Bright red hands and feet in babies

Raynaud Phenomenon | Boston Children's Hospital

In-Depth

Named for the French medical student who first described it in 1862, Raynaud’s phenomenon is a rare condition in which blood vessels react in an exaggerated way (called a vasospasm) to cold or emotional stress. You may also see the terms “Raynaud’s disease” and “Raynaud’s syndrome,” but they’re misleading. Raynaud’s isn’t a disease: It’s a variant of the body’s natural way of keeping its temperature under control.

When we’re hot, we get flushed as small blood vessels under the skin widen (dilate) to bring blood close to the surface and let its warmth escape. But when we’re cold, those blood vessels narrow (constrict) to preserve warmth inside for our brain, heart and other vital organs.

In Raynaud’s, blood vessels going to certain parts of the body—often the fingers—overreact to cold or even a brief drop in temperature, like walking into an air-conditioned room. The vessels clamp down in what’s called a vasospastic attack, blocking the blood flow and causing the skin in the affected area to:

• turn blue (called cyanosis), as the blood’s oxygen level drops
• turn white (called pallor), as the blood flow stops
• turn red (called rubor), as the vessels reopen and flood the tissues with blood

Not everyone with Raynaud’s has all three color changes, or in the same order. Which body parts are affected and how long the attacks last also varies from person to person. But all patients do fall into one of two categories of Raynaud’s.

• primary Raynaud’s: If your child has primary Raynaud’s, his blood vessels are healthy. They overreact simply because they’re more sensitive, or “twitchy,” than most people’s.
• secondary Raynaud’s: If your child has this rarer and more serious form of Raynaud’s, his blood vessels overreact because they have been damaged by an underlying disease or condition.

Who is at risk?

According to the Arthritis Foundation, 4 to 15 percent of the people in the United States have Raynaud’s phenomenon. In that group, more than 80 percent have primary Raynaud’s (largely benign), while the rest have secondary Raynaud’s (sometimes serious). And just as the severity of the two types of Raynaud’s is different, so are their risk factors.

Risk factors for Primary Raynaud’s

• gender: About 80 percent of those with primary Raynaud’s are female.
• body type: Raynaud’s is most often seen in slender girls and women.
• age: Primary Raynaud’s usually develops between the ages of 12 and 30.
• family history: About 25 percent of those with primary Raynaud’s have a family history of the condition.
• other factors: Certain foods and medications can exaggerate vasospasm, including caffeine and drugs often used for attention-deficit hyperactivity disorder (ADHD), such as Ritalin.

Risk factors for Secondary Raynaud’s

• age: Secondary Raynaud’s is more likely to occur in people older than 30.
• disease: Secondary Raynaud's is often seen in connection with scleroderma, lupus and other illnesses that damage blood vessels or the nerves that control them.
• other factors: Trauma to the hands or feet, like frostbite.

When to see a doctor

If your child seems extremely sensitive to cold or emotional stress and you think he may have Raynaud’s phenomenon, it’s generally okay to decide to wait until his next regular check-up. Raynaud’s isn’t a disease, and for the vast majority of kids, the diagnosis just means they’ll have to take extra care to stay warm.

But you should make an appointment to bring your child in sooner if his symptoms are accompanied by warning signs of a more serious illness. These include:

• skin sores
• substantial pain
• marked asymmetry (the fingers of one hand change color but not the other)
• rashes or other changes in the skin
• fever
• chest pain
• bad heartburn
• weakness

Complications

Most children with Raynaud’s phenomenon have no complications. While they may not outgrow their condition, it likely won’t get any worse and they’ll live a normal life.

For the rare few with secondary Raynaud’s, there is a risk of tissue damage if their condition is severe and their attacks tend to last a long time. Blood flow to the affected area may become permanently diminished, causing ulcers or gangrene—ailments that can be very difficult to treat.

Prevention

As a parent, you may worry whether there was anything you should’ve done to head off your child’s condition. Yet primary Raynaud’s phenomenon—which, by far, is the type most children have—can’t be prevented. Nor can secondary Raynaud’s, if it is caused by an underlying disease.

