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?

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.

Dr. Alan Greene

Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.

Get Dr. Greene's Wellness Recommendations

Sign up now for a delightful weekly email with insights for the whole family.

  1. shoana

    so this is a skin related problem. I have a dark line that runs down almost my whole body,from the middle of my chin but not my neck and it changes colour to a wide noticeable white line between my breast and gets darker the lower it runs down, even past my abdomen and hipbones. it basically halfs my whole body. I also have a line on my arms that divide my arms skin tone. I’m 21 and dark skinned but the lines are very noticeable and I was born with the lines. what is the condition and cause ? if anyone has the same problem let me know

  2. Don Cope

    Dr. Green,
    I have a son who is 28 years old who was born with a harlequin splitting his body in half right after breast feeding. The pediatric neurologist put him on phenobarbital for his first year and during that time the condition stopped. He has not had another event since but he grew up as a slow learner, almost like there is a learning disorder, unable to connect the dots at times. Recently (in the past year and a half) he suffers from lose of memory, anxiety when he is unable to process what is happening in his surroundings. We have had him to a psychiatrist recently and the group performed a test where leads were connected to his head and he went through many tests to see how his brain functions under these conditions. They mentioned the possibility of a condition called wernicke encephalopathy, a Thiamine (vitamin B-1) deficiency might be the problem and he is scheduled for a test. In your reading of medical papers or have you written one surrounding any correlation between a harlequin disorder and wernicke encephalopathy?

  3. cindy

    My daughter when born had a line down her nose. Over the years the line faded. My daughter is now 21yrs. old and expecting her own child. I was looking at her belly and her has a line going down her stomach. Should she be concerned?

  4. Don

    When my wife (48yrs old) came in from the sauna today we noticed that the left side of her face was red with a distinct line right down the middle and her right side was white. It cleared up in approx.1/2 hr. Only thing she has had recently is a flu shot yesterday and she started using a machine recently from Rebuilder Medical that you stick pads on her feet and it pulses at a Freq.7.83HZ for 30 min. It has helped her feet and lower back where she has two bad disc’s. Any ideas what this might have been?

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


Got an idea, tip or a comment?

Your email address will not be published. Required fields are marked *