Injuries manifest themselves in different ways, and some individuals (with or without hemophilia) are more likely to sustain bleeding injuries more than others. Bleeding episodes can be classified by the severity of the bleed, as well as where the bleed occurs. Sometimes, as with cuts, the blood is visible. Many times, the bleeding is internal. Usually, internal bleeds cause the most concern, especially head bleeds.
With young children, it can be difficult to know when your child is having a bleed. He or she cannot tell you if it hurts, where it hurts, or how badly it hurts. The more parents can learn about their child’s bleeding disorder, the better prepared a family will be able to cope with the everyday experiences they face. The types of bleeds your child experiences will change as he or she grows and becomes more active. For babies and toddlers, the most common bleeding sites are the head and the mouth.
Regardless of life stage, bleeds can happen in any area of the body including joints, muscles, the abdomen or the head. Sometimes you may notice an incident that may cause a bleed, such as falling and a head bump. Factor should be infused as soon as possible after a head bump/injury and the incident should be evaluated by a healthcare professional as soon as possible after it occurs. In these cases, for younger children that may not be able to express their feelings verbally, look for signs that a bleed is occurring:
- Pain when using the affected body part
- Noticeable bruising
- Swelling might be present
- Unexplained irritability
- When old enough to speak, he or she may be able to start describing various ways bleeds feel
Types of Bleeds
Head bleeds can happen on the inside or the outside of the skull and should always be considered serious bleeds. Head bleeds can occur spontaneously or as the result of an injury. Symptoms can progress slowly and may not be noticed for days after an injury. Prompt treatment is required as soon as possible after the injury occurs. A head bleed should be considered an emergency and your hematologist should be notified.
Early signs and symptoms of a head bleed:
- Nausea and vomiting
- Sensitivity to bright light
- Acting confused
- Being inconsolable
Later signs and symptoms of a head bleed:
- Inability to balance
- Dilated or unequal pupils
- Persistent headache
For babies, teething can cause some discomfort and gums may appear swollen or discolored. Do not apply over-the-counter medications to the baby’s gums without first discussing this with your pediatrician and hematologist. If bleeding occurs, speak with your hematologist. A damp, soft baby washcloth kept in a clean plastic bag in the refrigerator or freezer can be helpful. Always remove the clean cold baby washcloth from the plastic bag before gently applying it to the gums. Do not rub the gums if there is bleeding or a clot. To avoid the possibility of choking, never leave the baby alone with the washcloth.
1. National Heart, Lung and Blood Institute. What is hemophilia? https://www.nhlbi.nih.gov/health/health-topics/topics/hemophilia. Accessed Aug. 4, 2017.
2. White E, Christie B. "Common bleeding episodes." Nurses' Guide to Bleeding Disorders. National Hemophilia Foundation. 2013.
3. Banks D. "Introduction to Bleeding Disorders." Nurses' Guide to Bleeding Disorders. National Hemophilia Foundation. 2012.
4. Riske B. "Wellness in persons with bleeding disorders." Nurses' Guide to Bleeding Disorders. National Hemophilia Foundation. 2013.