The day care provider and two day care moms (both working in early elementary
special ed) have mentioned concerns about his condition wondering if perhaps
it could be caused by apnea or petit mal seizures.  His condition is such
that parents dropping off or picking up kids at day care will often ask
if he is okay.

I called the pediatrician today and have an appointment for next Tuesday.
When I described what I could, he said that it makes one think of heart
disease.  He'll start trying to rule things out.

The only other thing I could add is that the baby will sometimes just
'zone out', that is, have a blank look on his face, just staring off and it
is often difficult to cause him to respond.  Calling his name, clapping hands,
does not distract him.  Again, there is nothing that seems to cause him
to appear distressed.

Can anyone shed any light on this situation?  Does it sound at all familiar
to anyone?  Responses would be most welcome.  This is very puzzling.

Thanks.

Susan

*************************************************************************

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: The day care provider and two day care moms (both working in early elementary
: special ed) have mentioned concerns about his condition wondering if perhaps
: it could be caused by apnea or petit mal seizures.  His condition is such
: that parents dropping off or picking up kids at day care will often ask
: if he is okay.

: I called the pediatrician today and have an appointment for next Tuesday.
: When I described what I could, he said that it makes one think of heart
: disease.  He'll start trying to rule things out.

: The only other thing I could add is that the baby will sometimes just
: 'zone out', that is, have a blank look on his face, just staring off and it
: is often difficult to cause him to respond.  Calling his name, clapping hands,
: does not distract him.  Again, there is nothing that seems to cause him
: to appear distressed.

: Can anyone shed any light on this situation?  Does it sound at all familiar
: to anyone?  Responses would be most welcome.  This is very puzzling.

: Thanks.
Susan,
        I suspect the baby has con{*filter*} methemoglobinemia.  Although the
name sounds dreadful, in fact the prognosis is excellent, since the impact
is mainly cosmetic, not physiologic.  The key feature you describe is that
the baby is undistressed.  If he had cyanosis due to lack of oxygen, he
would be very distressed indeed.  The fact that it first appeared at age 3
months suggests a defect on the beta chain of hemoglobin, since "{*filter*}"
(i.e., not fetal) beta chain of hemoglobin kicks in at around that age.
        It's fairly easy to test for methemoglobinemia, and a positive
result leads to a completely different approach than does the workup for
con{*filter*} heart disease.
        A lot of doctors have not heard of the disorder; it's fairly rare.
 Write down the name so that you can ask your doctor.  If the baby seems
to have it, referral to a pediatric hematologist would be in order.
        To put simply what is quite complex, the disorder results from an
abnormal charge on the iron atom within the hemoglobin molecule.
        Of course, no on-line assessment can replace a competent
examination, and this information is not meant as a specific diagnosis or
recommendation for your child, but rather as a source of useful
information to you.
        Please let me know how things turn out.
        Eric Chevlen, MD
        hematologist, Youngstown, Ohio

'Absences' (or 'Petit-mal Epilepsy', as it used to be called) are not associated
with cyanosis (blue fingers etc.) but 'Clonic-tonic' fits (old name: 'Grand-mal
Epilepsy') can sometimes be associated with cyanosis. However, in these cases
it lasts seconds, not 45 minutes.

Cyanosis is an indication of lack of oxygen in the body. During bad asthma
attacks I have become cyanosed, and I have apparently become 'zoned out',
due to lack of oxygen to the brain. The problem is, what is causing this
lack of oxygen? It is most likely heart or lung problems (probably heart).
As a former nurse, I know that people are very frightened by heart
problems but they are not necessarily dangerous, as long as they are
treated. Your paediatrician sounds like he is taking this problem seriously,
and will get to the bottom of it soon. The fact that your daughter has not been
diagnosed already may be a good sign - serious things are usually easier to
diagnose.

Either way, I'll be thinking of you. Please post what happens.
--
Anna (mummy to Emma, born 17th Jan 1995)
------------------------------------------------------------------------------
The Lord God says:
'Share your bread with the hungry,
bring the homeless poor into your house,
cover the {*filter*}'.

Dear Lord God,
We have got new carpets so this will not be possible.        STEVE TURNER
------------------------------------------------------------------------------

|> With increasing frequency our 18-month-old son has episodes in which his
|> lips, around his mouth, and his fingertips turn blue.  When he was four
|> months old, we took him to the emergency room one night for this condition,
|> but they found nothing and his condition returned to normal while we where
|> there.  These episodes have been increasing to the point that he has had
|> at least one a day this week.  He had two today alone.  They both lasted
|> for about 45 minutes during which he coughed about 8-9 times.  He does not
|> appear to be distressed.  These episodes occur regardless of the clothing
|> he is wearing, how warm the room is or if he is active.

I have to say that it is *very* odd that your pediatrician hasn't
been *much* more agressive in trying to diagnosis this.  From what you
say, this has been going on for over a year, and nobody had done
any cardiac ultrasounds or cardiac caths?  (Unless they did this when
you took him in to the emergency room?)  

|> I called the pediatrician today and have an appointment for next Tuesday.
|> When I described what I could, he said that it makes one think of heart
|> disease.

Sure does.

|>
|> The only other thing I could add is that the baby will sometimes just
|> 'zone out', that is, have a blank look on his face, just staring off and it
|> is often difficult to cause him to respond.  Calling his name, clapping hands,
|> does not distract him.  Again, there is nothing that seems to cause him
|> to appear distressed.
|>
|> Can anyone shed any light on this situation?  Does it sound at all familiar
|> to anyone?  Responses would be most welcome.  This is very puzzling.

What you report is a pretty good description of what frequently is called
"blue spells".  There's a lack of oxygen being caused by something.
A cardiac problem is one possible (and perhaps the most likely at this
point) candidate.  As one example, if the kid has a hole in his ventricular
septum (VSD: ventricular septal defect), then under certain conditions
(usually conditions of some -- perhaps even mild -- stress), deoxygenated
{*filter*} will mix with oxygenated {*filter*} via the hole and you get that
blue/gray color in the lips and fingernails.  Other anatomical oddities
can cause the same phenomena (transposition of the great vessels,
stenosis of various vessels, etc.), but in the most dramatic cases
one would expect this to have shown up earlier and with greater effect.

Most of these things are straightforwardly fixable today (though
this means open heart surgery).  I've had quite a bit of experience
from the parent's perspective with this since my first-born had
Tetralogy of Fallot and went through open heart surgery three times
(most recently about four years ago).  He is now 19, 6'3" tall and
you would never guess (except by looking at the scars on his chest)
that he ever had a problem.

Good luck.  Ask lots of questions of your doctor(s) and don't delay
in finding out what the problem is.  (It may not be cardiac, in which
case I have no advice or information to give.)

--
Gary H. Merrill  [Principal Systems Developer, Compiler and Tools Division]
SAS Institute Inc. / SAS Campus Dr. / Cary, NC  27513 / (919) 677-8000

Susan, your baby's blue lips indicate a problem in oxygenation of the
{*filter*}.  This could be heart, lung, or {*filter*} disorder. Your baby zones
out, because not enough oxygen is getting to the brain, I'll wager.

Treat it aggressively and soon and you'll probably have no long-term
problems.

peg
-asthmatic mom of two asthmatics, and only one of us audibly
wheezes...

: blue lips and zoning can be an early sign of asthma.  not all
: asthmatics wheeze audibly, especially very little ones.

: peg
: -asthmatic mom of two asthmatics, and only one of us audibly
: wheezes...

Jake, 7 months, gets a little blue area between his
eyes when he has wheezing going on.  We can't hear it
audibly, so this is a major clue.

Carol