Bruising on a newborn can worry new parents. While some instances are harmless and common, others might indicate a need for medical attention. Understanding the reasons behind newborn bruising helps parents distinguish between typical occurrences and those requiring professional advice.
Common Causes of Newborn Bruising
Many newborns exhibit minor bruising from the birth process itself. The journey through the birth canal subjects the baby’s delicate body to pressure and squeezing, which can lead to bruising on the head, face, and other areas. This is common in larger babies or during prolonged and difficult labors. For instance, a face-first presentation can cause bruising around the eyes or face. Similarly, a feet-first (breech) delivery might result in swelling or bruising on the genitals.
Assisted deliveries, involving tools like forceps or vacuum extractors, can cause temporary marks or bruises. Forceps, curved metal tongs, can leave red marks, abrasions, or bruising on the scalp and face due to applied pressure. These marks typically fade within a few days to weeks. Vacuum extraction, which uses suction, can lead to a soft swelling on the head called a chignon, along with bruising or small cuts on the scalp. These changes usually resolve within days to a couple of weeks.
Beyond birth-related factors, minor bumps or accidental impacts during handling can cause bruising. As babies begin to move more, minor contusions from everyday activities are normal. Variations in newborn skin can also be mistaken for bruises. Mongolian spots (congenital dermal melanocytosis) are common birthmarks, appearing as flat, blue, blue-gray, or even greenish patches on the skin, often on the buttocks or lower back. Caused by pigment cells under the skin, these are not true bruises; they do not change color or cause pain, are harmless, and typically fade by adolescence.
Less Common or Concerning Causes
While most newborn bruising is benign, some instances can signal more serious underlying conditions. Bleeding disorders, which affect the blood’s ability to clot, can manifest as easy or unexplained bruising. Vitamin K deficiency bleeding (VKDB), previously known as hemorrhagic disease of the newborn, is one such condition. Newborns have naturally low levels of vitamin K, essential for blood clotting. If not supplemented at birth, this deficiency can lead to severe bleeding, including noticeable bruising, particularly around the head and face, and potentially internal bleeding.
Hemophilia is another inherited bleeding disorder where specific clotting factors are missing or reduced. While severe bleeding may not always appear immediately at birth, easy bruising can be a symptom, sometimes noticed during routine care like diaper changes or immunizations. Children with hemophilia may develop frequent bruising, even from minor contact. Bruising may also be associated with rare metabolic conditions that affect blood clotting or vessel integrity. Extensive Mongolian spots have been linked to certain metabolic problems, such as lysosomal storage diseases, though this is uncommon. Certain infections can also impact a baby’s clotting ability or vessel health, leading to bruising.
When to Seek Medical Attention
Parents should seek medical attention if they observe certain signs with bruising. Unexplained or excessive bruising, especially without any known trauma, warrants a medical evaluation. Bruising accompanied by symptoms like fever, lethargy, poor feeding, or unusual bleeding from areas such as the nose, gums, or umbilical cord site, should prompt immediate consultation.
Bruising in unusual areas, such as the ears, torso, or genital area, is a concern, particularly in non-mobile infants. Any bruising inconsistent with known minor trauma, or bruises that are unusually large, do not improve within two weeks, or are painful and swollen, should be assessed by a healthcare provider. Consulting a healthcare professional is always advisable if there are any doubts about a newborn’s bruising.
Preventing Bruising in Newborns
While some bruising is unavoidable, particularly during birth, parents can take steps to minimize the risk of accidental bruising in newborns. Gentle handling is essential, as a newborn’s skin is delicate and prone to injury. Supporting the baby’s head and neck, and avoiding rough movements, helps prevent unintended impacts.
Ensuring a safe environment is another preventative measure. This includes using clear cribs free of items that could cause bumps, securing changing tables, and baby-proofing the home by covering sharp furniture edges and securing cabinets as the baby becomes more mobile. Proper car seat usage, with the baby correctly buckled and the seat installed according to manufacturer guidelines, also contributes to safety during travel.
Vitamin K prophylaxis at birth is a significant preventative measure against certain bleeding and bruising. The American Academy of Pediatrics recommends all newborns receive a one-time vitamin K shot within six hours of birth. This prevents Vitamin K deficiency bleeding (VKDB), a serious condition causing severe bruising and internal hemorrhage. The stored vitamin K helps the baby’s blood clot effectively until their gut flora produces sufficient amounts.