700 Children's® – A Blog by Pediatric Experts

My Child Has a Bruise: When Should I Worry?

Oct 29, 2021
knee with bruise

When I see a child running around with a small bruise and a scrape on her knee, usually I think to myself, “There’s a sign of a kid doing exactly what they’re supposed to—being active and getting out to play!”

All children get bruises at some point. It’s an inevitable part of the process of learning how to explore the world! The body goes through a natural process of healing (and perhaps a child learns to slow down a little next time). Seeing a bruise can be distressing to parents, however, especially if they did not witness how their child got it. Many parents wonder when they should get a bruise checked out.

What Exactly Is a Bruise?

A bruise occurs when an injury is strong enough to cause small blood vessels to leak or tear under the skin. Soon after an injury, there may be some redness and swelling of the area. This is the stage when blood and fluid are moving into the tissue (icing the area can help slow down this process). Within 24 hours, the leaked blood within the soft tissues becomes deoxygenated and can have that classic blue/purple or sometimes black appearance.

My Child’s Bruise Is Turning Yellow. What Do the Different Colors Mean, and How Long Do Bruises Take To Go Away?

Old red blood cells are broken down all the time within our circulatory system while our bodies produce new red blood cells, and we never see this process. When a child has a bruise, this process becomes visible. Red blood cells are broken down into bilirubin and biliverdin, which are products that take on a more yellow/green appearance. Typically, this happens in 2-7 days but can vary depending on the severity of the bruise. It can also vary widely from person to person, so using colors to judge the “age of the bruise” is NOT an exact science. In the final stages of bruising, a bruise may appear a more yellow brown or light brown before all the red blood cell breakdown products are cleared away. Most bruises are gone within 10-14 days.

What Is a Hematoma?

Hematomas are like bruises but larger and can be more serious. There is more swelling and you may feel or see a bump or lump under the skin, which is a collection of blood within the skin or soft tissue. Hematomas may harden with time. Some will eventually go away without any intervention, but some may require drainage or removal.

When Does a Bruise Need to Be Checked?

The simple answer:

  • when you feel that a bruise is bigger than what you’d expect after an injury
  • you feel that the injury was significant enough to look for broken bones or deeper trauma
  • a bruise is unexplained or in an unusual location

There are rare medical conditions that can predispose children to severe bleeding or bruising. Rarely, an unexplained or unusual bruise can be a sign of child abuse. Talk with your pediatric provider if any of the following occur:

  • Any bruise on your child’s face, especially the cheeks, eyes, ears, nose or mouth. We need to make sure there isn’t a fracture or hematoma (larger blood collection) that, if present, may require intervention to prevent complications.
  • Bruising on the neck or torso (chest, abdomen, back, private parts). Arms and legs are exposed and more likely to bruise, but bruising in these areas may indicate more serious injury.
  • Your child hit their head, especially if they fell from an elevated surface, lost consciousness, seems confused, or have vomiting afterwards. This should be checked out right away.
  • Severe or persistent pain in a bruise, or a “lump” under the bruised skin. This is a sign of a hematoma and should be evaluated.
  • You notice bruising without any trauma at all, or bruises seem larger than you’d expect for the injury. For example, a child bruises after just touching their arm or picking them up. Or, a child has a very large bruise and swelling of the knee from tripping from standing height.
  • Your child has easy bruising with bleeding gums, frequent bloody noses, or blood in their urine or stool.
  • Bruising in a newborn or infant. There is a teaching phrase in pediatrics: “Those who don’t cruise rarely bruise,” meaning that if a child is not cruising or walking (usually any child under 6-9 months old), it would be unlikely for them to become bruised unless there was a more significant bleeding problem or injury.
  • You think a bruise is probably okay, but you’re still worried and want reassurance. We are more than happy to check it out!
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Lindsay Kneen, MD
Primary Care Pediatrics

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700 Children’s® features the most current pediatric health care information and research from our pediatric experts – physicians and specialists who have seen it all. Many of them are parents and bring a special understanding to what our patients and families experience. If you have a child – or care for a child – 700 Children’s was created especially for you.