Mottling in Newborns: Causes, Warning Signs, and When to Worry
Taking care of the little one can be overwhelming for first-time parents. This also comes with them checking up on every little thing. One of the common issues is mottling, and it happens when the baby’s skin looks like a marble cake (there will be pale and pink patches). The parents get scared when they see that web-like pattern on their baby’s skin. If you have the same issue going on, we are sharing all the reasons and when you need to call the pediatrician for mottling in newborns.
Table of Contents
What Does Mottled Skin Look Like in a Newborn?
Mottled skin looks like pink and pale patches in a web-like pattern. It is a common skin issue among babies, and it becomes noticeable. To be honest, it’s not a huge issue as it happens because the circulation is still developing. This condition is also known as cutis marmorata.
According to UMass Memorial Health, mottling in newborns shows up on the trunk, legs, and arms. This is because these areas are exposed to the temperature changes. It will also go away when the baby is warmed up (yes, the temperature changes are the reason).
However, parents need to know that mottling looks different on every baby. If your baby has a lighter skin tone, it will be purple, red, and bluish patches. In case of deeper skin tone, the patches will be gray, brown, and dusky. The color changes will be difficult to notice on darker skin, so you should check the lips, tongue, and gums. In addition, you should check the eye’s white part to keep an eye on oxygen levels and circulation.
What Causes Mottling in Newborns?
There are multiple reasons mottling happens in newborns. In this section, we are sharing the common causes.
- Newborn babies have an immature circulatory and nervous system, so they don’t respond well to cold. This means more blood will be sent to their vital organs and less to the skin, which leads to mottling
- If your newborn baby was born prematurely, the temperature regulation will not be developed properly
- Emotional stress, feeding, and crying can cause quick changes in heart rates and dilation of the blood vessels
- Low body temperature or blood sugar in a newborn can lead to pale or bluish skin
- Neonatal sepsis, which is a bloodstream infection, can cause patches on the skin. In this case, you will notice poor feeding, instability, and lethargy. If this is the case, your baby needs a medical check-up
- Some heart conditions impact how the heart pumps oxygen-rich blood to the body, which comes out as mottling. You can call the doctor, and they can use the pulse oximetry screening to see what the problem is
- Thin skin can make the blood vessels more visible, which makes the changes in normal blood circulation more dramatic
Cutis Marmorata vs. Acrocyanosis vs. CMTC vs. Central Cyanosis
When it comes to mottling, you should know the difference between different conditions. This is because mottling looks different because of different conditions.
| Condition | What It Looks Like | When It Appears | Fixable with Warming? |
|---|---|---|---|
| Physiologic Cutis Marmorata | Lacey, mottled skin pattern | Anytime baby is cold | Yes |
| Acrocyanosis | Bluish tint on hands, feet, sometimes mouth | First few days after birth | Yes |
| CMTC | Persistent marble method | Present from birth | No |
| Central Cyanosis | Bluish tint on torso, lips, gums, tongue | Not normal at any point | No |
Normal vs. Concerning Mottling: How to Tell the Difference
If the web-like pattern disappears within minutes of warming, you don’t need to worry. This is also when your baby is breathing and feeding properly (behaving normally). If the mottling in newborns doesn’t improve with warming or stays the same in one spot for a long time, you should take it up with your pediatrician.
The other thing you need to worry about is the gray or bluish coloring around the face, mouth, and tongue. In addition, you have to look out for poor feeding, difficult breathing, low temperature, or fever.
What to Do When Your Newborn's Skin Looks Mottled
If your baby’s skin looks mottled, there are a few steps that you can take to make it go away.
- Check the baby’s back and chest and note down the temperature reading. If the temperature is too low, you have to warm the baby up
- You can add a layer of clothing or wrap your little one in the blanket. However, you should not use heating pads, hot water bottles, or heat vents because direct heat is not recommended
- Once the baby is warmed up, check the skin in a natural or bright light to check if the skin color is back to normal
- Keep the temperature in check. You've to check the rectal temperature and if the temperature is 38°c or higher in your three months old or younger baby, you must take the baby to the hospital
- If mottling keeps coming back or lasts longer than usual, you should talk to the pediatrician. However, do tell the doctor how long it lasted and what other symptoms are there.
