Bleeding in Children: When Should You Be Concerned?

Bleeding in a child is always concerning and causes moments of panic among parents and householders. Every 4 out of 10 children experience one or more bleeding symptoms during the first 5 years of life. Bruising and epistaxis are the most common bleeding complaints witnessed on a daily basis in my outpatient practice. Bleeding can be simply classified as, external, internal, and occult (invisible) blood loss.

Not all bleeds are dangerous!!! However, it is often a diagnostic challenge to identify a bleeding disorder and ascertain if it needs any specific evaluation so that appropriate therapy can be provided.

Clues For a Bleeding Disorder

1. Recurrent and spontaneous (non-traumatic) bleeding.

2. Multiple site bleeding, e.g., external and internal bleeding at the same time.

3. Family history of bleeding symptoms.

4. Onset: early in life.

5. Nose bleed — not controlled at home; needs intervention or packing.

6. Prolonged bleeding. Eg: bleeding after tooth fall > 5 minutes.

7. Uncommon site: back, flank, abdomen, skin.

8. Deep bleeds (muscle hematomas, joint bleeds, and intracranial bleeds).

Causes Of a Bleeding Disorder

In simple terms, Bleeding Disorder in Children can be caused by defective platelets or a defective clotting system.

Platelet disorders include ITP (immune thrombocytopenia), aplastic anaemia, and platelet function disorders (Glanzman thrombesthenia, Bernaud Solier syndrome).

Clotting disorders include hemophilia, Von Willebrand disorder, and DIC (disseminated intravascular coagulation).

Common Sites of Bleeding

1. Over bony prominences (shin, elbow, forearm, and forehead)

This is very common in the toddler age group and is mostly after a trauma.

2. Nose bleed (epistaxis)

Nose bleed is always a panic site for a parent.

Very commonly associated with nose picking, injuries with sharp objects, common cold, and violent blowing of nose.

It is often self-limiting and usually resolves as the child grows.
Few people are habitual nose bleeders, and it can be Read More.