Bruising: information about injuries, bruises, marks or bleeding in non-mobile babies and children

Read our guide below to help you understand about bruising/marks/bleeding in non-mobile babies and children.

You can also download a PDF version of this patient information by following the link on the right.

Why is bruising in babies and children who aren’t independently mobile such a concern?

It’s rare for babies and non-mobile children to sustain an injury or bleeding during normal day-to-day activities. This includes feeding, nappy changing and normal handling.

Why might my child have a bruise and why do I need to explain how this happened?

Even when babies and immobile children fall or get knocked, it’s unusual for them to get injured or bleed. Unlike children who crawl and walk who often get bumps and bruises.

There are also some reasons and causes of injuries or bleeding which may seriously affect the child’s health.

Your child may bruise easily, for example due to haemophilia or suffer from a blood disease such as leukaemia or an infection such as meningitis.

Very occasionally, bruising may be due to deliberate injury. Even when there’s a simple explanation it’s important for professionals to make further enquiries. It also sometimes takes an expert or professional to tell the difference between a bruise and a certain type of birthmark.

I understand the need to see a paediatrician but why do I need a referral to Children’s Social Care?

Although rare, injuries or bleeding occasionally happen deliberately. When this happens, it’s important to address it as soon as possible to support the family and protect the child.

Referral to Children’s Social Care is not an accusation of wrongdoing, but a way of looking for causes of injuries in the same way that the doctor looks for illness.

What will happen next?

You’ll have an appointment as soon as possible and preferably straight away with a paediatrician. They’ll talk to you about your baby/child, examine them fully and decide whether to do further investigations such as blood tests or x-rays. This will help decide whether your child needs further treatment. The paediatrician will then talk to Children’s Social Care.

What will Children’s Social Care and the health specialist do?

They’ll check whether you had services from them in the past. They may talk to partner agencies including the GP, health visitor and/or school nurse and police and will make arrangements to speak to you.

This may be at the same time as your attendance with the specialist paediatrician or at a separate appointment.

They’ll discuss their findings with the paediatrician who examined your baby/child. Together, they’ll decide if there’s any further action or treatment needed.

All this is very upsetting. I/we feel as though I am/we’re being accused of hurting my/our baby/child. Why do I/we have to go through this?

We understand this can be very upsetting but the only way of addressing serious causes for injuries, bruising and bleeding is to investigate every case where it happens. We’ll treat you with courtesy and sensitivity andlisten to your explanations which we’ll discuss with you. We’ll keep you fully informed so that you know exactly what’s going on and why.

You can ask questions at any time and we’ll give you the opportunity to discuss your concerns fully at every stage.

What do the people involved with this do?

As part of their professional duties, all professionals working with babies and children make enquiries to make sure children are kept safe from harm.

Where bruising or injuries are considered non-accidental, they’ll take immediate steps to protect the baby/child and potentially siblings from further harm. This may include having a discussion / meeting with partner agencies including social care and the police.

My baby / child has a disability, and bruising is one of the consequences of their limited mobility. What will happen to my child?

Professionals know that bruising in children with disabilities and especially those with additional communication difficulties is more difficult to assess. They follow the same referral process for children who aren’t independently mobile or in walking children where bruising is a concern.

If the bruising is consistent with any explanation provided by the carer or the young person and in the context of their disability, a written record will be kept
using a body map and advice will be given if that’s considered appropriate.

Children with disabilities, particularly those with additional communication and learning difficulties, are more likely to suffer abuse from carers. This must be explored.

References

• Child maltreatment: when to suspect maltreatment in under 18s 
• Child abuse and neglect
• All-babies-count-research
• RCPCH Child Protection Portal

Information for parents and carers

Visit the Buckinghamshire Safeguarding Children Partnership 

Reducing associated healthcare infections

Find out how you can help to reduce healthcare associated infections when visiting hospital

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net