Why Do Children Turn Blue (Cyanosis)? How Is It Treated?

Why Do Children Turn Blue (Cyanosis)? How Is It Treated?

Cyanosis is a bluish discoloration of the skin, lips and nails caused by a lack of oxygen in the blood. Normally, red blood cells carry oxygen to the tissues, and because the blood is saturated with oxygen, it is bright red. This causes the skin to have a pinkish tone. However, when there is not enough oxygen in circulation, the blood becomes darker and takes on blue-purple tones. As a result, the skin reflects a paler and bluish color. Normal oxygen saturation in arterial blood is above 96%. A drop below 93% is abnormal, and when it falls below 85%, bluish discoloration of the skin begins to appear. Cyanosis is not a disease in itself, but it is a warning sign of an underlying condition.

Many areas are examined when determining cyanosis in the body. The visibility of cyanosis depends on the thinness of the skin and the richness of its blood supply. Therefore, the lips, oral cavity, nose, earlobes, arms and legs, and fingertips and toe tips are the areas that indicate the presence of cyanosis. In dark skin, cyanosis is detected on the lips, gums, nails and around the eyes. Cyanosis can be seen at any age and may result from conditions present from birth or acquired later. There are two main types of cyanosis:

Peripheral (environmental) cyanosis: A bluish discoloration concentrated in the hands, feet and fingertips. Peripheral cyanosis rarely causes life-threatening problems. It occurs as a result of narrowing of the blood vessels, such as with exposure to cold or Raynaud's disease.

Central cyanosis: A generalized bluish discoloration of the body, and is a more serious condition. It generally manifests as bluish discoloration of the lips, oral cavity, tongue, hands and feet. Central cyanosis, which develops due to decreased oxygen saturation, usually develops due to congenital heart disease and lung diseases.

Asymmetric bluish discoloration of the arms and legs is called differential cyanosis and may indicate a serious underlying heart-lung problem. In addition, discoloration caused by drugs, toxins and metal exposure also exists, and this condition is called “Pseudocyanosis.”

What Causes Blue Discoloration in Children?

Blue discoloration in children results from an insufficient level of oxygen in the blood. Less oxygen in the blood causes a darker red color that reflects more blue light. Consequently, the skin tone appears bluish. Central and peripheral cyanosis can occur due to different causes. The causes of central cyanosis can be listed as follows:

Intracranial bleeding

Lung-related causes such as pulmonary embolism (lung clot), pneumonia, asthma, COPD, pulmonary hypertension, bronchiolitis

Heart failure, heart valve diseases, congenital heart diseases

Hypothermia

High altitude

Obstructive sleep apnea

Polycythemia (increase in red blood cells)

Conditions affecting the nervous system, such as excessive heroin intake

Hemoglobinopathy (Abnormal hemoglobin production and structure)

The causes of central cyanosis can also lead to peripheral cyanosis. Cyanosis affecting peripheral circulation may be due to the following causes:

Heart failure, decreased blood volume due to shock

Raynaud's phenomenon

Arterial blockage due to atherosclerosis, Buerger's disease

Venous blockages such as deep vein thrombosis

Hyperviscosity (thick blood)

Causes originating from the heart and lungs, and abnormalities in hemoglobin production and structure, generally lead to central cyanosis. In children with cyanosis, sweating on the forehead and a weak pulse may be particularly indicative of congestive heart failure.

How Is Blue Discoloration in Children Diagnosed?

Cyanosis in children is diagnosed through a detailed history and physical examination. The detailed history includes exposure to cold, exposure to toxic substances, chronic diseases, trauma, surgical procedures and symptoms of cyanosis. If blue discoloration in children has been present since birth, the cause of cyanosis is congenital. In diagnosing cyanosis in children, the distribution and degree of discoloration are important. During physical examination, the entire body, arms and legs are carefully checked. The cheeks, nose, ears and mouth are the main areas for assessing cyanosis. The skin is thinner in these areas and blood flow is easier to examine. Examination under inadequate light, as well as factors such as skin thickness and skin color, may affect diagnostic results. In addition to cyanosis, fever may be a sign of diseases such as pneumonia, septic shock and croup.

In central cyanosis, color changes are seen especially on the lips, tongue, oral cavity, hands and feet. In patients with central cyanosis over a long period, clubbing of the fingers develops. Since the most common causes of central cyanosis are congenital heart disorders and polycythemia, diagnosing cyanosis is important. In addition, respiratory symptoms are generally associated with central cyanosis. Examining peripheral circulation is also important in determining the distribution of discoloration. In children, peripheral cyanosis is usually caused by exposure to cold and acrocyanosis. Patients whose blood gas values are normal but whose circulation is impaired may develop cyanosis.

In addition to diagnosing cyanosis, your doctor may order various tests. Devices and tests such as chest X-ray, electrocardiography, echocardiography, hyperoxia test and pulse oximeter may be used to evaluate blood gases and diagnose underlying diseases.

