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This is a life-threatening emergency. Call 911 immediately, then follow these steps while waiting for help.

Blue Baby (Cyanosis)

Content reviewed against published AAP, AHA, NIH guidelines

Editorial policy

Last reviewed:

Cyanosis — a blue or purple coloring of the skin, lips, or nail beds — indicates the baby is not getting enough oxygen. Central cyanosis (blue lips, tongue, or trunk) is always a medical emergency requiring immediate action.

Immediate actions

  • Call 911 immediately
  • Call 911 immediately if baby's lips, tongue, or trunk appear blue or purple
  • DO NOT: Do NOT ignore blue discoloration of lips or tongue — this is always serious

Step-by-Step Response

1

Identify the type of cyanosis

Central cyanosis (blue lips, tongue, trunk) = emergency. Peripheral cyanosis (just blue hands/feet in a newborn who is otherwise well) may be normal in first 48 hours but should still be evaluated.

2

Call 911

If baby has blue lips, tongue, or trunk, call 911 immediately. Every minute without adequate oxygen can cause harm.

3

Check airway and breathing

Is baby breathing? Is there anything blocking the airway? If not breathing, begin infant CPR immediately.

4

Position baby

Hold baby in a slightly upright position to ease breathing, unless CPR is needed (then flat on back). Keep the head in a neutral position to maintain an open airway.

5

Remove restrictive clothing

Loosen any tight clothing around the neck and chest to allow easier breathing. Keep baby warm with a blanket.

6

Monitor and note symptoms

Note: when it started, whether it comes and goes, if baby was feeding or crying, and any other symptoms like grunting, flaring nostrils, or chest retractions.

7

Prepare for EMS

Gather baby's medical information. Note any known heart conditions. Be ready to describe what happened and timeline of symptoms.

What NOT to Do

  • ✕Do NOT ignore blue discoloration of lips or tongue — this is always serious
  • ✕Do NOT confuse peripheral cyanosis (blue hands/feet in newborns) with central cyanosis
  • ✕Do NOT try to feed a baby who is blue and struggling to breathe
  • ✕Do NOT delay calling 911 to "wait and see"
  • ✕Do NOT assume it will resolve on its own

When to Seek Help

Call 911 if:

  • Blue or purple lips, tongue, or gums
  • Blue or dusky skin on trunk or face
  • Baby is struggling to breathe or not breathing
  • Baby is limp or unresponsive with blue coloring
  • Cyanosis that does not improve when baby is warmed
  • Blue color appearing during or after feeding with choking

Go to ER if:

  • Any episode of central cyanosis (blue lips/tongue) even if it resolved
  • Baby has recurrent episodes of turning blue
  • Blue color associated with feeding difficulties
  • Known heart defect with new or worsening blue color
  • Cyanosis with lethargy or poor feeding

Call your doctor if:

  • Baby's hands and feet appear blue but lips and tongue are pink (in first few days of life)
  • Brief blue color around mouth that resolves quickly with stimulation
  • Baby appears blue only during crying episodes (breath-holding spells in toddlers)
  • Any episode of cyanosis, even if it resolved, needs medical follow-up

Age-Specific Guidance

0-48 hours

Mild peripheral cyanosis (acrocyanosis) of hands and feet is common and usually normal in the first 48 hours. Central cyanosis (lips, tongue) is NEVER normal and may indicate a congenital heart defect or respiratory problem.

2 days - 6 months

New cyanosis at this age could indicate a heart defect, respiratory infection (RSV, bronchiolitis), or airway obstruction. Some heart defects present days to weeks after birth as fetal circulation changes.

6 months - 3 years

Cyanosis may result from choking, asthma, croup, pneumonia, or breath-holding spells. Breath-holding spells (turning blue during intense crying) are usually benign but should be evaluated on first occurrence.

Prevention

  • Attend all prenatal appointments — many heart defects are detected before birth
  • Ensure newborn pulse oximetry screening is completed before hospital discharge
  • Know the signs of congenital heart disease: blue skin, poor feeding, rapid breathing, poor weight gain
  • Keep follow-up appointments for babies with known heart conditions
  • Ensure safe sleep practices to prevent suffocation
  • Do not smoke around baby — secondhand smoke impairs oxygen delivery

Frequently asked questions

Should I call 911 for blue baby (cyanosis)?
Yes. Blue or purple lips, tongue, or gums
What should I do first?
Call 911 immediately if baby's lips, tongue, or trunk appear blue or purple. Check if baby is breathing — if not, begin CPR. Clear any obstructions from the airway. Keep baby warm but do not overheat
What should I NOT do?
Do NOT ignore blue discoloration of lips or tongue — this is always serious. Do NOT confuse peripheral cyanosis (blue hands/feet in newborns) with central cyanosis. Do NOT try to feed a baby who is blue and struggling to breathe. Do NOT delay calling 911 to "wait and see". Do NOT assume it will resolve on its own
How can I prevent this?
Attend all prenatal appointments — many heart defects are detected before birth. Ensure newborn pulse oximetry screening is completed before hospital discharge. Know the signs of congenital heart disease: blue skin, poor feeding, rapid breathing, poor weight gain

Sources

AAPAHANIH

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources

Related Emergency Guides

breathing emergencychoking infantunresponsive babycpr infant

Bottom line

This is a serious emergency. Always call 911 first, then follow the steps above while help is on the way.

You are doing the right thing by learning what to do in an emergency. Being prepared is one of the best things you can do for your child.