce pain and swelling.

Random bruising can also be caused if your child is being subjected to abuse that you are not aware of. If your child has to spend time with a babysitter or at the daycare, make sure your child is in safe hands. Still, if you find suspicious bruising, it is best to consult child welfare authorities, as childhood abuse is deeper than the bruise.

If the bruises are abnormal and your child is diagnosed with bleeding disorders, follow the treatment prescribed by your doctor.

Prevention Of Bruising In Children

When your child is growing up and exploring the world, it might not be possible to prevent bruising, as it is a part of the growing-up process. However, you can help your child avoid bruises to some extent by instructing them to wear shin, shoulder, knee, and thigh guards.

Most bleeding disorders need to be managed with the utmost care. If your child is diagnosed with a disorder, talk to your health care provider and gather as much information as possible. Also, explain the disorder to your child, and tell them the importance of taking certain precautions.

Normal bruises are common in children, and you need not worry about them. But, if your child has excess or easy bruising, talk to your pediatrician. It is also important to speak with your child regularly to understand if they are being subjected to abuse.

References:

1. Michelle GK Ward, et al.; The medical assessment of bruising in suspected child maltreatment cases: A clinical perspective; Pediatrics Child Health (2013).
2.Is it More Than a Bruise?; Children’s Hospital Colorado
3. James D. Anderst, et al.; Evaluation for Bleeding Disorders in Suspected Child Abuse; American Academy of Pediatrics (2013)
4. Thrombocytopenia; National Institutes of Health
5. Robert J Klaassen and Jacqueline M Halton;  The diagnosis and treatment of von Willebrand disease in children; Pediatrics Child Health (2002).
6. What is Hemophilia?; Centers for Disease Control and Prevention
7. Bruising in leukemia VS ordinary bruising; Leukemia Care
8. Signs and Symptoms of Childhood Leukemia; American Cancer Society
9. Louise Oni and Sunil Sampath; Childhood IgA Vasculitis (Henoch Schonlein Purpura)—Advances and Knowledge Gaps; Frontiers in Pediatrics (2019).
10. Prothrombin Deficiency; National Institute of Health
11. Amol Chingale, et al.; A neonatal presentation of factor V deficiency: A case report; BMC Pediatrics (2007).
12. Rina E. Eden and Jean M. Coviello; Vitamin K Deficiency; StatPearls (2020).
13. Vitamin K; National Institutes of Health
14. Bruises and Blood Spots Under the Skin; C.S. Mott Children’s Hospital

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