What Are the Symptoms of Blue Discoloration in Children?

Blue discoloration in children causes blue-purple color changes in various parts of the body. The discoloration can also affect the tongue, gums, nails and ears. More intense discoloration may be seen especially on the lips, nails and around the eyes. Other symptoms that may be encountered depending on the type of cyanosis may include:

Extreme fatigue

Tingling or numbness in the arms and legs

Drop in body temperature

Cough and wheezing

Difficulty breathing

Dizziness

Weakness

In individuals with dark skin, cyanosis may appear white or grayish. Discoloration may be detected especially in areas where the skin is thin.

What Are the Treatment Methods?

Treatment of cyanosis is determined according to the underlying cause. Factors such as diseases, environmental conditions and exposures determine the treatment plan. One of the primary treatments for cyanosis is oxygen therapy. Other treatment options can be grouped as follows:

Warming and massage: Gently warming and massaging areas affected by exposure to cold, such as in Raynaud's phenomenon.

Breathing devices: If the cause of cyanosis is lung diseases such as asthma or COPD, breathing devices are used in treatment.

Antibiotic therapy: Antibiotic treatment is applied in the treatment of infectious diseases that can cause cyanosis, such as pneumonia.

Other medications: Various drug groups used in the treatment of heart and lung diseases.

Correction of metabolic abnormalities: Correcting abnormalities such as hypoglycemia (low blood sugar) and hypocalcemia (low calcium) and nutritional problems prevents the development of some diseases that may cause cyanosis.

Surgery: Surgical intervention is required to correct congenital heart diseases such as tetralogy of Fallot and tricuspid atresia.

In addition to treatments, drug groups that narrow blood vessels and thereby impair blood flow and tissue oxygenation may be discontinued upon a doctor's recommendation. Also, some habits that have a vasoconstricting effect may need to be stopped. Intake of caffeinated foods such as coffee and tea may be limited. Environmental changes may be made to prevent exposure to various chemical and foreign substances. Depending on the severity of the condition, a respirator or ventilator may be needed.

Frequently Asked Questions:

Cyanosis, which is common in babies and children, can occur in different ways. Although cyanosis is seen as a normal condition in some cases, it may cause serious dangers in others. You can read the rest of the article to learn the answers to questions about cyanosis seen in children. Cyanosis may appear with breath-holding that starts when children cry. A cyanotic spell can often be a result of a reaction to fear or pain. Bluish discoloration, especially around the lips, may be seen as a result of vigorous crying. Cyanotic symptoms can also be seen when children hold their breath. In newborn babies, cyanosis of the lip corners and palms may be seen while crying. This is usually normal and temporary. However, cyanosis seen in different parts of the body may indicate different disorders. Cyanosis is caused by various factors, but its main cause is insufficient oxygen transport in the blood. Cyanosis affecting the circulatory system and other organs can be dangerous in some cases. Especially in children, cyanosis present from birth may be attributed to heart and lung diseases, and the cause of the problem needs to be investigated. Therefore, pediatric cardiology and chest diseases are the departments to consult for cyanosis in children. Cyanosis in children may be temporary or permanent. In addition, the prevalence of cyanosis, the areas where it occurs, and whether it is permanent provide important clues about it. Especially in young children, cyanosis caused by normal conditions such as crying spells and breath-holding spells is temporary and generally not considered dangerous. However, prolonged cyanosis of areas such as the lips, oral cavity, hands and toes may be a sign of some diseases. Central and peripheral circulation problems can cause cyanosis and may arise from other diseases. Blue discoloration seen on the lips, inside the mouth and on the tongue in children generally indicates central cyanosis. There may be different underlying causes of central cyanosis, and diagnosis of these causes is necessary. Central cyanosis generally arises from heart and lung disorders and can lead to serious consequences. Bluish discoloration of the lip corners, palms and soles in newborns is generally common and a normal condition. However, if there is cyanosis on the baby's head, trunk, arms or legs, seek medical help immediately. The presence of severe cyanosis is an indicator that the body is deprived of oxygen, and oxygen support may be needed. Cyanosis can occur when children are cold, crying, or holding their breath during breath-holding spells. These episodes are temporary and resolve on their own. However, congenital and persistent cyanosis is a sign of an underlying problem and always requires medical treatment. In addition to non-persistent cyanosis, consult your doctor if various symptoms are present. Since cyanosis can be serious and complicated in some cases, it may arise from many different conditions. In addition to bluish skin color in children:

Difficulty breathing and shortness of breath

Rapid breathing

Chest retraction when breathing

Sleep problems

Irritability

If feeding problems are seen, be sure to contact the relevant health institution.

In the diagnosis and treatment of cyanosis, the reliability of the physician and hospital, the medications given to patients, and the tests and analyses performed are of critical importance. In addition to the presence of a Pediatric Cardiology department and specialist physicians in the field at our hospital, the necessary materials and devices for diagnosis and treatment are available.