Harlequin

Dr. Greene, I have a rather panicked Parent Soup member I’m trying to help out. Her sister gave birth a day ago and shortly afterwards, her baby developed a line down the middle of her face and then her body. One side of her body then became dark, the other stayed light. A nurse said this was called “harlequin” and not to be TOO concerned — but tell that to a brand new mom! She’s trying to find out more info, but no luck. I did a web search but found nothing. Can you direct me to where I can find something to give her?
Teri

Harlequin

Dr. Greene’s Answer:

I can almost imagine the scene – the intensity of labor gives way to the quiet exhilaration of those golden first moments of a baby’s life. Mom and baby are gazing at each other for the very first time, perhaps the little girl searching for and finding her mother’s breast. It is a time of newness and wonder.

And then Mom notices a bold line appearing down the middle of her daughter’s face. An icy feeling penetrates Mom’s chest. The line continues to spread relentlessly. The baby’s body quickly discolors into dark violet and sickly pale portions. Peace is shattered. What’s wrong with my baby?!?!?

We’ve all had moments of clenched fear about our children. It might be the moment of panic when our son has disappeared from sight in a busy store, or when we discover a lump that we fear is cancer. Perhaps we feel it when we helplessly watch our toddler stepping naively in front of a car, or hear the sickening thunk when our daughter’s head hits the floor. It might be a slowly building fear – she’s thirsty all the time (diabetes?), or he has frequent headaches (a brain tumor?). Or it might be a less dramatic fear: Is his speech behind? Is she eating well? Smart enough? Strong enough? Too active?

Whatever the source or the degree, these moments of fear shine piercingly to the core of our hearts and illuminate freshly how precious our little ones are to us.

I’m not surprised that this brand new mom found the harlequin color change frightening — it is quite dramatic.

Babies’ blood vessels start off highly reactive and unstable. A mild change in temperature or position or mood can cause swift changes in the diameters of the blood vessels, with resultant color changes of the overlying skin. The most extraordinary example of this is the harlequin effect.

A sharp line from the forehead to the pubis divides the body into 2 vertical halves. One side turns dark red, the other quite pale. The overall effect is reminiscent of the bold patches of color on a harlequin costume.

This rare but dramatic event only occurs in the immediate newborn period. It usually begins when the baby is positioned on her side. The upper half of the body becomes pale, and the lower half deep red. Changing her position can reverse the pattern. If she moves a lot, the muscle activity will erase the color changes (rather like shaking an Etch-a-sketch toy).

The harlequin color change is most common in low birthweight infants, but can occur in any child. Babies who experience this once will often take on the harlequin pattern multiple times.

Still, the condition is as temporary as being a newborn. You can confidently reassure the mom that the harlequin color change is entirely harmless. It has never been associated with any permanent problem. Mom can relax — and try to get pictures if possible. These would be great to show on the evening of her daughter’s rehearsal dinner for her wedding!

Throughout the journey of parenthood, new fears will arise. Whether the dangers are real or imagined, each fear can spark a heightened awareness of how precious our children are to us. Sometimes the days of their childhood slide by in a taken-for-granted blur. Fears make these moments stand vivid in time, even deepening our love. They can call us back to the golden scene where our dance of love began.

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Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Im 47 years old and mine never went away…it still gets extremely dark when I get very cold or hot…

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