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Monday, August 28, 2006

Toddler with Yellow Skin

Dear Lisa,

I was looking at my 1 ½ year old son today and he looks a little yellow. His fingertips, feet, ears and the tip of his nose are yellowish-orange. He otherwise is a healthy little guy, he hasn’t been sick and has no problems eating or going to the bathroom. He’s not on any medication that could be causing any side effects. What could this be from?

“Son is yellow around the ears”,

Dear “Son is yellow around the ears”,

Many times the yellowish discoloration of a toddler’s skin is due to the type of food that he eats. Toddlers that eat a lot of orange vegetables may develop Carotonemia. Carotenemia is a benign condition that develops in children who ingest large amounts of Carotenoids over a long period of time. (1) Carotenoids are found in orange vegetables such as carrots, sweet potatoes and squash. Carotenemia is harmless and can be reversed by reducing the amount of orange vegetables in a child’s diet. (1) I found that if the amount of servings of orange vegetables is reduced to 2 to 3 times per week the yellowish-orange color of the child’s skin should disappear.

Jaundice is a different condition that involves the discoloration of the skin and sclera due to the build up of bilirubin. Children with jaundice develop yellow skin as well as yellow eyes. Therefore if the whites of a child’s eyes are yellow this would represent a more serious condition. Childhood conditions that cause jaundice include infections such as Hepatitis, Liver Disease, Hemolytic Anemia, medication side effects, prematurity, or bilirubin glucuronyl transferase enzyme deficiency. (2) If the whites of a child’s eyes are yellow this would require immediate medical attention.

Hepatitis is an inflammation of the liver caused by a virus;Hepatitis A Virus, Hepatitis B Virus, Hepatitis C virus or Hepatitis D virus. (3) Hepatitis A is spread through the fecal-oral route and is the least serious of the four types. (3) Hepatitis B is a blood borne pathogen which is transmitted through contact with bodily fluids, such as during unprotected sex, sharing of needles, contact with infected blood or from mother to child at birth.

The symptoms of Hepatitis include jaundice, fever, chills, fatigue, malaise, nausea, vomiting, anorexia, fever, abdominal pain, dark urine, pruritis (itchiness), acholic stools(light grey colored stools) and hepatomegaly(liver enlargement). (3) Many people with Hepatitis do not display any symptoms at all. (3) Interestingly, 70% of cases of Hepatitis A in children younger than 7 years old are subclinical or do not display symptoms. (4) Hepatitis is of a great concern because chronic Hepatitis B infection usually leads to liver inflammation and can progress to cirrhosis and liver cancer. (3,5)

If a child demonstrates orange discoloration localized to only his hands, you may want to review the amount and type of hand soap used. An interesting case documented in the literature describes a young adult female with an orange discoloration only on her hands. It turns out that she had an obsessive compulsive disorder which resulted in repetitive hand washing with an orange colored anti-bacterial hand soap. As a result her hands became stained orange. (6)

If you baby’s yellow discoloration is limited to his skin and his eyes remain white, you can try to limit the amount of orange vegetables that he consumes. After a few weeks you should notice that the yellowish color has dissipated. If it is too difficult to discern if your child’s eyes are yellow, it would be a good idea to have him checked by a health care professional. From the description that you gave, it sounds like your son is healthy and not exhibiting signs of Hepatitis or other conditions that present with jaundice. If your son develops changes in his feeding pattern, irritability, vomiting, abdominal pain, fever, flu like symptoms, light colored stools, dark urine, yellow eyes or has been exposed to someone with Hepatitis he should be examined by his doctor.

(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc 1990:22-23.

(2)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:748-749.
(3)Holloway M, D’Acunto K. An update on the ABC’s of viral hepatitis. 2006. The Clinical Advisor. June:29-39.
(4)Brunell P. New hepatitis recommendations issued. Infectious Diseases in Children. 2006. June:4-5.
(5)Infectious Diseases in children. High Hepatitis B infection rate found among NYC’s Asian American Community. 2006. June.20.
(6)Adams D. Orange pigmentation and other skin clues. The Clinical Advisor. 2006. August:111-112.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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