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Normal bruising pattern

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Normal bruising or bleeding due to accidental injury is commonly seen around the age of 1 when most children become mobile or 'cruising' (1)

  • it is usually restricted to certain areas of the body
    • in crawling children bruises may be seen on the knees, shins and the forehead
    • in preschool and school age children, small bruises on bony prominences on the front of the body (2)
    • in young children (<6 years)
      • if the head is involved - occurs predominantly in a 'T' shape across the forehead, nose, upper lip and chin (3)

  • is not associated with mucosal bleeding, petechiae, or purpura

  • the family history is negative (1)

In non mobile infants usually before the age of 9 months, occurrence of significant bruising is abnormal and is beyond the spectrum of 'normal' bruising (2)

A child with bruises in the typical distribution but seems to be "over bruised" may have a mild coagulation defect (4).

Abnormal bruising

Patients who present with an "abnormal" pattern of bruising may have a haemostatic disorder or may have been subjected to non-accidental injury (NAI).

  • physicians should remember that NAI and bleeding disorders are not mutually exclusive and any person with a haemostatic disorder may have experienced a non-accidental injury
  • if the bruising or bleeding is abnormal in site and severity relative to the history, suspect NAI (2)


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