Petechiae in Babies: Causes, Symptoms, and Treatment

Petechiae in babies are always a sign of alarm, as they can be the sign of a serious illness. Fortunately, in most cases, their causes are trivial.
Petechiae in Babies: Causes, Symptoms, and Treatment

Last update: 04 October, 2021

Petechiae in babies are fairly common skin rashes, but theyre one of the big red flags for parents and pediatricians. Do you want to know what they are? Then we’ll tell you everything you need to know.

What are petechiae?

Petechiae are tiny, very red lesions on the skin and mucosa. They look like small red dots that are less than 2 millimeters in diameter, which don’t disappear when you place pressure on them.

They result from the rupture of the small vessels of the skin and their consequent hemorrhage in the cutaneous dermis. However, they don’t cause bleeding to the outside.

Why do petechiae appear in babies?

As we mentioned earlier, petechiae are the sign of a lesion in the vessels of the dermis, called capillaries. These can break for multiple causes, but it’s important to determine what generates them, as in some contexts, they’re usually a warning sign of potentially serious diseases.

Regardless of the apparent reason, a baby with a fever and petechiae requires urgent evaluation.

In general, the diseases associated with petechiae vary according to the age of the child. Below, for practical purposes, we’ll list the most frequent causes according to the type of illness:

  • Viral infections: Parvovirus B19, Dengue, Enterovirus
  • Bacterial infections: Meningococcal infection, scarlet fever, infective endocarditis, Rocky Mountain spotted fever
  • Congenital: Perinatal infections (toxoplasmosis, Rubella, Cytomegalovirus, and HIV)
  • Yeast infections
  • Traumatic: Injuries of an external cause, such as bumps, scrapes, or sustained efforts, such as a coughing attack
  • Oncohematologic: Idiopathic thrombocytopenic purpura (ITP), Fanconi anemia, leukemia, thrombocytopenia-absent radius (TAR) syndrome, hemolytic uremic syndrome (HUS), and neonatal alloimmune thrombocytopenia (NAIT)
  • Inflammatory and autoimmune: Henoch-Schonlein purpura (HSP) and systemic lupus erythematosus (SLE)
  • Snake, spider, or other insect bites.

The main causes are hematological pathologies. However, invasive meningococcal disease is the most feared cause that must always be ruled out.

A doctor examining a child covered in red spots.

How are babies with petechiae evaluated?

When petechiae are found in the baby, a thorough physical examination and a complete history are necessary in order to arrive at the correct diagnosis.

It’s also important to consider the chronology of the case. In other words, the moment of appearance and how its evolution occurred until the moment of the consultation: If the lesions increased, if other symptoms were added, among other issues.

So, that being said, there are some signs and symptoms that can accompany petechiae and that represent red flags. Among them, the following stand out:

  • Fever
  • Increased blood pressure
  • Palpitations or tachycardia
  • Poor general condition or lethargy
  • Paleness, dark circles under the eyes, or bruises on different parts of the body
  • Bleeding in the skin or mucosa (gums, nose, or intestine)
  • The rapid spread of petechiae
  • Weightloss
  • Swelling of the lymph nodes

In the case of the appearance of one or more of these signs, you need to make an urgent medical consultation.

It’s important to note that petechiae usually appear on the chest, face, arms, back, abdomen, buttocks, and feet. In addition, they’re lesions that don’t itch or hurt. This helps differentiate them from common allergies or stinging rashes.

Treatment options for petechiae in babies

The treatment to be implemented is related to the cause that produces these lesions and the general condition of the child.

  • In the case of petechiae associated with trauma (blows, great efforts, or scrapes), the most appropriate behavior is to observe the evolution. In a typical scenario, petechiae resolve on their own within a few days.
  • When it comes to severe infections such as bacterial infections, treatment requires the early initiation of intravenous antibiotics. For this reason, babies usually stay in the hospital for at least 48 hours, to monitor their progress. If, after this period, the condition doesn’t worsen and the laboratory studies are normal, the medical discharge is granted.

Differential diagnoses of petechiae

A young girl with red spots on her back and shoulders.

It’s important to know that petechiae are just one of the possible manifestations of skin bleeding. Other forms of skin bleeding include the following:

  • Bruising
  • Purples
  • Ecchymosis

Therefore, the physician must differentiate between these types of bleeding and other similar-appearing lesions, which aren’t caused by lesions of the dermal vessels. Therefore, knowing the child’s vaccination status is a very important piece of information.

Petechiae in the baby and medical consultation

In conclusion, petechiae in the baby should be an alarm to consult a pediatrician, as there’s the possibility that they represent something serious.

Although they ultimately don’t require intervention to resolve, determining the cause of petechiae in young children is essential.

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