BRUISES IN CHILDREN
Bruises are made up of blood that has escaped from capillaries (tiny blood vessels) or larger blood vessels and can be seen through the skin. They vary from pinhead-size to several centimeters across. Bruises usually are black and blue in color. If they are near the skin’s surface, they appear maroon or purple. Bruises of the whites of the eyeballs are always blood-red. As blood in a bruise moves back into the bloodstream, a bruise often becomes yellow or green.
If the escape of blood has been deep in the tissues-as with torn ligaments or broken bones-it may take days to reach the skin’s surface as a visible bruise. Escaped blood often travels to other parts of the body. For example, a bruise of the forehead may travel to form black eyes.
Most bruises are caused by physical injuries. Most normally active children always seem to have one or more bruises. Children with fair complexions bruise more easily than children with darker complexions. Areas most likely to bruise are the shins, knees, arms, and thighs. Bruises may take days or weeks to disappear, depending upon their size.
A different type of bruises, called spontaneous bruises, may be a cause for concern. Spontaneous bruises suddenly appear on their own even though no injury or blow to the skin has occurred. Spontaneous bruises may be caused by abnormally fragile capillaries (sometimes due to scurvy, or a lack of vitamin C); capillaries injured by infections or by allergic reactions; or a lack of proper clotting of the blood.
Remember, however, that bruises often are caused by injuries that were simply not noticed. But if bruises appear in areas not likely to be injured, or if a great many bruises appear, it is less likely that they were caused by unnoticed injuries; these may be spontaneous bruises.
There is another type of bruise known as a petechia. Petechiae are pinhead to one-eighth inch in size. They are dark red or maroon in color and often appear by the hundreds. Forceful vomiting or coughing can sometimes cause many petechiae to appear on the body from the neck up.
Petechiae may also appear in one smaller area when caused by a blow to the skin.
Signs and symptoms
Bruises are easily recognized when an area of the skin is discolored (black, blue, purple, red, green, or yellow). Bruises can be distinguished from other skin marks or rashes by a simple test. A bruise of any size does not blanch (turn white or lighter color) when pressed; all other red or purple marks or skin rashes will blanch when pressed.
Home care
Cold applications soon after an injury has occurred help decrease bleeding and lessen bruising. Warm applications 24 or more hours after the injury can help the body reabsorb the blood in the bruise.
Precautions
• Spontaneous bruising should always be examined by a doctor. Spontaneous bruising may be a sign of illness.
• Petechiae scattered over the body can indicate an urgent situation. If there is also fever or prostration (extreme exhaustion or collapse), a true emergency exists. Don’t waste any time: See your doctor at once.
Medical treatment
For bruises caused by injuries, a doctor’s treatment is the same as home care. For spontaneous bruises, including petechiae that are scattered over the body, your doctor will give a complete physical examination. The examination may include a blood count; platelet count; blood coagulation studies; nose, throat, and blood cultures; spinal tap; and bone marrow studies. The patient may be hospitalized to be given intravenous fluids and antibiotics.
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