Harlequin Color Change in Newborns

by Alan Greene, MD, FAAP

I can almost imagine the scene -- the intensity of labor gives way to the quiet exhilaration of those golden first moments of a baby's life. Mom and baby are gazing at each other for the very first time, perhaps the little girl searching for and finding her mother's breast. It is a time of newness and wonder.

And then Mom notices a bold line appearing down the middle of her daughter's face. An icy feeling penetrates Mom's chest. The line continues to spread relentlessly. The baby's body quickly discolors into dark violet and sickly pale portions. Peace is shattered. What's wrong with my baby?!?!?

We've all had moments of clenched fear about our children. It might be the moment of panic when our son has disappeared from sight in a busy store, or when we discover a lump that we fear is cancer. Perhaps we feel it when we helplessly watch our toddler stepping naively in front of a car, or hear the sickening thunk when our daughter's head hits the floor. It might be a slowly building fear -- she's thirsty all the time (diabetes?), or he has frequent headaches (a brain tumor?). Or it might be a less dramatic fear: Is his speech behind? Is she eating well? Smart enough? Strong enough? Too active?

Whatever the source or the degree, these moments of fear shine piercingly to the core of our hearts and illuminate freshly how precious our little ones are to us.

I'm not surprised that a brand new mom would find the harlequin color change frightening -- it is quite dramatic.

Babies' blood vessels start off highly reactive and unstable. A mild change in temperature or position or mood can cause swift changes in the diameters of the blood vessels, with resultant color changes of the overlying skin. The most extraordinary example of this is the harlequin effect.

A sharp line from the forehead to the pubis divides the body into 2 vertical halves. One side turns dark red, the other quite pale. The overall effect is reminiscent of the bold patches of color on a harlequin costume.

This rare but dramatic event only occurs in the immediate newborn period. It usually begins when the baby is positioned on her side. The upper half of the body becomes pale, and the lower half deep red. Changing her position can reverse the pattern. If she moves a lot, the muscle activity will erase the color changes (rather like shaking an Etch-a-sketch toy).

The harlequin color change is most common in low birthweight infants, but can occur in any child. Babies who experience this once will often take on the harlequin pattern multiple times.

Still, the condition is as temporary as being a newborn. You can confidently reassure the mom that the harlequin color change is entirely harmless. It has never been associated with any permanent problem. Mom can relax -- and try to get pictures if possible. These would be great to show on the evening of her daughter's rehearsal dinner for her wedding!

Throughout the journey of parenthood, new fears will arise. Whether the dangers are real or imagined, each fear can spark a heightened awareness of how precious our children are to us. Sometimes the days of their childhood slide by in a taken-for-granted blur. Fears make these moments stand vivid in time, even deepening our love. They can call us back to the golden scene where our dance of love began.

Dr. Alan GreeneDr. Alan Greene, author of Raising Baby Green and Feeding Baby Greene, is the founder of Dr.Greene.com and the WhiteOut Movement. He is a frequent guest on such shows as Good Morning America, The Today Show, and the Dr. Oz Show. He is on the Board of Directors of Healthy Child Healthy World and The Lunchbox Project. Dr. Greene is a practicing pediatrician at Stanford University's Packard Children's Hospital.

Copyright © Greene Ink, Inc., all rights reserved. Permission to republish granted to Pregnancy.org. Reviewed by: Khanh-Van Le-Bucklin M.D. & Liat Simkhay Snyder M.D. October 27, 2010.