Petechiae In Children: Causes, Symptoms And Treatment

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Petechiae in children can be a symptom of an underlying illness or bacterial infection. It results in pinpointed, non-blanching spots less than two millimeters in size that may be caused by blood leakage from the capillaries (tiny blood vessels) to the skin. Petechiae spots often appear on the skin where the body’s mucous membranes are located, such as the arms, stomach, buttocks, and legs. Prompt medical care may be required if your child has a fever with petechial rashes.

Read on to know the symptoms, causes, and treatment of petechiae in children.

Causes Of Petechiae In Children

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The causes of petechiae rashes could range from a bacterial, fungal, or viral infection to an underlying blood disorder. Here are some common causes of petechiae in children (1) (2).

• Viral infections such as enterovirus, Epstein-Barr virus infection, and influenza

• Sepsis caused by Neisseria meningitidis  bacterial infection (meningococcemia)

• Cytomegalovirus (CMV) infection

• Blood disorders such as von Willebrand disease thrombocytopeniaⁱXMedical condition of having a low blood platelet count , platelet dysfunction, disorders of coagulation, and loss of vascular integrity

• Other diseases such as dengue fever, Henoch Schonlein purpuraⁱXA vascular disorder that causes swelling and bleeding of small blood vessels and leukemiaⁱXAn umbrella term for blood cancer

On her blog, Aunt Michelle Gourdin speaks on behalf of her niece, Jessica Taylor Reynolds, who was diagnosed with leukemia and had petechiae rashes, “I (Jessica) was diagnosed with acute myeloid leukemia (AML M7). My mom and dad had noticed that I was very pale, bruised very easily, and had petechiae (small purple dots that look like a rash) on my lower legs (i).”

• Congenital abnormalities such as Wiscott-Aldrich syndromeⁱXA genetic immunodeficiency disorder characterized by reduced ability to form blood clots and eczema , Glanzmann thrombastheniaⁱXA rare, genetic bleeding disorder characterized by prolonged or spontaneous bleeding that starts from birth , and Bernard-Soulier syndromeⁱX A rare, inherited blood clotting disorder

• Drug reactions, vitamins C and K deficiency, and chronic liver disease

• Mechanical causes such as coughing or vomiting, which may cause increased pressure to the upper body and neck regions, 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 bruising and injuries

Point to consider

Petechiae may also be caused due to collagen disorder. However, if the spots keep growing and blending, they may also be due to a bleeding disorder (8).

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 (3).

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 8mg/L.

Children would be unwell and also show abnormal vital signs such as tachycardiaⁱXA medical term for having a heart rate above 100 beats per minute , 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

PurpuraⁱXSmall, flat purple spots on the skin due to leaking blood vessels under the skin less than 2mm in diameter may indicate meningococcal disease. Rashes mostly seen on the lower limbs and buttocks, with or without arthritis or abdominal pain, could be due to 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 (3).

Be watchful

See a doctor if your child develops long streaks under their nails, bruises that worsen, or breathing problems (8).

Diagnosis Of Petechiae In Children

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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.

Quick fact

The glass test is used to diagnose petechiae. When a drinking glass is firmly placed on the small spots, they don’t blanch (do not disappear) (9).

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

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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 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

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You may not be able to prevent petechiae if the underlying cause is an autoimmune disorderⁱXDisorders where the body's immune system mistakes healthy tissues for foreign bodies and tries to damage them  or cancer. However, infections and mechanical causes can be prevented by following the tips mentioned below (6).

• 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.

Infographic: A Quick Overview Of Petechiae In Children

Petechiae in children can sometimes be an indication of an underlying infection. Check out this infographic to know:

• What exactly is Petechiae
• What triggers the condition
• How to prevent it

Illustration: Momjunction Design Team

Petechiae in children could be due to an underlying issue. The experts in this video discuss its causes, symptoms, diagnosis, and treatments.

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Dr. Neema ShresthaMD

Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.Y. Patil University in 2011, MD from Nepal Medical College in 2015...more

• Dr. Leah AlexanderMD, FAAP

  Dr. Leah Alexander is a board-certified pediatrician who provides medical care in an outpatient setting in Fair Lawn, New Jersey. She has also been working as a pediatrician with Medical Doctors Associates at Pediatricare Associates, New Jersey, since 2005. Dr. Alexander holds a bachelor's degree in Health Science from Kalamazoo College and a Doctor of Medicine degree from Michigan State University.
  
  Dr. Leah Alexander is a board-certified pediatrician who provides medical care in an outpatient setting in Fair Lawn, New Jersey. She has also been working as a pediatrician with Medical Doctors Associates at Pediatricare Associates, New Jersey, since 2005. Dr. Alexander holds a bachelor's degree in Health Science from Kalamazoo College and a Doctor of Medicine degree from Michigan State University.

Dr Bisny T. JosephMedical Doctor

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has around 5 years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education...more

Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to...more

Vidya TadapatriMSc (Biotechnology)

Vidya did her post-graduation in Biotechnology from Osmania University, Hyderabad. Her interest in scientific research and writing made her pursue a career in writing, in which she now has over five years of experience. She has done certified biotechnology-related training programs under renowned organizations such as Centre For Cellular & Molecular Biology and Department of Biotechnology. Vidya writes health-based articles...more