Bruises – What Are bruises?

Bruises are areas of skin discoloration and usually follow some injury to the skin or body tissue. Due to the injury, the vessels underlying the skin rupture, and blood extravasates into the tissues outside the blood vessels. The skin is usually intact, though there may be a small abrasion at the point of impact with a bruise that surrounds the abrasion.

Doctor, my son had bruises following a fall yesterday, and they seem to be changing color!

First aid management of bruises

Changing color is part and parcel of the bruising process. Initially, the bruises look red and angry looking, with some swelling. As time passes, bruises turn blue, black, green, and an intervening constellation of colors. The initial swelling is due to the blood and the fluid that the body secretes in response to any injury. The pigment in blood that gives its characteristic red color is hemoglobin. Hemoglobin in tissues undergoes chemical degradation, and the different colors you see are those of the byproducts of this degradation.
So, please don’t get alarmed by the changing colors.

Applying direct pressure over the injured area will decrease the extravasation of blood and prevent a large bruise from forming. This only works if you apply pressure within a few minutes of the injury. Applying pressure later may be counterproductive. You are just causing pain and may add to the internal injury. In any case, start off with the following:

• Elevate the part: The laws of physics are universal. If you elevate the part, any extravasated fluid or blood dissipates back into the body, alleviating the swelling and bruising. Elevation works for bruises in the extremities and if the torso is bruised, ask your child to preferentially lie down on the opposite side, which should serve the same purpose. You need not get overboard on the elevation. Just elevate to the point of comfort.
• Rest the part: rest heals anything and everything. The biggest example of this is sleep. Allow the injured part to focus on healing and do not distract it by making it work. This advice is again to be followed within reasonable limits.
• Ice it! Icing makes the part cold. The normal response of the body to cold is to constrict blood vessels. If the blood vessels constrict, less blood will extravasate into the tissues, limiting the bruising. Icing works in the first 24 hours after the injury.
  Cover ice cubes with a thin cloth, e.g., a handkerchief, and apply directly to the wound for five to 10 minutes at a time and repeat as frequently as your child will allow.
• Take a painkiller: If your child complains of significant pain, you may need to give her either Paracetamol or Ibuprofen. Please text your doctor the child’s weight, and she will guide you regarding the optimum dose.
• Warm the part: After the first 48 hours, hot water fomentation decreases swelling and pain.

Know when to consult your doctor

You should consult your doctor either urgently or later if you see any of the following:

• The bruise is rapidly or significantly increasing in size.
• Your child has developed a bruise with a trivial injury or without any injury.
• Your child has a bruise over vital body parts, e.g., the face, the hands, the genitals, or the torso.
• Your child has significant symptoms like headache, vomiting, convulsions, and bleeding or a discharge from the ear, nose, or throat.
• Your child refuses to move the affected limb selectively. It could indicate an underlying fracture.
• It is always better to take an expert medical opinion whenever unsure.