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Evaluation of pallor in children

Char Witmer, MD, MSCE
Catherine S Manno, MD
Section Editors
Gary R Fleisher, MD
Jan E Drutz, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will review the differential diagnosis and approach to children with pallor.

The approach to the child with anemia is discussed separately. (See "Approach to the child with anemia".)


The development of pallor can be acute and associated with a life-threatening illness, or it can be chronic and subtle, occasionally first noted by someone who sees the child less often than the parents. The onset of pallor can provoke anxiety for parents who are familiar with the descriptions of the presentation of leukemia in childhood. In some instances, only reassurance may be needed, as in the case of a light complexioned or fair-skinned, non-anemic child. In other instances, pallor may occur in patients with nonhematologic conditions such as shock, anaphylaxis, respiratory failure, or hypoglycemia. Even if there is a hematologic cause for the pallor, it often is a temporary condition readily amenable to therapy. However, pallor can portend a serious disease, and when onset is acute, it can herald a true pediatric emergency for which rapid diagnosis and treatment are needed.


Any condition that decreases the concentration of hemoglobin or alters the distribution of blood away from the body's surface may present as pallor (table 1). Clinically, pallor caused by anemia usually can be appreciated when the hemoglobin concentration is below 8 to 9 g/dL (4.96 to 5.56 mmol/L), although the complexion of the child and the rapidity of onset may influence this value.

The concentration of hemoglobin in the blood can be lowered by three basic mechanisms:

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Literature review current through: Nov 2017. | This topic last updated: Oct 25, 2016.
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