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Blue Spells (Cyanosis) and Children with Heart Conditions

What are blue spells?

Blue spells, which are also called "cyanotic spells", are short periods when a reduced amount of blood flows into the lungs. Since blood carries oxygen, less oxygen is delivered to the body. As a result, a child may appear blue or bluish. Most spells last less than a minute.

During a blue spell your child may

  • Suddenly feel uncomfortable or be cranky or less alert
  • Begin to breathe faster and deeper
  • Turn blue, especially around the mouth and face
  • Faint or feel faint

Blue spells are caused by reduced blood flow to the lungs

The most common cause of blue spells is contraction or narrowing of the path between the heart and the lungs. This narrowing lowers the amount of blood going to the lungs. The children most often affected by blue spells are those with Tetralogy of Fallot (a form of congenital heart disease). However, blue spells may also occur in children with other forms of heart disease in which blood flow to the lungs is reduced.

Some children may appear blue after getting cold or having a bath; this is not a blue spell.

Blue spells are most common

  • when a baby cries strongly
  • soon after waking
  • soon after a feeding
  • soon after a bowel movement
  • if a baby is dehydrated and needs liquids

Helping your child during a blue spell

If your child has a blue spell, do not panic. To help your child, follow these steps:

For babies

  • Place your baby on their back.
  • Bring the baby's knees up to touch the chest and hold them firmly in place. You can also do this while holding your baby.
  • Comfort and settle your baby by holding and rocking, giving a soother, and gentle cuddling.
  • Remain calm. Your baby can sense when you are upset, which will make it harder to settle the baby.
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For older children

Place your child on their side, bringing the knees up to the chest and hold them firmly in place. Some children will automatically squat during a blue spell. This is their way of bringing their knees to the chest on their own. Make sure you can see your child's face so you can watch for colour changes and check the degree of alertness and length of the spell.

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When you should call the doctor

  • If this is your child's first blue spell, tell your child's cardiologist (heart specialist).
  • If the frequency of your child's blue spells increases, tell your child's cardiologist.
  • If the blue spell lasts longer than one minute, take your child to the nearest emergency department.

If the blue spell lasts longer than one minute and there is also a change in your child's level of alertness or if your child faints, call 911.

Key points

  • During a blue spell, your child may suddenly feel uncomfortable; be cranky or less alert; breathe faster and deeper; turn blue, especially around the mouth and face; faint; or feel faint.
  • If your child has a blue spell, stay calm.
  • If your child is a baby, place them on their back and bring their knees up to touch their chest. Comfort and soothe them.
  • If your child is older, place them on their side and bring their knees up to their chest.
  • If the blue spell is long and your child is less alert, or if your child faints, call 911.

Jennifer Russell, MD, FRCPC

Cindy Wasyliw, RN,MN

Laurie Cender, RN, MSN,

Clinical Nurse Specialist

Mary Spencer, RN, MSN,

Clinical Nurse Specialist

Norma Becker, RN, BN, Nurse Clinician

Mandy Johnson, RN, Nurse Clinician

Bindy Sweett, CCLS, Child Life Specialist

2/11/2014




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