Cyanosis (blue spells)

What is cyanosis (blue spell)?

Cyanosis, or blue spells, is 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.

The colour is caused by high levels of reduced (deoxygenated) hemoglobin in the blood near the surface of the skin. Hemoglobin is the molecule that allows red blood cells to carry oxygen. Oxygenated hemoglobin is bright red, while deoxygenated hemoglobin is bluish.

There are two main categories of cyanosis: central and peripheral. Central cyanosis causes a bluish colour in the lips, tongue, and skin, especially the fingers and toes. Peripheral cyanosis is seen only in the fingers and toes.

Cyanosis caused by congenital heart conditions is often seen soon after birth, but sometimes it does not appear until a baby is older.

Signs and symptoms of cyanosis

If your child is showing the following signs and symptoms they may be experiencing cyanosis.

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

What causes cyanosis?

Cyanosis may mean that the lungs are not oxygenating the blood properly, or that not enough oxygenated blood is getting to the body.

The most common cause of cyanosis is a sudden 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 cyanosis are those with tetralogy of Fallot (a form of congenital heart disease). However, cyanosis 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 cyanosis.

Cyanosis is 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

Causes of central cyanosis

Central cyanosis has many possible causes, including:

• breathing and lung problems
• heart defects that allow oxygen-poor blood from the right side of the heart to mix with oxygen-rich blood in the left side of the heart, so the blood that is pumped out to the body is low in oxygen; these defects are known as right-to-left shunts
• problems with blood flow to and/or from the lungs: this may be due to abnormal connections of the blood vessels between the heart and lungs, or obstruction of the blood vessels
• fluid build-up in the lungs (pulmonary edema) caused by congestive heart failure
• disorders of hemoglobin, which mean the blood cannot carry oxygen properly

Causes of peripheral cyanosis

Peripheral cyanosis can also be caused by:

• cold temperature
• crying in a newborn
• seizures
• shock, among other things

Congenital heart defects that cause cyanosis include transposition of the great arteries, pulmonary atresia, tetralogy of Fallot, tricuspid atresia, hypoplastic left heart syndrome, truncus arteriosus, and interrupted aortic arch.

Helping your child during a cyanotic or blue spell

If your child has a cyanotic or 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.

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.

When you should call the doctor

• If this is your child's first blue spell, tell your child's doctor.
• 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.

Your child may show physical changes when their condition is serious or when their condition gets worse. Parents and caregivers can learn how to spot these signs in order to seek help from a health-care provider.