Paediatric Pearl: Cyanosis is it Temperature or Breathing?

When you see cyanosis, ask one question first:

👉 Is it central or peripheral?

🔵 Central cyanosis (lips, tongue, mucous membranes)

➡️ Always pathological

➡️ Think breathing, heart, or haemoglobin

Common causes:

Respiratory disease (apnoea, bronchiolitis, pneumonia)

Congenital heart disease

Sepsis

Airway obstruction

🧊 Peripheral cyanosis (acrocyanosis) (hands, feet, around mouth with pink lips)

➡️ Usually temperature-related

➡️ Common in newborns, especially when cold or unsettled

➡️ Improves with warming

🚩 Red flags this is NOT just temperature:

Blue lips or tongue

Cyanosis not improving with warmth

Associated apnoea, poor feeding, or lethargy

Desaturation on monitoring

🧠 Pearl to remember:

Cold babies have blue hands. Sick babies have blue mouths.

✅ Bottom line:

If cyanosis involves the central areas, assume respiratory or cardiac until proven otherwise and act fast.

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