But by helping your child avoid cold, reduce stress and make some simple lifestyle changes, you can help him cut down on the frequency and severity of his Raynaud’s attacks. For tips on how to do this, see our Treatment and Care section.

For children with primary Raynaud’s, we don’t yet know what causes their blood vessels to react in such a vigorous way to cold and emotional stress.

However, there are concrete causes for secondary Raynaud’s, and in children it’s most often an underlying autoimmune disease. Here at Children’s Hospital Boston, the illnesses we tend to see with secondary Raynaud’s are:

• scleroderma, which leads to the hardening and scarring of the skin and other body tissues (about 90 percent of those with scleroderma also have Raynaud’s)
• systemic lupus erythematosus (SLE, or simply lupus), which can cause inflammation and damage in many parts of the body, especially the heart, lungs, kidneys and brain (about a third of those with lupus also have Raynaud’s)
• mixed connective tissue disease, an “overlap” disease that has features of scleroderma, lupus, polymyositis and sometimes rheumatoid arthritis
• vasculitis, which causes inflammation of the blood vessels

Diseases like arteriosclerosis and hypertension can also damage the blood vessels and cause secondary Raynaud’s, though almost always in adults. Other potential causes of secondary Raynaud’s include:

• medications: Certain kinds of drugs have been linked to Raynaud’s, such as beta blockers (used to treat high blood pressure), migraine prescriptions with ergotamine, medications with estrogen, drugs containing caffeine (such as Excedrin), medications used for ADHD (like Ritalin) and some over-the-counter decongestants.
• injury to the hands and feet: Frostbite is a notable culprit in this category, but things like repetitive trauma—seen mainly in adults who work with vibrating tools, like drills—can also trigger Raynaud’s.

Raynaud’s phenomenon isn’t something you can spot by simply looking at your child. Symptoms occur only when the blood vessels are actually in vasospasm—clamping down—in response to cold or emotional stress. Here are the telltales of a Raynaud’s attack:

• changes in skin color occur as the blood vessels seal off and cause the affected areas (usually the fingers and/or toes) to turn blue or white, or first one and then the other. The skin may then become red and puffy as the vessels reopen. The discoloration can be splotchy or solid, and usually affects both hands and/or both feet at the same time.
   
• coldness, numbness and/or clumsiness happens in the blue or white phase, as if the affected areas have “gone to sleep.”
   
• warmth, tingling and/or throbbing happens in the red, or “rewarming,” phase. This can feel like the pins-and-needles sensation of “waking up” a limb that’s fallen asleep. It can be uncomfortable, and occasionally painful.

It usually takes about 15 to 20 minutes for these symptoms to resolve themselves after whatever triggered the attack is gone (for example, after you’ve moved your child to a warmer area or helped him calm down).

In secondary Raynaud’s, the attacks can last longer and may have more severe symptoms, such as pain in the affected area; lingering weakness or numbness; and skin ulcers or dead tissue (gangrene).

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

If your child has Raynaud’s phenomenon and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling that you have the information you need.

If your child is old enough, you may want to suggest that he write down what he wants to ask his health care provider, too.

Here are some questions you may want to ask:

• Is this primary or secondary Raynaud’s?
• What is the cause of my child’s Raynaud’s?
• What further tests does my child need?
• When might medications be required?
• What are the side effects of those medications?
• What is the outlook for my child?
• What can I do to help minimize the impact of my child’s Raynaud’s?

Cyanosis: A bluish color of the skin caused by insufficient oxygen in the blood; one of three color changes associated with Raynaud’s phenomenon.

Digit: A finger or toe. The small blood vessels that feed the fingers and toes are called digital arteries.

Extremities: The limbs of the body, most commonly referring to the hands and feet.

Ischemia: A lack of blood flow in a body part.

Necrosis: The death of body tissue. Gangrene is a kind of necrosis.

Pallor: A whitening of the skin caused by lack of blood flow; one of three color changes associated with Raynaud’s.

Rubor: A reddish color of the skin caused by increased blood flow; one of three color changes associated with Raynaud’s.

Triphasic: Having three parts. If the skin changes to blue, white and then red during a Raynaud’s attack, it’s called a triphasic reaction. If only two colors occur, it’s called a biphasic reaction.

