BRUISES AND HEMATOMAS
Bruises are purple-red stains in the skin resulting from a blow or bump that ruptures small blood vessels near the skin's surface. Children with fair skin bruise more easily than those with darker skin. Hematomas are dome-shaped collections of blood--usually clotted -- under the skin and the scalp or inside the abdomen. The hematoma is formed by bleeding from a broken blood vessel. Bruises and hematomas fade from purple-red to maroon, then green or yellow.
Appropriate health care includes: doctor's care unless the bruise or hematoma is very small; needle aspiration of blood from the hematoma if the hematoma is accessible; at the same time, hyaluronidase (an enzyme) can be injected into the hematoma space; self-care for minor bruises or hematomas, or during the rehabilitation phase following serious hematomas; physical therapy for serious hematomas.
SIGNS & SYMPTOMSSwelling over the injury site.
Fluctuance (feeling of tenseness to the touch, like pushing on an overinflated balloon).
Tenderness for 1 to 3 days.
Redness that progresses through several color changes--purple, green-yellow, and yellow--before it completely heals.
Direct blow to the injured part, usually with a blunt object. Bleeding into the tissue causes the surrounding tissue to be pushed away.
Contact sports, especially if the child is not adequately protected; medical history of any bleeding disorder such as hemophilia; poor nutrition, including vitamin deficiency; use of anticoagulants or aspirin.
PREVENTING COMPLICATIONS OR RECURRENCEProtect the child's body with padding if there is a risk during participation in athletic activity. If the child must compete before healing, use tape, padding, splits, or a cast to prevent reinjury.
MEDICAL TESTSYour own observation of symptoms; medical history and physical exam by a doctor; X-rays of the injured area to assess the total injury and to rule out underlying bone fractures. The total extent of the child's injury may not be apparent for 48 to 72 hours.
POSSIBLE COMPLICATIONSInfection introduced through a break in the child's skin at the time of injury, or during aspiration of the hematoma by a doctor; prolonged healing time if the child resumes activity too soon; calcification of the blood remaining in the hematoma, if blood has not been completely removed or absorbed.
Complete resorption of blood and healing within 10 to 60 days unless blood is removed from significant hematomas with aspiration, which reduces healing time.
Use instructions for R.I.C.E., the first letters of rest, ice, compression, and elevation. See Appendix 39 for details.
Use ice soaks on the child's injury 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
After 48 hours, localized heat promotes healing.
Don't massage the bruised area or the hematoma. You may trigger bleeding again.
MEDICATIONFor minor discomfort use non-prescription medicines such as acetaminophen or ibuprofen; topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain, if needed.
ACTIVITYYour child should begin daily rehabilitation exercises when able.
Use a gentle ice massage on the child's injury for 10 minutes before and after physical activity. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
Your child can begin activities slowly and stop exercise as soon as pain begins. The child should increase activity as healing progresses. To prevent delayed healing, protect the injured part against excessive motion soon after injury. Motion breaks down the clot and causes irritation throughout, leading to possible scar formation, calcification, and limited movement after healing.
DIET & FLUIDS
During recovery, your child should eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk, and eggs.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has signs or symptoms of a serious bruise or hematoma that doesn't begin to improve in 1 or 2 days.
The child's skin is broken and signs of infection (drainage, increasing pain, fever, headache, muscle aches, dizziness, or a general ill feeling) occur.