When a child is referred to my clinic I have one job. I have to prove that they have cancer or not. That’s my job. Is childhood cancer rare? In the grand scheme of diseases yes..but 1 in 285 children will develop cancer before they reach age 20 (0.3% chance to save you from the math). Every day the hospital and clinic are packed with kids getting cancer treatment. So to me , cancer doesn’t seem that rare.
The other part of my job as a physician is to look at a problem and anticipate what is the worst thing that could happen – and then try to prevent that from happening or at least be prepared for it. Well, herein lies a little problem. Sometimes when my own children are sick, my mind will automatically jump to the worst case scenario. It’s second nature and it can be anxiety provoking.
When my daughter was a baby she had petechiae around her eyes. Petechiae are tiny little blood vessels that have ruptured and results in little micro-bleeds into the skin. Here is a picture of petechiae around the eyes of a child.
Now, in my rational head, I knew that petechiae could be caused by a lot of things and the most common cause of facial petechiae in children is from forceful vomiting. At the time my daughter was maybe 7 months old and she sure wasn’t experiencing forceful vomiting, so my mind jumped to the worst case scenario. At worst, she could have had leukemia, as petechiae are common in children with leukemia because the platelets (blood cells that help stop bleeding) are often very low. At best case I figured she had ITP which is an immune mediated disorder that destroys platelets. The next day she had more petechiae around her eyes and I caved and emailed my pediatrician for her thoughts because she has the luxury of seeing “normal” kids every day that don’t have cancer. Her response to me was a simple question.
“Does she rub her eyes when she’s tired?”
Ummm…well didn’t I feel silly? She did indeed rub her eyes all of the time when she was tired. The delicate skin around the eyes is easy to damage and the rubbing along with her alabaster skin caused the petechiae to form and be seen quite easily. Thank goodness for good pediatricians.
This “knowing too much” phenomenon can be detrimental as above, but sometimes it can also be very helpful. When my son was an infant, my husband, myself, and my daughter all caught a nasty summer cold. I tried very hard to keep him separate from the rest of us because as I commented to my husband, “I don’t want him to get meningitis”. {my husband thought I was crazy} August 21st, the day my daughter started preschool and about a week and half before Hurricane Harvey hit, he just didn’t seem right. He was sleeping more and he seemed to be in pain when I picked him up. I took his temperature at it was 100.6 F – not terribly high. I immediately started packing things up to go to the hospital, including clothes for an overnight stay. Indeed, he had the same virus we had all had, and his poor little body couldn’t keep it out of his brain. He had viral meningitis. He spent a week in the hospital and seems to have no lasting effects.
This is the life of a Doctor Mom.
Thank you for this article.
I have a daughter who is a year and a half, and has Down syndrome. She is particularly prone to petechia because collagen is regulated by the 21st chromosome, so of course her extra copy affects her skin significantly. Unfortunately, she also has a 15-30 fold increase in her likelihood of developing childhood leukemia, so I have taken her for countless CBCs, due to petechia.
She recently had her first ever infection; an ear infection, and was prescribed Amoxicillin, to which she developed a macropapular rash, not allergic in nature. She is concurrently teething, having several teeth coming in very slowly (poor girl!). Her favorite method for dealing with teething is to chew her hand and grind her thumb into her gums quite aggressively! This leads to a lot of friction from the rest of her hand on her cheeks. Simultaneously, she is almost 2, and wants to be more independent, and this is an age where all children seem to experience a lot of frustration where their desires to perform certain functions outstrip their physical abilities. All my children had hair trigger tempers at this age! So she’s recently began registering her dissatisfaction at things like spoon feeding by turning as red as a beet and screaming at the top of her lungs.
Of course, this would be the time that she develops petechia…
A very diffuse smattering of single petechia here and there on her body where her Amoxicillin rash was most pronounced, a diffuse concentration on her cheek where she usually rests her hand when she teethes on it (yes, she has many teethers but prefers her hand and immediately defeats the teething mitts) appeared during this time. My immediate response is to worry about leukemia, but she is a well baby. Not febrile. No bruising. She has a fantastic appetite, is very active and attentive, and a happy kid! She’s growing and developing and sleeping a completely appropriate amount; a 2 hour nap in the afternoon, and high quality consistent sleep without apnea from 8pm-6am. Amoxicillin can contribute to petechia. So can friction. So can screaming! Even the infant Motrin that she took during her ear infection and to ameliorate her gum pain can contribute to them. And while it is not a common side effect of the omleprazole, it is a rarely reported side effect, and she has been on this medication since birth… and oh yeah, Down syndrome affects her collagen.
Of course, rationally I know there are many reasons she may have a few petechia at the moment. All indications are that she is a well baby, and when I brought up my concerns with the doctor she saw I’m emergency, his reaction was “She is consolable, so alert and STRONG! This is a well baby, minus the ear infection!” But petechia are scary! I get scared every time.
My 4 year old keeps getting petechia around 1 eye. She had it on her back and her ear too (at least that’s what I think it was) but those went away and never returned but she has had a single petechia under her eye 2-3 times now. Tonight I noticed 5 petechia, 1 under her eyelid and 4 above. I’ve been freaking out from googling. The doctor looked at her single one a few weeks ago and said she wasn’t concerned. But now that there’s multiple I’m so worried. But she does indeed run her eyes constantly due to a lot of allergies, she cries HARD when she’s upset, and she throws up a lot (like every other day) due to her crying hard and throwing up. She will be 4 next month. This made me feel a little better but I am still going to show her pediatrician the videos I took of the petechia just in case. Also she just had blood work done last week and everything was fine.