Vasoconstriction: A narrowing of blood vessels caused by the tightening of muscles in their walls.

Vasodilation: A widening of blood vessels caused by the relaxation of muscles in their walls.

Vasospasm: Sudden, temporary vasoconstriction—literally, a spasm in the blood vessels.

Q: Is Raynaud’s phenomenon dangerous?
A: By and large, Raynaud’s is more a nuisance than a cause for concern. But there is a risk of long-term tissue damage and other complications with secondary Raynaud’s, the rare form caused by an underlying disease.

Q: Will my child outgrow Raynaud’s?
A: This condition tends not to go away, but it also tends not to get any worse. Most people with primary Raynaud’s can manage their symptoms with minor lifestyle changes, and don’t need medication.

Q: Are Raynaud’s attacks painful?
A: Only rarely, in truly severe cases. By contrast, children with primary Raynaud’s may feel cold, stiffness and a “pins and needles” sensation in their hands or feet—but some may not even sense they’re having an attack at all, and notice it only by sight.

Q: How is Raynaud’s different from frostbite?
A: Exposure to extreme cold causes frostbite, in which there is actual tissue damage. A Raynaud’s attack can occur in fairly mild temperatures (say, around 60 degrees) and doesn’t injure the affected fingers or toes, except in severe cases.

Q: Why does emotional stress trigger an attack?
A: It’s tied into our natural “fight or flight” response. The body reacts to stress the way it would a physical threat, pulling blood away from the skin’s surface and concentrating it in the muscles, brain, heart, lungs—the things you’d really need to fight or flee!

Q: Are there any alternative therapies?
A: Certain people find help in alternative therapies such as biofeedback, fish oil, dietary supplements and acupuncture. However, most patients need no therapy or choose to use well-tolerated medications. You can discuss these options with your doctor.

Kawasaki disease - NHS

The symptoms of Kawasaki disease usually develop in 3 phases over a 6-week period.

Phase 1: acute (weeks 1 to 2)

Your child's symptoms will appear suddenly and may be severe. Your child may be very irritable.

High temperature

The first and most common symptom of Kawasaki disease is usually a high temperature.

The high temperature can come on quickly and doesn't respond to antibiotics or medicines like ibuprofen or paracetamol.

Your child's high temperature will usually last for at least 5 days, but it can last for around 11 days without the proper treatment for Kawasaki disease.

Rarely, the high temperature can last for as long as 3 to 4 weeks.

Your child's body temperature could possibly reach a high of 40C.

Rash

Your child will almost always have a skin rash. This can vary in appearance from child to child.

Read more about skin rashes in children.

Hands and feet

Your child’s hands and feet may swell up, and the skin on their hands and feet may become red or hard.

Your child may feel their hands and feet are tender and painful to touch or put weight on, so they may be reluctant to walk or crawl while these symptoms persist.

Conjunctival injection

Conjunctival injection is where the whites of the eyes become red and swollen. Both eyes are usually affected, but the condition isn't painful.

Unlike conjunctivitis, where the thin layer of cells that cover the white part of the eye (conjunctiva) becomes inflamed, fluid doesn't leak from the eyes in conjunctival injection.

Lips, mouth, throat and tongue

Your child's lips may be red, dry or cracked. They may also swell up and peel or bleed.

The inside of your child's mouth and throat may also be inflamed. 

Their tongue may be red, swollen and covered in small lumps. This is known as "strawberry tongue".

Swollen lymph glands

If you gently feel your child's neck, you may be able to feel swollen lumps usually on one side. The lumps could be swollen lymph glands.

Read more about the complications of Kawasaki disease.

Phase 2: sub-acute (weeks 2 to 4)

During the sub-acute phase, your child's symptoms will become less severe, but may last a while.

The high temperature should subside, but your child may still be irritable and in considerable pain.

