Bruises on a Baby

When to get help

Call emergency services — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if bruising comes with a rash that does not fade when you press a glass against it, a fever, drowsiness, bleeding that will not stop, a swollen or deformed limb, or a head injury with any loss of consciousness or repeated vomiting.

Arrange a same-day or prompt appointment — GP or NHS 111 in the UK, GP or out-of-hours service in Ireland, paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand — for any of these:

• A bruise on a baby who is not yet independently mobile — not rolling, crawling, cruising or walking on their own.
• Bruises appearing with no known cause, or more bruising than you can account for.
• Bruises in unusual places: the ears, the neck, the cheeks, around the eyes, the buttocks, the back of the hands, the abdomen, or the genital area.
• Bruises that look like a shape — a hand, fingertips, a strap, a bite mark.
• Tiny red or purple pinprick spots (petechiae), or bleeding gums and frequent nosebleeds alongside bruising.

What NICE actually says

This page exists because parents who take a bruised baby to a clinician are sometimes surprised by the questions, and it is better to know why in advance.

NICE clinical guideline CG89 tells clinicians to suspect child maltreatment if there is bruising or petechiae not caused by a medical condition and the explanation for the bruising is unsuitable. Its examples include bruising in a child who is not independently mobile, multiple bruises or bruises in clusters, bruises of a similar shape and size, bruises on any non-bony part of the body or face including the eyes, ears and buttocks, bruises on the neck that look like attempted strangulation, and bruises on the ankles and wrists that look like ligature marks. The same guideline separately says to suspect maltreatment if a child has bruising in the shape of a hand, ligature, stick, teeth mark, grip or implement.

Read those two recommendations together and the logic is plain. It is not that a bruise means harm. It is that a baby who cannot move independently cannot generate their own bruises, so a bruise on such a baby always has an external cause, and that cause needs to be understood rather than assumed.

Why the questions are asked of everybody

The questions are the safeguard, and they are applied to every family. You will be asked what happened, when, who was present, and whether your baby has been unwell or is on any medicine. You may be asked the same questions twice by different people, and a body map may be drawn. Blood tests are often done to look for a bleeding or clotting disorder, and depending on the situation an X-ray survey or a scan may be arranged.

None of that is an accusation. It is the same process a clinician follows whether the family is a consultant paediatrician's or anyone else's, and it exists because babies cannot say what happened to them. The most helpful thing you can do is give a clear, consistent account and say honestly if you do not know how a bruise appeared. "I don't know" is a perfectly acceptable answer and is far better than a guess that later turns out to be wrong.

Mobile babies bruise, and that is normal

Once a baby is pulling to stand, cruising and walking, bruises arrive constantly and predictably: on the shins, the knees, the forehead and the elbows. Those are the bony prominences that hit the world first, and bruising there in a mobile child is entirely expected.

The bruises that raise questions are the ones in soft, protected places that do not hit anything on the way down. That distinction — bony and exposed versus soft and sheltered — is the one clinicians actually use, and it is more useful than counting bruises.

The medical causes that also need excluding

Bruising in a baby is not always trauma at all, and part of the assessment is looking for other explanations. Clotting and platelet disorders, including haemophilia and immune thrombocytopenia, can cause easy bruising. Vitamin K deficiency bleeding is why babies are offered vitamin K after birth. Some leukaemias present with bruising and petechiae. Infections, including meningococcal disease, cause a non-blanching rash that can be mistaken for bruising, which is why the glass test comes first in the list above.

Birthmarks are also frequently mistaken for bruises. Congenital dermal melanocytosis, the blue-grey patches often seen over the lower back and buttocks in babies with more pigmented skin, looks like bruising but does not change colour over days and does not fade in a week. Having these documented in your baby's records early avoids repeated conversations later.

What to do at home

Photograph any bruise with a date and something for scale, and note where and when you first saw it. This is useful for entirely practical reasons: bruises change colour and fade, and a photograph taken today answers a question asked next week.

Do not put anything on a bruise beyond a cool compress wrapped in a cloth for the first day. Do not massage it. For discomfort, infant paracetamol or ibuprofen may be options, but follow the instructions on the packaging or ask a pharmacist, and never give aspirin to a child under 16.

If you are worried about someone else's care of your baby

If any part of your concern is about how your baby is treated by another person, say so directly to a health visitor, public health nurse, GP or paediatrician. You do not need proof and you do not need to name a suspicion for it to be taken seriously. Saying it out loud once to a professional is the step that matters.