Petechiae are pinpointed, non-blanching spots less than two millimeters in size that mostly appear on the skin and the mucous membranes of the body. Petechiae are often a symptom of an underlying medical condition or a bacterial infection.
Petechiae rashes are usually seen on the arms, legs, stomach, and buttocks. The rashes appear when the capillaries bleed, leaking blood into the skin. It is important to seek medical attention if your child has a fever along with the rashes.
Read this post to understand the symptoms, causes, and treatment options for petechiae in children.
Causes Of Petechiae In Children
- Viral infections such as enterovirus and influenza
- Neisseria meningitis (meningococcal) bacterial infection
- Blood disorders such as thrombocytopenia, platelet dysfunction, disorders of coagulation, and loss of vascular integrity
- Other diseases such as Henoch Schonlein purpura and leukemia
- Congenital abnormalities such as Wiscott-Aldrich syndrome, Glanzmann thrombasthenia, and Bernard-Soulier syndrome
- Drug reactions, vitamins C and K deficiency, and chronic liver disease
- Mechanical causes such as coughing or vomiting, leading to petechiae around the neck region
- Localized physical pressure due to tight stroller straps, car seats, or legs caught in cots
- Accidental and non-accidental injuries
Symptoms Of Petechiae In Children
Along with the pinpoint rashes, the child may also display other symptoms based on the underlying cause. These symptoms can be grouped into four main types for ease of understanding.
1. Unwell children with fever and petechiae
This could be a sign of meningococcal disease, which includes other symptoms such as rashes less than 2mm in diameter, abnormal blood indices such as white blood cells count > 15*10٨9/L and < 5*10٨9/L and raised C-reactive protein > 8mg/L.
Children would be unwell and also show abnormal vital signs such as tachycardia, desaturation of air, and increasing systolic to diastolic difference in blood pressure. The child would also have cold extremities, irritability, and lethargy.
2. Well children with fever and petechiae
Purpura less than 2mm in diameter may indicate meningococcal disease. However, if the rashes are on the lower limbs and buttocks, with or without arthritis or abdominal pain, it could be Henoch Schonlein purpura.
3. Petechiae in well children due to mechanical causes
These children do not exhibit any abnormal signs and have a clear history of mechanical causes such as coughing or vomiting, leading to petechiae around the neck region.
4. Well children with petechiae not due to mechanical causes
If the child has fever and petechiae and there are no mechanical causes involved, blood tests must be performed to rule out leukemia. When the child seems well, with a white blood cells count of 5 – 15*10٨9/L, C-reactive protein < 8mg/L, and no change in the state or progression of the rashes over four hours, they are at low risk of meningococcal disease (3).
Diagnosis Of Petechiae In Children
Your doctor would do a physical examination to identify petechiae and their occurrence on your child’s body. The doctor may also ask questions about other symptoms and the child’s medical history to ascertain the cause behind the rashes.
If the cause cannot be identified, your doctor may prescribe blood or urine tests to understand the underlying cause.
Treatment Of Petechiae In Children
The treatment depends on the underlying cause. If the rashes do not spread and the child has a normal platelet count, they may not require any specific treatment. However, if there is any sign of abnormality in the tests, your child’s doctor would prescribe an appropriate treatment (2).
- If the rashes are due to a drug reaction, they will subside on their own once you stop the medication.
- Antimicrobial therapy may be recommended if the petechiae are due to meningococcal infection (4).
- In the case of Henoch-Schonlein disease, your doctor might recommend bed rest and elevation of the affected areas. They may also prescribe paracetamol or NSAIDs for mild pain. Steroids are given in the case of moderate to severe pain (5).
- Chemotherapy or radiation could be the options for cancer.
Home Care Tips For Petechiae
Along with your doctor’s treatment, you can try some of the tips mentioned below to help your child. However, make sure you talk to your doctor before trying any of these home care tips.
- If the reason behind your child’s petechiae is due to medications, stop them and observe the rashes for every hour to see if they are subsiding or spreading.
- Help your child take adequate rest. If the rashes are due to a bacterial or viral infection, do not send your child to school as these are highly contagious.
- Keep them hydrated by giving them fluids such as water and fruit juices.
Prevention Of Petechiae
- Inform your doctor of any allergies or drug reactions your child might have.
- Make sure the stroller straps, belts, etc. are not too tight.
- Keep your child away from family members or people who are sick.
- Do not share their items, such as glasses or towels, with others.
- Always apply insect repellent on your child’s body if they are heading to the playground or the woods.
- Instruct your children to wash their hands before eating and after coming home from the playground.
Petechiae can cause concern in parents. If you spot red rashes on your child’s body, it is best to get it evaluated, as bacterial or viral infections can cause serious reactions. Also, if the red spots reappear, it might be due to an underlying cause. Take your child to your pediatrician to get them evaluated and treated on time.
2. Ailbhe McGrath, and Michael J. Barrett; Petechiae; StatPearls (2020).
3. Petechiae and purpura; The Royal Children’s Hospital Melbourne
4. Acute meningococcal disease; The Royal Children’s Hospital Melbourne
5. Henoch-Schönlein purpura; The Royal Children’s Hospital Melbourne
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