Symptoms during the second phase of Kawasaki disease may include:

• abdominal pain
• vomiting
• diarrhoea
• pee that contains pus
• feeling drowsy and lacking energy (lethargic)
• headache
• joint pain and swollen joints
• yellowing of the skin and the whites of the eyes (jaundice)
• peeling skin on the hands and feet, and sometimes also on the palms of the hands or the soles of the feet

Phase 3: convalescent (weeks 4 to 6)

Your child will begin to recover during the third phase of Kawasaki disease, which is known as the convalescent phase.

Their symptoms should begin to improve and all signs of the illness should eventually disappear.

But your child may still have a lack of energy and tire easily during this time.

Page last reviewed: 26 October 2021
Next review due: 26 October 2024

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Parental leaflet on viral diseases

Parental leaflet.

Measles is a viral infection with a very high susceptibility. If a person has not had measles or has not been vaccinated against this infection, then after contact with the patient, infection occurs in almost 100% of cases. The measles virus is highly volatile. The virus can spread through ventilation pipes and elevator shafts - at the same time, children living on different floors of the house get sick.

The period from contact with a person with measles to the appearance of the first signs of the disease lasts from 7 to 14 days.

The disease begins with a severe headache, weakness, fever up to 40 degrees C. A little later, a runny nose, cough and almost complete lack of appetite join these symptoms.

Very characteristic of measles is the appearance of conjunctivitis - inflammation of the mucous membrane of the eyes, which is manifested by photophobia, lacrimation, sharp redness of the eyes, and subsequently - the appearance of purulent discharge. These symptoms last 2 to 4 days.

On the 4th day of illness, a rash appears , which looks like small red spots of various sizes (from 1 to 3 mm in diameter), with a tendency to merge. The rash occurs on the face and head (it is especially characteristic of its appearance behind the ears) and spreads throughout the body for 3-4 days. It is very characteristic of measles that the rash leaves behind pigmentation (dark spots that persist for several days), which disappears in the same sequence as the rash appears.

Measles can cause serious complications . These include inflammation of the lungs (pneumonia), inflammation of the middle ear (otitis media), and sometimes such a formidable complication as encephalitis (inflammation of the brain).

It must be remembered that after suffering from measles for a sufficiently long period of time (up to 2 months) there is a suppression of immunity, so the child can get sick with some cold or viral disease, so you need to protect him from excessive stress, if possible from contact with sick children.

After measles, lifelong immunity develops. All those who have had measles become immune to this infection.

The only reliable protection against the disease is vaccination against measles, which is included in the National Immunization Schedule.

Reminder for parents.

Rubella is an airborne viral infection. As a rule, children who stay in a water room for a long time with a child who is a source of infection get sick. Rubella in its manifestations is very similar to measles, but it is much easier.

The period from contact to the appearance of the first signs of illness lasts from 14 to 21 days.

Rubella begins with an increase in the occipital lymph nodes and an increase in body temperature up to 38 degrees C. A runny nose, and sometimes a cough, joins a little later. A rash appears 2 to 3 days after the onset of the disease. Rubella is characterized by a pink, punctate rash that begins with a rash on the face and spreads throughout the body. Rubella rash, unlike measles, never merges, there may be a slight itch. The period of rashes can be from several hours, during which there is no trace of the rash, up to 2 days.

The treatment of rubella is to relieve the main symptoms - the fight against fever, if any, the treatment of the common cold, expectorants.

Complications from rubella are rare.

After rubella, immunity also develops, re-infection is extremely rare, but can occur.

It is therefore very important to get the rubella vaccine, which, like the measles vaccine, is included in the National Immunization Schedule.

Note for parents.

Mumps (mumps) is a childhood viral infection characterized by acute inflammation in the salivary glands.

Infection occurs by airborne droplets. Susceptibility to this disease is about 50-60% (that is, 50-60% of those who were in contact and who were not ill and not vaccinated get sick).

It can take 11 to 23 days from contact with a sick mumps to the onset of illness.

Mumps begins with an increase in body temperature up to 39 degrees C and severe pain in or under the ear, aggravated by swallowing or chewing. At the same time, salivation increases. Swelling quickly grows in the area of ​​​​the upper part of the neck and cheeks, touching this place causes severe pain in the child. Unpleasant symptoms disappear within three to four days: body temperature decreases, swelling decreases, pain disappears.

