Published: May 3, 2007
Updated: June 23, 2008
When you see the black-and-blue marks from a bruise on your child, should you be concerned? It can be confusing to differentiate between normal bruising and something more serious.
Courtney D. Thornburg, MD, a pediatric hematologist, helps us understand when to worry -- and when not to worry -- about bruises.
-- Dennis Clements, MD, PhD, MPH
A 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 activity.
Most 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).
Bruises 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.
Bruises may also be abnormal if they are larger than expected for the degree of injury.
Apply 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 be necessary.
Give 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 the blood.
Bruises clear in about two weeks. They change colors during this time from black-and blue to green-and-yellow.
Abnormal bruising occurs if there is:
Bleeding disorders may be caused by abnormalities in blood clotting factors or in platelets.
Bruising 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:
The evaluation for a bleeding tendency includes:
Types of bleeding disorders include:
Bruising may be a sign of an underlying illness especially if it occurs suddenly and with other symptoms such as:
Illnesses associated with bruising include:
Bruising 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.
Call your child’s primary care physician to talk about how your child is doing and decide how soon your child needs to be evaluated.
Depending on your child’s symptoms your child may be seen in the clinic or may need to go directly to the emergency room.
Your child’s physician will also decide if your child needs to see a doctor who specializes in blood disorders or blood clotting.
Call immediately if:
On Other Web Sites
Visit these sites for more information:
-- Courtney D. Thornburg, MD , is a pediatric hematologist at Duke.
-- Dennis Clements,
MD, PhD, MPH, is the chief of primary care pediatrics at
Duke Children's Hospital.