What is the treatment for a bruise on a 29-month-old child?

Management of Bruise in a 29-Month-Old Child

For a 29-month-old child with a bruise, the primary treatment is supportive care with observation, but the critical clinical priority is determining whether skeletal survey or child abuse evaluation is warranted based on bruise location, pattern, and history.

Immediate Assessment Priorities

The evaluation must first determine if this represents potential non-accidental trauma, as this directly impacts morbidity and mortality outcomes:

High-Risk Features Requiring Immediate Skeletal Survey

Any of the following scenarios mandate skeletal survey regardless of the child's age: 1, 2

• Witnessed or confessed history of abuse
• History of domestic violence in the home
• Patterned bruising (showing imprint of an object)
• Additional injuries present (burns, whip marks, frenulum tears)

Age-Specific Skeletal Survey Guidelines for 29-Month-Old

Since this child is 29 months old (over 24 months), they fall outside the strict guidelines developed for children under 24 months. However, clinical judgment should apply principles from the toddler guidelines: 1, 2

For children 12-24 months (closest age bracket), skeletal survey is NOT routinely indicated for: 1, 2

• Single bruise on forehead, upper lip, or chin (T-shaped zone)
• Single bruise on scalp
• Single bruise on extremity bony prominences (knees, shins, elbows)

Skeletal survey IS necessary if the bruise is located on: 1, 2

• Ear, neck, torso, hand, or foot
• AND there is no history of trauma OR only vague history of "rough play"

Evaluation for Underlying Bleeding Disorders

Consider laboratory testing if: 3, 2

• Bruising is disproportionate to reported trauma
• Multiple bruises in unusual locations
• Personal or family history of bleeding symptoms (excessive bleeding after surgery, frequent nosebleeds, joint hemorrhages)

Initial screening panel should include: 3

• Complete blood count with platelet count
• Peripheral blood smear
• Prothrombin time (PT)
• Activated partial thromboplastin time (aPTT)

Important caveat: PT and aPTT do not reliably detect von Willebrand disease or Factor XIII deficiency. 3, 4

Symptomatic Treatment of the Bruise Itself

For uncomplicated bruising without concerning features:

• No specific medical treatment is required for simple bruises, as they resolve spontaneously 5, 6
• Apply cold compress in first 24-48 hours to minimize swelling
• Avoid aspirin or NSAIDs which could worsen bruising
• Monitor for expansion or development of additional bruising

Documentation Requirements

When any concern for non-accidental trauma exists: 2

• Photograph bruising patterns immediately, as appearance changes rapidly
• Document exact location, size, color, and pattern
• Record developmental capabilities (is child walking, running, climbing?)
• Obtain detailed trauma history and assess consistency with injury pattern

Critical Pitfalls to Avoid

• Do not dismiss bruising in unusual locations (ears, neck, torso, genitals, hands, feet) as these have higher specificity for abuse 1, 3, 2
• Do not assume bruising is superficial - assess for deeper injuries including underlying fractures, organ damage, or traumatic brain injury that may require urgent imaging 2
• Do not perform extensive coagulation testing without clinical indication, as the extreme rarity of some bleeding disorders makes universal screening unreasonable 3
• Do not overlook medication history - document all medications including over-the-counter NSAIDs, steroids, and alternative therapies that may affect bleeding 3, 4

When to Refer

Immediate referral to child protective services if: 2, 5

• Any high-risk features for abuse are present
• History is inconsistent with injury pattern
• Developmental capabilities don't explain bruise location

Referral to hematology if: 3

• Initial laboratory evaluation indicates bleeding disorder
• High clinical suspicion remains despite normal laboratory workup
• Specialized testing or expert interpretation needed