Mottling and Cynosis

[mshanson]

I know that periperal cyanosis of the extremities can persist past the newborn stage, however, how long past is normal? My daughter is 13.5 months old, however she still often looks mottled in her legs and arms, and her hands and feet still turn dark blue, on a daily basis, several times a day. Is this still normal at her age?

[Jeffrey R Boris, M.D.]

Dear MSHanson,

The peripheral mottling that can be seen in infants and toddlers typically resolves sometime between age 1 and 2, usually.  Having responded to your questions before, I know that your daughter's heart overall seems to be doing well, so this is likely not related and is a typical "baby thing".  As long as she isn't turning blue inside her mouth (i.e. gums or tongue), she should most likely be fine (of course, without seeing her, I can't say for sure).

[protea]

Hey there
Sorry to hear she is still having those issues.I really hope you get some answers.Chat soon.

[mshanson]

At least, I should say heart is ruled out, I would think it is, but hopefully one of the cardiologists will chime in.

[mshanson]

Thanks, heart is ruled out. She was already born with two heart defects, that we know are not the cause of this. And I can't see it being lung/pulmonary since her pulse ox sats have always been 98%+, except for a few times when she was in CHF that they'd dip down to 90-94%. Her only issues now thankfully are a very mild VSD and some very mild TV regurg.

I've wondered about endocrine issues since auto-immune issues run in the family (I have Raynauds, but like you said, she's not having the color changes, my mother has systemic lupus, and her grandfather has severe rheumatoid arthritis).

This cyanosis started when she was about 4 months old and isn't getting any better. Doesn't matter if she's warm or cold, it happens. Today her arms and legs were mottled, but feet/hands dark, and it was 78 deg inside the house.

[heartmama]

My daughter had this same description. She would turn blue when the house was below 68 degrees.  Her GP said it was Raynaud's Syndrome, however b/c there is no pain or whiteness in the extremities we ruled this out, another cause is acrocyanosis - a benign condition.  It turned out my daughter has progressive infantile scoliosis (a curvature of the spine) and as we began treatment for her spine her blue hands and feet improved.  Because my son was born with CHD's we of course had an echo done and that only showed minor mitral valve regurgitation, which would not account for her blueness.  She is now 4 and has improved greatly, she still has boughts of it but we know it is harmless.  

I would first get a referral to a pediatric cardiologist and make sure it is not heart related.  Also don't forget to rule out lung/pulmonary issues like asthma.  A referal to an endrocrine specialist might be helpful but so far from what I've read they haven't been able to help so we turned down the referral that was offered us.  If you google this you will see there are A LOT of parents experiencing this same thing, and unfortuantly most of them are not getting any answers from the professionals, there is a huge discussion on Yahoo about this.  I think the most important place to start is with the heart.

Good luck with your little one, remember persistance pays off!

(Disclaimer:  I am not an M.D, just a parent with 2 medically interesting kids)