Menu Search Donate
Child Health Guideline Identifier


This document is only valid for the day on which it is accessed. Please read our disclaimer.


This bleeding questionnaire is a tool designed to ensure a comprehensive bleeding history has been obtained and to help decide which patients should be considered for investigation of a bleeding tendency. 

The most common bleeding condition in children is trauma, and after that immune thrombocytopenia. The commonest inherited bleeding disorder is von Willebrand disease which is symptomatic in approximately 1:1000 people.

The questionnaire has been validated for von Willebrand disease but is likely to be applicable to a wider range of platelet function disorders. A negative score is 2 or less and in most circumstances this would preclude investigation or referral of the child to a haematologist.

If there are further questions about the questionnaire please discuss with the on call paediatric haematologist.

Bleeding Questionnaire

View a PDF copy of the Bleeding Questionnaire and Scoring Sheet by clicking on the image below:

Bleeding Questionnaire image

Did you find this information helpful?

Document Control

  • Date last published: 27 January 2017
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Haematology/Oncology
  • Author(s): Peter Bradbeer
  • Editor: Greg Williams
  • Review frequency: 2 years
  • Keywords: von Willebrand disease, platelet function disorders

More From Starship