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Are Your Child’s Lips Blue? Here’s When to Head to the ER

When a child's blue lips are the sign of something serious
Image: kali9/Getty Images

Let’s be honest: The second we’re in charge of a kid’s well-being, a lot of us start developing an unhealthy relationship with WebMD. It’s totally normal (this parenting gig is pretty tough, after all), and most of the time a simple Google search helps soothe our worries. But when a kid’s lips start turning blue out of nowhere, well, that’s when panic starts to set in.

But hold on.

There’s good news and bad news here. The good news is that often, blue lips in children are an innocent side effect of something completely normal. Other times, a child with blue lips may need to see a doctor right away. Here’s what the experts say.

Normal blue lips in children: When not to worry

We’ll start out with the good news first. There are plenty of times when you as a caregiver can work yourself into a tizzy over nothing (no thanks to hours spent consulting Dr. Google, often in the middle of the night), and blue lips might be one of those times.

Before you panic and assume the worst, Dr. Janet Prystowsky, board-certified dermatologist in Manhattan, says, “A child’s lips may be blue for a few reasons. Since these reasons range from incredibly mild to incredibly severe, it’s important to rule out the most likely and least harmful causes first.”

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Prystowsky recommends asking yourself two important questions before you head to the ER:

  1. Did your child recently eat something blue? If your little boy or girl just had a bowl of blueberries, blackberries or blue-colored candy, then their lips are probably just stained from the blue coloring. Blotting their lips with a warm, wet cloth should get rid of most of the color. But don’t try to rub or scrub their lips, which could irritate them.
  2. Is it cold outside? (And is your child wet?) If your child’s body temperature drops to 95 degrees F or 35 degrees C (normal is 98.6 degrees F or 37 degrees C), then their lips will turn blue. Swimming in an unheated pool, lake or ocean will cause a relatively rapid transfer of heat from their body to the cold water. Playing outside in snow will also cause blue lips if your child is outside too long. As your child’s core body temperature drops, their body will try to preserve its heat by reducing blood circulation to the skin and lips. This saves circulation for internal organs, like the heart, brain and others. If your child’s lips are blue, get them out of the water or cold weather and rapidly warm them.

However, even when it’s cold outside, there are still times when “normal” blue lips may be a cause for concern. Prystowsky says, “In the case of cold weather, be on the lookout for frostbite, which would mean your child’s skin has frozen. If your child’s skin feels numb after rewarming, then it’s likely that they have frostbite. If frostbite has occurred, seek immediate medical advice. If your child’s core temperature has dropped towards 82.4 degrees F or 28 degrees C, then you must immediately remove them from the cold environment and seek medical help. Such a cold body temperature can cause a fatal arrhythmia of the heart when rewarming.”

Abnormal blue lips in children: When to worry

As Dr. Danelle Fisher, chair of pediatrics at Providence Saint John’s Health Center in Santa Monica, California, explains that blue lips can occasionally be a sign of a bigger problem — but that tends to be rare. Still, if you see blue lips in your child without a known trigger (like a cold day), Fisher advises, “The first thing to evaluate is how the child is breathing.”

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Fisher recommends asking yourself a few questions to determine the level of emergency:

  1. Is he/she coughing or feeding when this occurs?
  2. Is there any seizure activity?
  3. Does the child have a fever?

“Blue lips are a sign of cyanosis, which is caused by a lack of oxygen in the blood or a lack of blood circulation. Blue lips could occur when a child has heart disease, pneumonia, asthma or a list of rarer causes,” says Fisher. “In a happy, playful and healthy child who just ate or drank food or liquid with a bluish or purplish color, that is not a concern. If there are other symptoms occurring, particularly respiratory symptoms, neurologic symptoms or extreme lethargy, the child should be brought to medical attention immediately.”

Now, here’s the answer all worried parents have been waiting for. According to Fisher, it’s critical to call 911 immediately for any child with blue lips who is unresponsive, not breathing well or struggling to breathe. Parents should also call 911 for a child who is having seizure activity and resultant blueness of the lips. And, Fisher says, “Call your physician for any child with blue lips who is very stable and breathing comfortably for an emergent evaluation.”

Seeing a child with blue lips is probably going to make your heart skip a beat, but understanding the possible causes of the condition can help you to evaluate your child more carefully. If there’s a direct reason for the blue lips, like a recent chilly swim, then get the kid warm, but don’t worry. But if your child is having difficulty breathing or, even worse, is unresponsive, seek medical attention right away.

Originally published May 2008. Updated September 2017.

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