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Column originally published Jun 20, 2005

Raynaud’s Phenomenon Can Cause Hands And Feet To Turn White And Blue

Question: Our eighteen-month-old daughter has a strange problem. Her feet turns dark blue almost every day, especially during the winter months. Lately, she cries and wants me to pick her up when she walks barefeet on the kitchen floor. We also noticed that sometimes she also turns blue in her fingers. When we put her in a warm tub of water, her feet will turn beef-red in colour. We are concerned that she may have some serious medical problem, although she seems to be perfectly healthy otherwise. Please advise us what we should do.


You have given me a very good description of a medical condition that is called Raynaud’s phenomenon. However, it doesn’t happen very often in young children like her; therefore, most people would never have heard of it, and would worry that there is a serious medical problem.

Since Raynaud’s phenomenon occurs mostly in older children and adults, I will begin by explaining about it in the older age group, and then discuss about your daughter’s situation.

Raynaud’s phenomenon refers to a change of colour, usually in the extremities. The hands are most frequently affected, although it can occur more frequently in the toes and feet of young children. Other areas that can be involved include the ears, tip of the nose, as well as the lips.

An attack of Raynaud’s typically consists of three distinctive phases. At the beginning, there is severe spasm of the small arteries that supply blood to the fingers. As a result, very little or no blood can get through, resulting in the fingers turning very pale or completely white in colour. The fingers feel very cold to touch and there can be pain as well as tingling feeling.

After a period of time, the muscle surrounding the arteries starts to relax, and some blood begins to flow, although slowly, into the fingers. Because the blood is flowing much slower than normal, less oxygen goes to the fingers. As a result, the fingers would turn from white to dark purple in colour.

When the hands warm up, the muscle around the arteries become fully relaxed, allowing more blood to flow into the fingers, turning them to a bright red colour. This is the final phase of Raynaud’s.

As you have already noticed, the most common trigger of Raynaud’s phenomenon is exposure to cold temperature. However, many adults recognize that stress or emotion can also induce an attack of Raynaud’s.

For many, Raynaud’s phenomenon is an isolated medical condition. Some develop Raynaud’s as a result of taking certain medications that cause spasm of small blood vessels. When they stop these medications, Raynaud’s resolves completely.

There are others who develop Raynaud’s as a result of using vibratory tools daily. These tools include pneumatic hammers, chain saws, sanders, grinders, and even sewing machines. These vibratory tools somehow stimulate the nerves that control the calibre of the blood vessels to the fingers. When exposed to cold temperature, the blood vessels go into spasm, resulting in a Raynaud’s attack.

I should caution here that this doesn’t mean everyone who uses these tools will develop Raynaud’s. It can happen to those who use these tools very frequently. If a person develops symptoms of Raynaud’s, one should stop using the vibratory tools, otherwise the danger of developing frequent Raynaud’s attack becomes very high.

There is another group of medical conditions that can have Raynaud’s phenomenon as part of the symptoms. It is called connective tissue disorder, which includes such conditions as rheumatoid arthritis, scleroderma, lupus, and others.

By itself, Raynaud’s is not dangerous, although it is rather painful during an attack. The greatest danger is damage to the tissues in the fingers and toes, because of a lack of blood supply during one of these attacks. The combination of poor blood supply and cold temperature can result in severe gangrene and loss of fingers and toes.

Therefore it is most important to prevent Raynaud’s from occurring. This is especially true in winter time. As expected, keeping the hands and feet warm when going outside is a priority. This would include putting on mittens, and even double gloves. Sometimes using small packages of chemical warmer or battery-powered warmer inside the gloves can keep the hands warm.

Wearing good socks and proper footwear are important to prevent the feet from developing a Raynaud’s attack. It is important to avoid snow getting inside the shoes or socks. When the snow melts, the evaporating water will take away whatever little heat that is there, and chill the foot and toes even more.

In addition, it is also important to keep the body warm. In this way, more blood will circulate to the extremities, and keep the fingers and toes warm, preventing a Raynaud’s attack.

In your daughter’s situation, although you haven’t seen the first phase of Raynaud’s phenomenon, the dark bluish colour when her feet are cold and the intense red colour in warm water points to the medical problem. Obviously she is experiencing pain in her feet when she walks on the cushioned floor of your kitchen.

Although Raynaud’s is not common at this age, it can still happen. As I have explained earlier, the most important thing for you to do is to prevent her hands and feet from getting cold. This is important even when she is indoors. You should try to put socks and shoes on her feet when she walks around inside the house. Dress her warmly when she goes outside, put a hat on her head, and always put mittens on her hands unless the weather is warm.

It is also important to watch whether she develops any pain when she eats food that is cold, like popsicles and ice cream. Raynaud’s can affect the esophagus, the tube that brings food from the mouth into the stomach.

Although connective tissue disorder is uncommon in young children, it is important to watch for symptoms relating to these conditions together with your doctor. She should have regular examination by your doctor to make sure that she is not developing any other medical conditions.

I hope the above advice is helpful for you.