Bruising on a Newborn Child

NewbornChildbirth is a physically demanding and stressful process that often pushes the physical limits of both mother and baby. Many newborns often look like they have just been in a little fist fight when they first come out. Bruises on the head and face of a newborn baby are a very common sight. In most cases, bruises on a newborn are nothing to worry about and they go away on their own within a few days. If you are a parent coming here out of fear that something is wrong or something happened to your child, the odds are overwhelming in your favor trhat your baby is just find. But it is not hard to understand why you are worried. In some rare cases, bruises can sometimes be one of the earliest indications of a more serious injury during childbirth. Again, it is very unlikely to be a forerunner for something serious. But parents of newborns are going to be paranoid. So let's talk about your concerns and what you would expect to see if the bruise is anything more than just a bruise.

Newborn Bruises and Birth Injuries

Although bruises on a newborn are a common consequence of childbirth, not all babies are born with bruises. So if a newborn baby has extensive bruising it is a clear indication that they endured a particularly stressful passage through the birth canal which caused enough physical trauma to trigger the bruise. Bruises on a newborn baby can be related to the following events:

  • Caput Succedaneum: caput succedaneum is very common neonatal condition in which the baby has an area of edema or swelling on their head caused by compression as the head passed through the birth canal. Caput succedaneum is a benign condition but it can lead to other complications including a higher risk of infant jaundice.
  • Forceps Trauma: if operative tools were used to facilitate delivery (e.g., obstetrical forceps or vacuum extractor) bruises on the baby's head or neck may be evidence that the doctor used excessive force or improper technique when employing those tools. Negligent misuse of forceps and vacuum extractors are a very common reason for major birth injuries such as Erb's palsy an even more serious types of brain injuries. If you see a child with bruises, abrasions, forceps marks, or lacerations, you have to question whether there was excessive traction.
  • Shoulder Dystocia: shoulder dystocia occurs when one of the baby's shoulders becomes stuck behind the mother's pelvis. When this occurs the shoulder must be physically dislodged in order to deliver the baby. Bruising to the neck and shoulder area can often result from the efforts to free the stuck shoulder.
Bruises in Childhood

Newborn Bruises Birth Injury InfographicThe focus of this post is bruises that could be harbingers of a birth injury. But anytime you are talking about kids and bruises, it is important to take a timeout and underscore the importance of monitoring bruises in older children, too.

Bruises are a painful part of growing up. They include scrapes, brush burns and blunt injuries. As any parent knows, it is almost impossible to monitor them 24/7, resulting in the need for caregiver's to temporarily relieve parents from parental responsibilities. A parent's worst nightmare is trusting your child in the hands of someone else only to notice bruising that was not there previously. Most of us would safely assume an accident occurred, a fall took place and there was no fault to it. But when should a parent be concerned regarding this? What is considered to be "acceptable" as bruising resulting from an accidental fall or mishap? In the following excerpt, we hope to paint a clearer picture of how to approach this difficult topic and situation and what is considered to be abnormal.

First, you as a parent, need to talk with the caregiver and ask the following questions:

  • What exactly happened?
  • Where did this bruise come from?
  • When did this occur?
  • Why was I, the caregiver, not informed of this prior to picking my child up?

A caregiver shoulder be able to reliably explain what happened in a manner that makes both physical and logical sense. If the story does not quite add up, the injuries don't reflect what is seen on the child or you suspect any suppression of truth, continue to ask questions. These questions allow you to get a picture of what happened.

Next, consider taking your child aside to talk with them 1 on 1. If your child is greater than the age of 5, they are likely able to provide more information as to what happened. It is very important to interview and talk with your child away from the caregiver as this can potentially reveal more information that would otherwise have not been disclosed. If possible, have the child point to where it hurts on his/her body, ask yes or no questions to the child and watch their reaction to the questions. Look at their eye contact and posture. Children can sometimes reveal when they are withholding something by looking down or playing with their hands and feet.

If your child is under the age of 1 or not able to speak, you will have to apply more critical thinking to the situation. Does the story match the injury? Infants below the age of 4 months are not capable of rolling, climbing furniture or sitting up without support, thus falling off of changing tables from rolling over is less likely to be accidental2. Infants between 4 and 7 months have been known to grasp objects, put things in their mouths, roll over(closer to 7 months), sit up without support(closer to 7 months) and possibly even crawl(closer 7 months)2. Infants between 7 and 12 months can sit without support and crawl but are unable to climb on top of furniture2. However, they will begin to pull themselves up on furniture or chairs(closer to 10 months) in order further explore2. With further development, this transitions into walking a few steps either with or without support from furniture, increasing the chance of falls and collisions with furniture. Bruises on the knees, elbows, forehead, hands and feet can begin to occur with falls around this age. After 12 months, children are more likely to walk without support, opening up many possibilities of accidental injury.

Next, as a parent, you should look for any behavioral changes with your child.

  • Do they seem excited to see you when picked up or are they quivering, shaking or crying uncontrollably when you pick them up?
  • If they are currently potty-trained, do they now have any relapses or episodes of bed wetting or wetting their underpants?
  • Do they flinch with any sudden movements on your end, hold their hands up to protect their face or cower in any way?
  • Do they have urinary complaints resembling a UTI (hurts to pee, cries with trips to the bathroom, fearful of urinating or now showing embarrassment with going to the bathroom)
    • Toddlers, especially females, can get vaginitis, a condition that results in irritation of the vagina from frictional contact from either the fabric of the diaper or sitting in a urine soaked diaper for too long.
    • Excessive redness, pain, recurrent urinary symptoms, or any bleeding should always get evaluated by a medical professional as this can also be concerning for sexual abuse
  • Is your child now fearful of getting undressed, changed or getting ready for bath-time?
  • This may show concerns for sexual abuse
  • Are they having vivid nightmares or dreams?
  • Are they more "clingy" or overall more insecure than normal?

The obvious subtext here is the fear that thebruising and trauma is could be from possible abuse. These include:

  • Burn marks in the shape of cigarette tips, iron, stove coils or stocking and glove patterns
    • Stocking and glove patterns result from placing a child's hands and/or feet into a boiling pot of water
  • Bruises in the shape of a hand, fist, fingers or belt buckle
  • Bruises that encompass a large portion of the child's body, particularly their abdomen, back, arms, legs, thighs, head or face
  • Multiple stages of healing bruises, i.e. new bruises present with ones that are fading
  • Black/blue/purple reflects recent injury while yellow/green reflect older injury
  • Bruises at joints(elbow, knee, ankle) that are noticeably swollen and the child cries with any movement of the joint or has severe restriction of the joint
    • However, knees, elbows and ankles are common places for scrapes, mild bruises and trauma from falls that would not be considered abuse
  • Bruises on the legs that result in child not wanting to walk or bare any weight on them
  • Bruises on the thighs of children that results in one leg appearing shorter than the other
  • Pain that is out of proportion to the appearance of the bruise or child (this one is probably the least predictive of abuse but it is something to consider)

Any of the above should immediately be reported to the police.

  • Do not leave the child alone while making the call
    • This is especially important if picking up from a caregiver's home
  • Do not leave the location to where you picked your child up, have the police come to you
  • If at a daycare, get the supervisor or manager involved