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Forum Name: Pediatric Topics

Question: Petechiae in otherwise healthy 16-month-old


 ChristinaMB - Wed May 23, 2007 9:34 am

I have an 16-month-old son with an intermittent 4-week history of petechiae. I first noticed it after trauma to the forehead requiring 4 sutures. The petechiae were on his face, scalp, and a few on his back. The pediatrician saw them at his well check and didn't comment on them. I assume the ones on his face and scalp were from crying when got his stitches. They went away and reoccurred on his back and shoulder two weeks later with no known inciting event. I went back to the pediatrician the next day and she did a finger stick CBC that was WNL. No history of bleeding problems or fever. These are very subtle pinpoint red marks (about a dozen at a time) that fade within a few days and don't blanch with pressure. The only other history he has is of food allergies. He has urticaria with exposure to milk and eggs. He gets inadvertently exposed to milk occasionally with resultant hives. He is also allergic to peanuts although has never been exposed. Could the petechiae be related to the accidental milk exposures? The pediatrician said, "We see this in healthy kids (the petechiae), " and diagnosed it as "local irritation" from his car seat perhaps. I am not 100% satisfied with the explanation and worry a lot about this child. He is happy, healthy, eating, sleeping, otherwise. Thanks so much in advance.
 Dr. Chan Lowe - Wed May 23, 2007 2:48 pm

User avatar It is unlikely that the petechiae are related to the milk exposure. There are several conditions that can cause recurrent petechiae. Most of them are ruled out in your child since the CBC was normal (specifically the platelet count was not low).

It may be that your son had a recent infection that has left his capillaries a little weak. Then trauma, such as from a car seat strap, could cause small breaks.

It is also possible to get some petechiae with significant coughing or straining (such as with constipation).

There is a condition called Henoch-Schonlein Purpura that can give petechiae without a low platelet count; however, it generally is focused on the legs and buttocks and the petechiae tend to coallesce into larger areas called purpura. Based on your description, I would not be suspicious of this.

If your son continues to get petechiae you may want to have him seen by a hematologist to get some platelet function testing, although since he is not having nosebleeds, etc. I think his function is probably normal.

Best wishes.

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