When to Call the Pediatrician or Seek Emergency Care
Mottling usually happens when the baby is cold and goes away with warming. It can happen with normal feeding and does not mean you need to see the doctor. However, if the mottling lasts a long time and your baby is getting fussy, you can call the doctor. In case you see blue or gray pattern around the torso, tongue, or lips with a high temperature and difficult breathing, you should take the little one to the emergency.
How Doctors Evaluate Mottling in a Newborn
If you don’t know how doctors evaluate mottling in a newborn, we are sharing some steps that they will perform.
Medical History and Physical Examination
The first step is usually asking about when the mottling started and how long it lasts. In addition, the doctor will ask what could be triggering it (just to take your input). The doctor will also examine the baby’s skin and color. It is recommended that you record their skin changes in the form of pictures too. The visuals can actually help the doctor get to the root cause quicker.
Temperature, Oxygen Saturation, and Blood Glucose Checks
The doctor will check the temperature, conduct pulse oximetry to measure the blood oxygen levels, and perform a blood glucose test. It will help the doctor rule out the serious issues.
Blood Tests and Infection Screening
If the doctor suspects sepsis, and if there is a fever, he/she will ask for blood cultures, blood counts, and different infection markers. This will help them guide you with the right treatment.
Heart, Lung, and Vascular Testing
If the doctor suspects a lung or heart issue, the doctor will listen for abnormal breathing sounds or murmurs. Then, the doctor will order an echocardiogram or other cardigan testing.
Are There Other Skin Changes in Babies That I Should Be Aware Of?
While mottling is a common skin issue among babies, there are some other skin changes that your baby might have.
- Baby’s skin will start out dark red to purple and turn to a red or pink tone as the baby starts breathing air
- Small white or red bumps on the nose, cheeks, and forehead are common in the first few weeks, but they will clear up on their own
- Tiny white bumps on the cheeks and nose are common and happen because skin flakes are trapped under the pores. They will go away within a few weeks
- Small yellow-white bumps on the red skin are also common but harmless (they go away within one to two weeks)
- Yellow skin and eyes (jaundice) is also normal, but you can check with the doctor if it’s mild jaundice
- Some babies have peeling skin on their feet and hands, but it happens as babies adjust to their life outside the womb. It does not need any treatment
How Long Does Newborn Mottling Last?
According to Seattle Children's Hospital, mottling in newborns lasts for a few minutes and goes away when the baby is warmed up. However, they will keep mottling within the first few months of the baby’s birth until their nervous system matures fully. As far as the premature babies are concerned, they have thinner skin and a less mature circulatory system, so they will be mottled longer. On the other hand, if mottling does not get better with time or warmth, you should talk to the pediatrician.
Can Mottling in Newborns Be Prevented?
Yes, mottling can be prevented. To begin with, you have to keep the baby’s room temperature at a stable and comfortable level. In addition, you should add one more light layer to their clothes (don’t add too many because overheating is not good either). Lastly, you should feed the baby consistently because it will help maintain the body temperature and blood sugar level. It will reduce the mottling triggers.
Conclusion
Mottled and marble-like skin is very common among little ones, and the parents have nothing to worry about. This is actually a good sign that your baby’s blood circulation system is learning to regulate itself. However, keep the context in mind because if the baby is behaving (feeding and breathing) normally and the mottling is settling once you warm up the baby, it’s fine. If the mottling is persistent and your baby is lethargic or has a fever, a trip to your pediatrician wouldn’t hurt.
Disclaimer: Every baby develops differently. This article provides general information and should not replace advice from a qualified healthcare professional. If your baby has persistent back arching, feeding difficulties, breathing problems, seizure-like movements, or other concerning symptoms, seek prompt medical evaluation.