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Nurse Milli, RN
Nurse Milli, RN, Nurse (RN)
Category: Health
Satisfied Customers: 4139
Experience:  20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
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4 yr old son has unexplained bruising on his ears, temple,

Customer Question

4 yr old son has unexplained bruising on his ears, temple, underneath chin, back, tummy (above hip), arms. NOT ABUSE/Trauma. Pediatrician did bloodwork but claims no abnormalities. Complains of headaches and tummy pain periodically. That was written off as heartburn.
Submitted: 8 years ago.
Category: Health
Expert:  Nurse Milli, RN replied 8 years ago.


Do you or your Spouse work? (if single, do you work?)

Customer: replied 8 years ago.
His mother and I are divorced. We both work.
Expert:  Nurse Milli, RN replied 8 years ago.

Ok, thanks for the reply

If he is not in your care 24/7 there is no way to know that he is not being physically assaulted...not necessarily by an adult, but other kids can be doing this. I am particularly suspicious of it since nothing was found to be abnormal so far.

If he is in daycare, I would take him out of this particular daycare and alert the owner(s) of what has happened and to be on the alert of other children whose parents might complain of the same thing happening.

If he is not in daycare, I would watch him closely and if continues to have bruising and you can account for his whereabouts 24/7, he will need to see a Hematologist for more specialized testing.

Customer: replied 8 years ago.
These occur overnight and usually when he's not in daycare. He does have transitional anxiety when he goes from daddy's house to mommy's and vice versa. There has already been a police and child services investigation done and nothing was found. Although for most people, like his pediatrician, unexplained bruises = child abuse. This is not the case and his mother and I are working very hard towards a real solution. Again, this is not abuse because someone cannot give another person stomaches and headaches with touching them.
Expert:  Nurse Milli, RN replied 8 years ago.

Ok, thanks for the added info...I can understand your frustration and remember I am only on the outside looking scenarios, if you will.

Sounds like it is time to see a Pediatric Hematologist. Some possible reason for unexplained bruising could include the following...

  • effects of medications or supplements - aspirin, anticoagulants (blood thinners), corticosteroids, and dietary supplements, such as fish oil, ginkgo, ginger, and garlic (which I doubt he is on any of these)
  • a bleeding or clotting disorder
  • nutritional deficiencies of vitamins B12, C, K, or folic acid
  • inflammation of a blood vessel(s)
  • liver disease
  • sepsis - a widespread presence of infection-causing organisms or their toxins in the blood or tissues
  • chronic inflammatory diseases, e.g., lupus
  • certain cancers, including Hodgkin's disease, leukemia, or multiple myeloma

So, your correct that a real solution needs to be reached for your little guy. I would look for a Pediatric Hematologist in your area at one of the larger hospitals and let him/her take him under their care and find out what is going on.


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Expert:  Nurse Milli, RN replied 8 years ago.

I also wanted to add that bruises will come not show up immediately after he is hit or kicked (say at daycare)....these may not be visable until some 10-24 hours later (explaination of why they may be noticed to appear "overnight"). So, I know you don't want to think the daycare (or the kids at the day care could be at fault here) but I would not 100% completely rule it out.

The stomach ache and headache are usually components of stress in 4 year olds.

Just don't completely rule out foul play until you get other answers from the specialist.

Customer: replied 8 years ago.
We've been informed about Henoch-Schönlein purpura (HSP) by an ER doctor and have been researching this possiblity. I started him on Flinstone vitamins this morning (just in case it is a deficiency). What are the signs/symptoms of this? Is it possible it can be undiagnosed especially since the bruises themselves are not painful? How do you receive bruises to the tops of your ears?
Expert:  Nurse Milli, RN replied 8 years ago.

Signs and symptoms of HSP would look like tiny hemorrhages in the skin ..... tiny purple spots. It is basically an inflammation of the blood vessels and would not look like bruises. Joint pain is usually involved with HSP also. Also a fair number of children HSP would have kidney involvement as well.

Bruising on the tops of the ears could come from anything being thrown at his head and hitting the side of his head/ears.

HSP would look like this.... (tiny hemorrhages) This picture has been enlarged to show detail.

Customer: replied 8 years ago.
The first time the marks appeared, we had a CAT scan performed which showed absolutely no trauma to his head/neck. At his age he would most definitely disclose information about someone (adult or child) hitting him. [The reason for the therapist.] Although he does get into toddler-style altercations at daycare, his provider would tell me of major accidents/boo-boos especially with a child-abuse investigation looming. We will be continuing our pursuit of an answer. Are there any other possibilities?
Expert:  Nurse Milli, RN replied 8 years ago.

Just the above mentioned....I would definitely see the Hematologist.

Bruising is not normal, and at 4 years of age, he needs this looked into as soon as possible.

Good luck with him...and good luck to you and your ex-wife as well!