You notice a few tiny red spots on your toddler’s skin while getting them ready for bed. At first, they look like a heat rash. But when you press on them, they don’t fade. Now what?
Rashes are common in children. Usually, rashes don’t need more than a little tender loving care until they fade away. Some rashes, however, should raise a red flag to get treatment and a non-blanching rash is one of them as it may mean something serious is happening inside your child’s body.
We spoke with Saisho Mangla, DO, a pediatrician with Banner Health. He explains what a non-blanching rash is, how to identify one and when your child needs prompt treatment.
What are non-blanching rashes?
Most rashes turn white or fade temporarily when you press on them. This is called blanching.
“A non-blanching rash does not fade or turn white when pressed,” Dr. Mangla said. “The rash stays red, purple or brown no matter how hard you press.”
A non-blanching rash is a sign of something happening in the body. It tells your provider that blood may have leaked from tiny blood vessels under the skin.
What do non-blanching rashes look like?
A non-blanching rash can look different depending on your toddler’s skin color. It might appear red, purple, brown, or bruise-like. It can look like someone flicked paint on your child’s skin or like tiny blood vessels have burst. On darker skin tones, the rash may look brown or darker than the surrounding skin and might be harder to see.
Some types of non-blanching rashes are:
- Petechiae: Small dots smaller than the tip of a pencil, less than 5mm. They may be red, purple or brown.
- Purpura: Slightly bigger spots or patches, like small bruises, measuring 5 to 10mm.
- Ecchymoses: Larger bruise-like patches over 1cm.
These rashes can look flat or a little raised
- May or may not itch
- May appear in small clusters or large patches
- May appear on the face, neck, chest, legs, buttocks, feet or other parts of the body
What causes a non-blanching rash in toddlers?
A non-blanching rash is a sign that blood has leaked under the skin. This can happen for different reasons.
Less serious causes:
- Forceful coughing or vomiting
- Minor injuries
- Viral infections like adenovirus
Serious causes that need urgent or emergency care include:
- Meningococcal disease
- Henoch-Schönlein purpura (HSP)
- Hemolytic uremic syndrome (HUS)
- Immune thrombocytopenic purpura (ITP)
- Leukemia
Meningococcal disease
Meningococcal disease is a serious type of meningitis. It's a bacterial infection that can spread through the blood and cause sepsis, which is life-threatening. It can kill a child within hours. At first, the rash appears as small red or purple spots. These spots can quickly grow into larger patches.
Other symptoms:
- High fever
- Stiff neck
- Extreme sleepiness or difficulty waking
- Sensitivity to light
- Vomiting
- Cold hands and feet
- Rapid breathing
Henoch-Schönlein purpura (HSP)
HSP, also known as IgA vasculitis, is a common cause of purple spots (purpura) in children under 10. It happens when small blood vessels become inflamed, often after a viral infection. HSP can be serious but usually isn’t life-threatening. Still, it requires prompt medical care.
The rash usually shows up on the legs and buttocks. It is often raised and feels bumpy.
Other symptoms include:
- Stomach pain
- Joint pain
- Blood in the urine
Hemolytic uremic syndrome (HUS)
HUS usually happens in children aged 6 months to 5 years. It often develops after an infection that causes diarrhea, especially bloody diarrhea. It can lower the number of platelets, which help the blood to clot, and can also affect the kidneys.
Other symptoms:
- Fever
- Belly pain
- Pale or jaundiced (yellowed) skin
Immune thrombocytopenia (ITP)
ITP is a condition where the immune system mistakenly attacks and destroys platelets, which are blood cells that help the blood clot. When there are fewer platelets, a child can bruise easily and might get small red or purple spots called petechiae.
Most children have the short-term form of this condition. It often happens after they have a viral infection. While it's not as serious as some other illnesses, it still needs to be watched carefully.
Other symptoms:
- Nosebleeds
- Bleeding gums
Leukemia
Rarely, a non-blanching rash and unexplained bruising can be signs of leukemia.
Other symptoms:
- Extreme tiredness
- Frequent infections
- Bone or joint pain
- Fever
- Pale skin
What is the glass test for a rash?
You can check the rash at home using the glass test. Take a clear glass and press its side gently but firmly against the rash. Look through the glass at the spot.
“If the rash gets lighter or disappears, it’s called blanching,” Dr. Mangla said. “If the rash stays visible and doesn’t fade, it might be non-blanching and should be checked by a health care provider.”
Non-blanching rash and fever: When to seek urgent care
A non-blanching rash with fever deserves prompt medical attention, especially if your child appears ill. While many children with fever have common viral illnesses, a non-blanching rash can sometimes occur with serious infections.
