Unexplained Bruising on Babies, Toddlers, and Older Children

Bruises on the knees and shins of active children are very normal. Unexpected bruising or abnormal bruises that don't seem connected with a known injury could be a sign of an underlying medical condition. Bruising in unusual areas such as the hands, genitals, or ears may be a sign of abuse and should be checked by a pediatrician.

This article will explore signs of abnormal bruising, possible causes, and what you should do if unexplained bruising on a baby, toddler, or older child seems like it could be related to something serious.

What Is Normal Bruising?

Normal bruising is usually found on a child's shins. That's because they often bump their lower legs against things as they walk or run.

These bruises are usually flat and smaller than the size of a quarter. Younger children often get bruises on their foreheads from falling and bumping their heads, too.

Typical Color of Bruises

Typically the first sign of a bruise is a red spot. You may or may not notice this initial discoloration. Then, a day or so later, the deep purple or blue color commonly associated with bruising appears.

As the bruise heals, it turns green, yellow, and possibly yellowish-brown before disappearing.

How Long a Bruise Usually Lasts

A normal bruise usually does not last longer than two weeks. A bruise that lasts longer than that, does not seem to fade over time, gets worse, or is accompanied by other symptoms may be a sign of a more serious problem.

Bruises Related to Child Abuse

A bruise that is related to child abuse is medically referred to as a "non-accidental injury." Bruises that may indicate that someone has been abusing your baby, toddler, or older child often appear in unexpected places such as the:

• Chest
• Back
• Hands
• Face
• Ears
• Genitals
• Buttocks

Recurrent bruises, unexplained bruises that occur without any known fall or injury, and bruising on a baby who isn't crawling or walking yet should be evaluated by a pediatrician right away.

Likewise, bruises in specific shapes, like a large bite mark, cigarette burn, or belt mark can be signs of child abuse.

Medical Conditions That Cause Bruising

Severe injuries can often lead to extensive bruising. Instead of simply looking at the size of a bruise, it is more important to think about whether or not the bruise is proportionate to the injury. You would expect a larger bruise if your child falls out of a tree than if they trip on grass.

Certain signs can indicate that your child's bruise is abnormal. The size and location of bruises or the time it takes for bleeding to stop can be red flags.

Some of the medical conditions that can cause abnormal bruising include:

Acute Hemorrhagic Edema of Infancy 

This is a condition that causes large, bruise-like lesions that look purplish red on light skin and brownish black on dark skin. There may also be fever and swelling that begins in the hands and feet and progresses to the arms and legs. The rash associated with the condition may appear on the ear or elsewhere on the body.

The cause of acute hemorrhagic edema of infancy is unknown, but it is thought to be immune-related. It often appears shortly after a viral illness.

The condition is typically seen in children under the age of 2. Most children recover without treatment in one to three weeks.

Von Willebrand Disease

Von Willebrand disease is a common and often mild genetic bleeding disorder. It can cause easy bruising, frequent nosebleeds, heavy menstrual bleeding, and bleeding after surgery.

Thrombocytopenia

Thrombocytopenia is the medical term for a low count of platelets, which are important in helping blood to clot. A low platelet count can be caused when platelets aren't being produced, are being destroyed, or are contained in an enlarged spleen.

Some of the symptoms of thrombocytopenia include easy bruising, frequent nosebleeds, and heavy periods. The condition is usually caused by an underlying problem such as a bone marrow disorder, a viral infection, or a problem with the liver.

Idiopathic Thrombocytopenic Purpura (ITP)

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder where the body does not produce enough platelets. It is usually triggered by a recent viral infection, where young children develop large bruises and petechiae (small purple dots under the skin) after an illness.

Henoch-Schonlein Purpura (HSP)

Henoch-Schonlein purpura (HSP) is an immune disorder that can cause abdominal pain, bloody stools, and joint pain. In addition, it produces a distinctive rash on a child's arms, legs, and buttocks that looks like bruises (purpura).

The cause of Henoch-Schonlein purpura is unknown, but it is often triggered by a viral illness such as a cold or influenza.

Hemophilia

Hemophilia is a genetic condition caused by a mutation in a gene that is responsible for clotting blood. It is usually diagnosed before a child is 2 to 5 years old. It may be suspected when a child has easy bruising, bleeding in joints, or excessive bleeding after a cut or dental procedure.

Leukemia

Leukemia is a cancer that affects blood cells. It is caused by genetic changes in bone marrow cells.

In addition to easy bruising, bleeding, and a low platelet count, children with leukemia usually have other signs and symptoms. They may have a low red blood cell count, fever, and weight loss.

Vitamin K Deficiency

Vitamin K1 or vitamin K2 are needed for blood clotting. Because of their essential role in producing prothrombin, a protein made by the liver that works to form blood clots, having a lack of either can lead to bleeding problems.

Vitamin K deficiency can occur when a person doesn't eat enough vitamin K-containing foods, like leafy greens. In newborns, vitamin K deficiency occurs because very little vitamin K is passed from the mother to the fetus.

Medications That Cause Bruising

Certain medications can cause abnormal bruising as a side effect. Some of these include:

• Aspirin (Never give aspirin to a child under the age of 16, as it puts them at risk of a serious condition called Reye's syndrome.)
• Seizure medicines
• Antibiotics
  

When to See a Pediatrician About Bruising

If you find unexplained bruising on your child and you suspect someone may be abusing them, it is important to have them evaluated by a pediatrician right away.

You should also see a pediatrician if you notice:

• Bruises that are bigger than expected
• Signs of a broken bone or deeper trauma, including swelling, inability to use a limb, and/or severe pain
• Bruising on the face, neck, or torso
• A lump under the skin, which may be a sign of a hematoma
• Any bruising on a baby who is not walking yet (even if you don't suspect abuse)
  
• Bruises that do not follow a typical pattern of color progression or do not heal

See a healthcare provider anytime if you feel unsure about your child's symptoms. 

Summary

Bruising is normal in active, healthy children. Sometimes, however, bruising can be a sign of something serious, like a health condition or even child abuse.

Normal bruises will usually go away in around two weeks. A bruise that lasts longer than that or gets worse over time could be a sign of a medical condition like a blood disorder, a vitamin K deficiency, or leukemia.

Bruises on a baby who isn't walking or crawling yet and bruises that appear in unusual places like the chest, hands, ears, face, or genitals could be a sign of child abuse. See your child's pediatrician for any bruising that seems abnormal.