However, quite often mumps ends inflammation in glandular organs such as pancreas (pancreatitis), gonads. Past pancreatitis in some cases leads to diabetes mellitus . Inflammation of the gonads (testicles) is more common in boys. This significantly complicates the course of the disease, and in some cases may result in infertility. In especially severe cases, mumps can be complicated by viral meningitis (inflammation of the meninges), which is severe.

After a disease, a strong immunity is formed, but complications can lead to disability.

The only reliable protection against the disease is vaccination against mumps, which is included in the National Immunization Schedule.

Reminder for parents.

Varicella (chickenpox) is a common childhood infection. Mostly young children or preschoolers are ill. Susceptibility to the causative agent of chickenpox (the virus that causes chickenpox refers to herpes viruses) is also quite high. About 80% of contact persons who have not been ill before develop chickenpox.

14 to 21 days pass from the moment of contact with a patient with chickenpox until the first signs of the disease appear.

The disease begins with a rash. Usually it is one or two reddish spots, similar to a mosquito bite. These elements of the rash can be located on any part of the body, but most often they first appear on the stomach or face. Usually the rash spreads very quickly - new elements appear every few minutes or hours. Reddish spots, which at first look like mosquito bites, the next day take the form of bubbles filled with transparent contents. These blisters are very itchy. The rash spreads throughout the body, to the limbs, to the scalp. In severe cases, there are elements of the rash on the mucous membranes - in the mouth, nose, on the conjunctiva of the sclera, genitals, intestines. By the end of the first day of the disease, the general state of health worsens, the body temperature rises (up to 40 degrees C and above). The severity of the condition depends on the number of lesions. If there are elements of the rash on the mucous membranes of the pharynx, nose and on the conjunctiva of the sclera, then pharyngitis, rhinitis and conjunctivitis develop due to the addition of a bacterial infection. Bubbles open in a day or two with the formation of sores, which are covered with crusts. Headache, feeling unwell, fever persist until new rashes appear. This usually happens within 3 to 5 days. Within 5-7 days after the last sprinkling, the rash disappears.

Treatment of chickenpox is to reduce itching, intoxication and prevent bacterial complications. The elements of the rash must be lubricated with antiseptic solutions (as a rule, this is an aqueous solution of brilliant green or manganese). Treatment with coloring antiseptics prevents bacterial infection of rashes, allows you to track the dynamics of the appearance of rashes. It is necessary to monitor the hygiene of the mouth and nose, eyes - you can rinse your mouth with a solution of calendula, the mucous membranes of the nose and mouth also need to be treated with antiseptic solutions.

Complications of chickenpox include myocarditis - inflammation of the heart muscle, meningitis and meningoencephalitis (inflammation of the meninges, brain matter), inflammation of the kidneys (nephritis). Fortunately, these complications are quite rare. After chickenpox, as well as after all childhood infections, immunity develops. Re-infection happens, but very rarely.

Reminder for parents.

Scarlet fever is the only childhood infection caused not by viruses but by bacteria (group A streptococcus). This is an acute disease transmitted by airborne droplets. Infection through household items (toys, dishes) is also possible. Children of early and preschool age are ill. The most dangerous in terms of infection are patients in the first two to three days of the disease.

Scarlet fever begins very acutely with fever up to 39 degrees C, vomiting, headache. The most characteristic symptom of scarlet fever is tonsillitis , in which the mucous membrane of the throat has a bright red color, swelling is pronounced. The patient notes a sharp pain when swallowing. There may be a whitish coating on the tongue and tonsils. The tongue subsequently acquires a very characteristic appearance ( “crimson ”) - bright pink and coarsely granular.

By the end of the first beginning of the second day of illness, 9 appears0093 the second characteristic symptom of scarlet fever is a rash. It appears immediately on several parts of the body, most densely located in the folds (elbow, inguinal). Its distinguishing feature is that the bright red punctate scarlatinal rash is located on a red background, which gives the impression of a general confluent redness. Pressing on the skin leaves a white line . The rash may be spread all over the body, but there is always a clean (white) area of ​​skin between the upper lip and nose, and also the chin. Itching is much less pronounced than with chickenpox.