A 6-week-old boy with a history of gastroesophageal reflux presents to the emergency department with bruising and bleeding. He was born full term via normal spontaneous vaginal delivery without complications. His parents had refused vitamin K administration. Since birth, he had been exclusively breastfeeding and growing well, without a recent change in mental status or seizure. Three days ago, the child received craniosacral massage therapy for reflux. The following day, the parents noticed a bruise on his left axilla, bumps with a purplish discoloration on the back of his head, and a few dry facial patches that bled for a day after scratching. There is no history of previous bleeding or family history of bleeding disorders.
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