Go to the ER or call 911 if your toddler has a non-blanching rash and:
- Fever of 102°F (38.9°C) or higher
- Trouble breathing or fast breathing
- Extreme sleepiness, hard to wake up or not acting like themselves
- Seizure
- Stiff neck
- Signs of dehydration
- Severe headache
- Swelling of legs
- Repeated vomiting
- Blue, gray or mottled skin
Dr. Mangla noted that additional concerns include:
- Age younger than 6 months
- Incomplete immunizations
- Trouble moving the neck
- Rapidly spreading rash
Non-blanching rash without fever
A non-blanching rash without a fever isn't always an emergency but you should still talk to your child’s provider. The causes can be simple (like pressure on the skin) or they might need follow-up and treatment.
What happens during a medical evaluation?
If your toddler develops a non-blanching rash, your provider will start by asking questions about:
- When the rash appeared
- Whether it is spreading
- Recent illness
- Fever and other symptoms
- Medication use
- Vaccination history
They will look at the rash and check your vital signs. They might see if the rash is flat or raised and where it is on your body. They may also check for swollen joints, tummy pain, dehydration or infection.
Depending on your child’s symptoms, testing may include:
- Complete blood count (CBC)
- Blood cultures
- Comprehensive metabolic panel (CMP)
- Inflammatory marker tests
- Urine test to check the kidneys
- Blood pressure monitoring
Not all children need every test. The decision depends on your child’s age, symptoms and overall health.
Can a non-blanching rash go away on its own?
Some rashes that don't turn white when pressed may go away on their own but it’s important to know what's causing them.
Call your child’s provider if:
- The rash is new and does not fade when pressed
- The rash lasts more than a few days
- The rash spreads
- Your child has belly pain, joint pain or swelling
- You notice blood in the urine or stool (poop)
- Your child has frequent nosebleeds, bruising or bleeding gums
- Your child recently had a cold and now has a purple rash on their legs or buttocks
- You feel something is not right
Call 911 or go to the ER if:
- Your toddler has a fever and looks very sick
- The rash spreads quickly
- Your child is hard to wake up
- Your child has trouble breathing
- Your child has a stiff neck, seizure, confusion or severe headache
- Your child has signs of dehydration
- You are worried your child is seriously ill
Bottom line
A non-blanching rash is one that remains visible when pressed. It may appear as tiny red, purple or brown dots, spots or patches on the skin. Some causes are mild but others can be more serious. Because of this, a non-blanching rash should be checked by a health care provider, even if your child seems fine otherwise.
Make an appointment with Banner Children’s or go to a pediatric urgent care if your child develops a non-blanching rash. Seek emergency care for fever with serious illness, trouble breathing, a stiff neck, seizures or rapid rash spread.
Frequently asked questions about non-blanching rashes in toddlers
Is a non-blanching rash always serious?
No. Some non-blanching rashes are caused by coughing, vomiting or minor pressure. But because some causes are serious, a new non-blanching rash in a toddler should be checked by a health care provider.
What does it mean if a rash doesn’t fade when pressed?
A rash that does not fade when pressed may mean blood has leaked under the skin or small blood vessels are inflamed. This can cause tiny spots called petechiae or larger patches called purpura or ecchymoses.
Can teething cause a non-blanching rash?
Teething may cause drooling and irritation around the mouth but it should not cause a true non-blanching purple or red rash. If spots do not fade when pressed, contact your child’s provider.
Does HSP cause a non-blanching rash?
Yes. HSP (now often called IgA vasculitis) can cause a non-blanching purple rash, often on the legs and buttocks. It may also cause joint pain, swelling, belly pain or kidney changes.
Should I take my toddler to urgent care for a purple rash?
If your child has a purple rash that doesn’t fade when pressed, they should be seen by a health care provider. If the rash is accompanied by a fever, extreme sleepiness, difficulty breathing, stiff neck, severe headache or if it spreads quickly, go to the ER or call 911.
What are petechiae in toddlers?
Petechiae are very small red, purple or brown spots caused by bleeding under the skin. They do not fade when pressed and can have many causes, from straining to infections or blood-related problems.
What are purpura in toddlers?
Purpura are bigger patches on the skin that look red, purple, brown or bruise-like. They don't go away when pressed. If you notice new ones or if they are spreading, you should see a provider.
Can a non-blanching rash happen without fever?
Yes. A non-blanching rash can happen without a fever. It may still need medical evaluation, especially if it’s new, spreading or comes with joint pain, belly pain, swelling or unusual bruising.
