Bruising in children

Abstract

Terence Stephenson DM, FRCP, Senior Lecturer in Child Health, Department of Child Health, University Hospital, Nott ingham NG7 2UH. Correspondence and requests for offprints to TS. tion of blood and tracking between tissue planes. 'Gravity shifting' of the blood may result in a bruise appearing in a place remote from the point of injury. Bruises do not blanch on pressure but may vary in colour, depending on their age. Bruising can be confused with paint or pen marks, dye from clothes, a Mongolian blue spot, a capillary haemangioma and periorbital swelling as a result of allergy or infection. In dark-skinned children, bruises may also be confused with caf6-au-lait spots. If there is any doubt that a lesion is a bruise, serial examination will decide the matter. Petechiae are tiny blood spots in the skin, each about the size of a pinhead. They are of fairly regular size and circular in shape and are usually red or purple at initial presentation. They classically arise in idiopathic thrombocytopenic purpura, meningococcal infection and leukaemia, all as a result of reduced platelet count or abnormal clotting, but petechiae may also arise in children with normal clotting and platelet counts as a result of trauma. Examples are the petechial bruising which occurs as a result of a suction bite (a 'love bite' on the soft tissues of the neck), petechial bruising which may affect the pinna of the ear when it is squeezed or slapped, and petechial bruising on the cheek or around the orbit as a result of a slap mark to the face.