When to worry about easy bruising with childhood cancer

Bruising may relate to the illness itself or to treatment effects on blood cells and tissues. A bruise is more concerning when it is unexplained, rapidly enlarging, unusually painful, or accompanied by tiny red-purple spots, nosebleeds, gum bleeding, fever, or unusual paleness.

Children may not remember minor knocks, so ask gently about play, falls, and recent procedures. Photographing a changing bruise with the date can help the clinical team compare it over time.

Call the oncology team about new or changing bruises and follow their instructions about examination or blood testing. Keep the child's medication list ready, including pain relief and supplements. Avoid giving aspirin or anti-inflammatory pain medicines unless the team has approved them.

Use protective play choices and a soft toothbrush if advised. Do not stop cancer treatment or prescribed medicines because of bruising; speak with the team first.

Seek emergency help for bleeding that does not stop with pressure, blood in vomit or stool, severe headache, confusion, a head injury with unusual sleepiness, fainting, chest pain, or difficulty breathing. Contact the oncology team urgently for fever, worsening pallor, or rapidly spreading bruises.

Could treatment or a low platelet count explain this change? Does the child need a blood count today? Which activities and medicines are safe? What number should we call overnight, and which signs mean we should go straight to emergency care?