Why Do Babies Look Blue When They Are Born?

Most parents-to-be dream about what their baby will look like, and picture a tiny, sweet-cheeked little bundle.

If you’ve never seen a newborn baby, it can be a surprise to find out a baby can look very different from what you imagined.

Babies are born in all different shapes and sizes. Although most babies are born a reddish-purple color, some are born blue.

This blue colour can be frightening, and sometimes it is a cause for concern to new parents.

Why do babies look blue when they are born?

Your baby’s skin colour at birth depends on a number of factors. Most babies are born with a dark purple-red colour but, depending on how fair or dark your child’s skin is, this colour might be more or less obvious.

Until she takes a breath on her own, your baby receives oxygen via the umbilical cord and placenta. As she begins to breathe, her skin color will change; midwives often refer to this as ‘pinking up’. The color will lighten to something closer to dark pink or red.

It’s not unusual for your baby’s hands and feet to remain a bluish color for several days after birth. This is because her circulation system is still quite immature and it will eventually be resolved.

A blue color in other parts of the body is not normal, however, and should be looked at.

What causes a baby to be born blue?

There are two different reasons why babies can be born blue:

1. Cyanosis. This is considered a genuine ‘blue baby’ situation and is a serious condition. Usually, it is caused by a congenital heart defect. A baby born blue in appearance and not crying or moving is considered to be in respiratory or cardiac distress. The heart is not pumping blood efficiently and there is not enough available oxygen. The blue color is due to the deoxygenated blood, which appears much darker in color than oxygenated blood.
2. Acrocyanosis. This is usually when a baby is born with blue hands and feet, while the rest of the body – particularly the chest and torso – assume a pink color. It is rarely a concern, especially if the umbilical cord is left intact until it stops pulsating, as blood and oxygen are still being pumped to the baby while breathing is established.

What is the most common cause of a blue baby?

Sometimes, babies are quite purple in appearance when they are born. This is due to minor oxygen deprivation in the last moments of birth, caused by cord compression or an odd position during crowning. Their color will change to pink when the red blood cells are once again carrying enough oxygen.

If the mother has any health conditions, such as high or low blood pressure, this can have an impact on how well her baby copes during labor and the baby’s condition at birth.

If you are in this situation, your care provider will monitor your condition and check on the baby to ensure there is no distress or any health consequences due to lack of oxygen.

If you have pain relief medication that contains narcotics or opioids, they can cause your baby’s heart rate to drop during labor, as well as depress respiration after birth. This can lead to a blue appearance on your baby’s skin.

What happens if my baby is born blue?

At birth, your baby’s entire body might appear blue and that could just be physiological, depending on how much oxygen deprivation the baby has experienced while going through the birth canal.

Some babies are born blue due to an oxygen-poor blood flow at the moment of birth. This makes the baby’s skin appear blue but it quickly turns pink as soon as the pressure of going through the birth canal is removed and the blood becomes oxygen-rich again.

However, a blue skin color might be a sign of more severe health conditions.

Blue baby syndrome

Blue baby syndrome stands for a condition called infant methemoglobinemia where the baby’s skin has a bluish discoloration due to the blood’s failure to transport enough oxygen.

If your baby is born with a blue tint and is floppy, barely moving or not moving at all, and doesn’t cry or has a very weak cry (a low Apgar score), these are all signs she is struggling.

You will notice a sudden flurry of action as your care provider assesses your baby and begins management to encourage breathing. This might include rubbing the baby’s body vigorously, blowing on her face to stimulate breathing, and adjusting her position to drain any mucus from the airways. The aim of these actions is to provide oxygen to your baby’s cells.

At birth your baby mainly receives oxygen through the blood running through the umbilical cord.

Despite the latest research, in many hospitals, when a baby’s skin turns blue at birth, immediate cord clamping is the norm. This is done so the baby can be taken to the resuscitation table, which is usually fixed to the wall. If your hospital has a portable resuscitation unit, it can be brought to you. If you have birthed at home, your midwife will have a resuscitation kit close by.

If rubbing your baby doesn’t resolve her breathing, color and movement, then your care provider will begin artificial ventilation, using a mask and bag to get oxygen flowing into your baby’s lungs. Again, depending on your birth setting, this might happen next to you or in a different part of the birth room.

The ideal situation for your baby at this stage is to maintain skin to skin contact with her, with the cord intact and with both of you covered to keep warm. Unfortunately, this is not always possible.

If your care provider can delay clamping the cord for as long as possible, this will allow your baby to remain oxygenated while maintaining a rapid heartbeat. If this isn’t possible, make sure your partner or support person goes with the baby and keeps you informed about what is happening.

Some heart defects can also cause a bluish color in the baby’s skin. If the blue color doesn’t resolve completely with the first medical actions, your baby will be admitted to the neonatal unit. The neonatal team will take a thorough medical history, perform a physical exam, and do blood tests to check nitrate levels and other important parameters, so as to determine how best to help your baby’s transition into the newborn period.

Infant methemoglobinemia

Infant methemoglobinemia can also occur later in life. It can happen when a child is exposed to certain chemicals, drugs or nutrients. Drinking water that contains nitrates or consuming nitrate-rich foods can aggravate this condition, especially if there’s a predisposition caused by genetic enzyme deficiencies.

If your baby’s skin turns blue at any time, call emergency services. Most children will have a satisfactory outcome if prompt action is taken.

Babies born blue: long-term effects

Babies who are born with a blue discoloration and receive treatment immediately have a reduced risk of developing any severe outcomes of oxygen deprivation. They might require observation for several hours, or even days, after birth, and will have check ups as they grow and develop.

Prompt action will be of invaluable benefit for your baby’s future.

If the situation isn’t immediately recognized and treated, there can be severe outcomes for the baby, including cerebral palsy, behavioural disorders, seizures, intellectual and cognitive disabilities and, in some cases, death can occur because of severe brain injury due to lack of oxygen.

It’s important to know babies can be born in all different shapes, sizes, and even colors. Some babies appear covered in blood and vernix, others have dark purple or even bluish skin. It is usually not a concern if your baby has blue hands and feet but your care provider will assess her condition and help you to ensure her circulation improves and she ‘pinks up’ nicely.

Why do babies’ hands and feet turn blue?

A baby’s hands and feet might be blue at times and this doesn’t mean the baby has a health condition.

So many things are going on inside the baby’s little body that most of the baby’s blood flows quite centrally, to make sure her brain and organs are well oxygenated. Obviously, most baby’s organs need more oxygen to function than the hands and feet require to keep functioning. During the newborn period, the hands and feet are not so necessary; therefore the blood flow to them is slightly reduced to favour a more central blood circulation.

Cold and, sometimes, blue hands and feet are very common and normal in newborns. As long as the rest of the body is warm and pink, blue hands and feet are not a problem.

Do not overdress your baby to try to warm up her hands and feet. You can put some socks on her feet but leave her hands uncovered; being able to take her hands to her mouth is very beneficial for your little one.

If you’re worried about your baby’s temperature, check the back of her neck. If it feels nice and warm, your baby’s temperature is completely fine, despite her cold feet or hands.