Defective or diseased native valves have been replaced by bileaflet mechanical heart valves (BMHVs) for many years. However, severe complications still exist, and thus blood damage that occurs in BMHV flows must be well understood. The aim of this research is to numerically study platelet damage that occurs in BMHV flows. The numerical suspension flow method combines lattice-Boltzmann fluid modeling with the external boundary force method. This method is validated as a general suspension flow solver, and then validated against experimental BMHV flow data. Blood damage is evaluated for a physiologic adult case of BMHV flow and then for BMHVs with pediatric sizing and flow conditions. Simulations reveal intricate, small-scale BMHV flow features, and the presence of turbulence in BMHV flow. The results suggest a shift from previous evaluations of instantaneous flow to the determination of long-term flow recirculation regions when assessing thromboembolic potential. Sharp geometries that may induce these recirculation regions should be avoided in device design. Simulations for predictive assessment of pediatric sized valves show increased platelet damage values for potential pediatric valves. However, damage values do not exceed platelet activation thresholds, and highly damaged platelets are found far from the valve. Thus, the increased damage associated with resized valves is not such that pediatric valve development should be hindered. This method can also be used as a generic tool for future evaluation of novel prosthetic devices or cardiovascular flow problems.