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Children's Health

Blue spell

02/16/2009

Question:

I noted my 7 months old daughter`s lips became blue when she cried strongly. It already happened 3 times within last 2 days. She is otherwise well. One week before the first incidence, she had fever with cough and running nose. I gave her sy pcm, and promethazine but only for 2 days which then she was ok.

I myself having cough and took dyphenhydramine. For your info, she is still breastfeed.

What is the reason of her having this blue lips? Is that any relation with the medication that i gave her or that i took myself?

Answer:

Thank you for your question. I don't know at what sy pcm is. However, carbocysteine is considered a safe drug for nursing mothers and babies to break up mucus. Promethazine is considered poorly safe for both lactating mothers and babies when it is used repeatedly since it can make the baby very sleepy and impair feeding. However, a single dose of promthazine is considered safe. In contrast, promethazine (Benadryl) is considered moderately safe. Cetirizine (Zyrtec) and loratidine (Claritin) are both safer alternatives to promethazine and diphenhydramine.

It is important to sort out whether her lips really were blue or whether the areas around her lips were blue. There is a significant difference between true central cyanosis and circumoral (around the mouth) cyanosis. Circumoral cyanosis occurs fairly commonly in small children with vigorous crying, while true central cyanosis with blue lips may signal a significant problem with the baby's heart, lungs and breathing, severe infection infection, or a possible seizure.

If the blueness of the lips happens again, look at the bay's tongue, lips, and nailbeds. If these are indeed truly blue, take the baby to a doctor immediately.

If your baby is NOT growing and developing normally, has had a heart murmur diagnosed, tires easily in comparison to age mates, or is weak and sleepy after such an episode, there is cause for concern regarding a significant underlying problem. If that is not the case, then it is unlikely that there is an important underlying condition causing the problem.

Please be sure to discuss this with your baby's doctor and to develop a plan to follow with the doctor if you see the blueness again. I hope this is helpful information.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University