Common paeds histories - Childhood bruising

Question 1

What would you want to ask about childhood bruising?

Answer 1

• Onset/progression
• Pattern
• Mechanism of injury
• Associated symptoms

Question 2

What should you ahve a low threshold for in a child with bruising?

Answer 2

Safeguarding issues and NAI

Question 3

What general symptoms would you check for in a child with bruising?

Answer 3

• Fever
• Behaviour
• Activity/apathy/alertness

Question 4

What features of childhood bruising would suggest NAI as a cause?

Answer 4

• Bruises on soft tissues (ears/neck/chest/abdomen/buttocks/calves/thighs)
• Story consistent with injury

Question 5

What features of bruising would suggest accidental injury?

Answer 5

• Bruising overlying bony prominence (forehead, shins, hips etc.)
• Story consistent with injury

Question 6

What features of bruising would suggest HSP as a cause?

Answer 6

• Symmetrical rash on back of legs and buttocks - purpuric and slightly raised
• May have abdominal/joint pain
• Nephritis

Question 7

What features of bruising would suggest ITP as a cause?

Answer 7

• Spontaneous purpura and petechiae
• Usually post-infection

Question 8

What features of bruising would suggest meningococcal septicaemia?

Answer 8

• Non-blanching rash
• Neck pain/stiffness
• Photophobia
• Fever

Question 9

What are non-injury related causes of bruising in children?

Answer 9

• HSP
• ITP
• Meningitis
• Acute lymphoblastic leukaemia
• Traumatic petechiae
• Coagulation disorders -haemophilia