In toddlers and children who are in an active phase, bruises around the knees, shins and elbows are to be expected. What calls for evaluation is not the presence of a bruise, but its location, its number and the findings that go with it.

Expected bruising

  • In areas where bone lies close to the skin (knees, shins, elbows)
  • Following a knock the family knows about
  • Changing colour over time and fading away
  • The child is otherwise well

Bruising that needs investigating

  • In protected areas such as the back, abdomen, buttocks, behind the ears or the neck
  • Appearing without any history of a knock
  • Numerous, and at different stages of healing
  • With marked swelling and pain
  • If nosebleeds and gum bleeding, wounds that bleed for a long time, or blood in the urine go with it
  • If there is fatigue, pallor, fever, weight loss or bone pain
  • If there is a bleeding disorder in the family history

What the doctor assesses

History and physical examination are the first step. If it is considered necessary, a complete blood count and clotting tests are requested. Which test is needed varies from child to child; not every bruise calls for testing.

What families can do

When a new bruise appears, noting down where it is and the date is valuable for the doctor. Aspirin and similar medicines are not used without a doctor's advice.