Investigating easy bruising in a child.

life and more often associated with injury or severe illness) or of gingival or mucocutaneous bleeding (suggesting a platelet abnormality or severe Von Willebrand disease) • A history of prolonged bleeding after surgery such as circumcision or tooth extraction • Any pain or joint swelling or reluctance to move a limb (as seen with haemarthroses) • The age of onset of bruising, since bruising is uncommon in infants before they crawl • Unusual bleeding or bruising out of proportion to the injury sustained; this should always be investigated and an open view kept • Family history of haemophilia, Von Willebrand disease, or platelet function defects (in 30% of cases, haemophilia may arise secondary to new genetic mutations and, as a result, there will be no family history) • Drug history, remembering that children may have taken medicines (such as warfarin) accidentally. In the case presented, the child was born by atraumatic spontaneous vaginal delivery with no noted bruising or bleeding. Intramuscular vitamin K was given without complication, and he had no bruising or bleeding with his vaccinations. He had not had any surgery or previous abnormal haemorrhagic symptoms. His parents had noticed the bruising two weeks before the consultation, which coincided with the start of crawling at home; the child was not obviously reluctant to move any particular limb. There was no history of consanguinity in this family. None of the child’s siblings, cousins, or parents had any spontaneous bleeding, although the children had not undergone any dental or surgical challenges.