Clinical Quick Guide
Approach to a Child with Bruising
A Practical Algorithm for Frontline Clinicians
Bruising in children should be assessed systematically. This practical algorithm outlines four key steps for frontline clinicians: identifying red flags, taking a focused history, performing a physical examination, and selecting first-line laboratory tests.
Is This Child Sick?
Red Flags
- Ill appearance
- Fever
- Pallor
- Bone pain or limping
- Hepatosplenomegaly
- Lymphadenopathy
- Mucosal bleeding
- Extensive or rapidly progressive bruising
Important Clinical Alert
Think leukemia, severe thrombocytopenia, or sepsis/DIC. Urgent CBC + peripheral smear.
Key History Questions
Ask these key questions:
- Age at onset
- First episode or recurrent?
- Easy bruising or trauma-related?
- Epistaxis, gum bleeding, menorrhagia?
- Hemarthrosis or muscle hematomas?
- Recent viral illness?
- Medications (NSAIDs, aspirin, anticoagulants)
- Family history of bleeding disorders
- Previous surgery or dental extraction bleeding
Physical Examination
Look for:
- Pattern and location of bruises
- Petechiae or purpura
- Joint swelling
- Hepatosplenomegaly
- Lymph nodes
- Signs of connective tissue disorders
- Consider non-accidental injury if bruising pattern is unusual
First-Line Laboratory Tests
- CBC with platelet count
- Peripheral blood smear
- PT / INR
- aPTT
- ± Fibrinogen (if clinically indicated)
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