How is Blue Baby Syndrome Treated?

Marjorie McAtee

Blue baby syndrome, or methemoglobinemia, is a disorder of the blood that can occur in babies exposed to high levels of nitrates in drinking water. The disorder that usually occurs when nitrates in the blood form chemical bonds with hemoglobin, forming methemoglobin. Methemoglobin generally can't carry adequate amounts of oxygen to the cells of the body. Babies with this syndrome typically suffer from low blood-oxygen levels, which can cause the skin of the feet, hands and face to take on a blue tint, and it can also cause vomiting, diarrhea, and, in severe cases, death. Mild cases of this condition are often treated by removing nitrate-contaminated water from the baby's diet, while more severe cases might require medication.

Babies who develop blue baby syndrome may only show mild symptoms.
Babies who develop blue baby syndrome may only show mild symptoms.

According to the United States Environmental Protection Agency (EPA), nitrate levels of more than ten parts per million in drinking water could be unsafe. Babies who develop blue baby syndrome are generally those who must rely on wells or other natural sources for drinking water. Nitrates often enter these sources of drinking water through surface run-off, usually from barnyards or septic systems. The EPA generally recommends that all sources of drinking water be located at least 100 feet (30.5 meters) away from septic systems, cesspools, barnyards, and other potential sources of nitrate contamination.

All sources of drinking water should be located at least 100 feet away from barnyards.
All sources of drinking water should be located at least 100 feet away from barnyards.

Babies who develop this condition may not seem terribly unhealthy. Many babies show only mild symptoms, which include blueness of the face, feet, and hands. In some babies, the face, feet, and hands may take on a purplish tint. Difficulty breathing can occur, as can vomiting and diarrhea. Methemoglobinemia doesn't typically afflict adults.

The most common cause of blue baby syndrome is a congenital heart problem.
The most common cause of blue baby syndrome is a congenital heart problem.

Blood taken from babies with methemoglobinemia may appear dark brown in hue, rather than bright red. Babies severely affected by the syndrome may become extremely lethargic, drool, and lose consciousness. Seizures and death are a possible outcome.

Mild cases of blue baby syndrome are often treated simply by removing contaminated water from the baby's diet. It can be incredibly difficult, time-consuming, and expensive to purify drinking water contaminated by nitrates, so most experts recommend simply finding another source of drinking water.

Removing contaminated water from the baby's diet is often all that is needed to treat this disease. Blood-oxygen levels typically begin to rise to normal within two or three days. Injections of methylene blue can increase blood hemoglobin and blood-oxygen levels in severely affected babies.

Babies severely affected by blue baby syndrome may drool.
Babies severely affected by blue baby syndrome may drool.

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Discussion Comments


@ysmina-- My sister was told that it's most likely due to run-off from farm land. The well is not in close proximity to a septic system and since they live on a farm and have neighboring farms, this is the best guess.

I think nitrate is found in fertilizer so it might be seeping into the well water through the farm soil.

Anyway, they're not going to worry about it because they won't use the well water for anything other than watering their plants. They have a new pipeline put in, but they've been purchasing spring water just in case.


@burcidi-- Yea, a relative of mine had the same experience. You would think that most well waters are clean in a rural environment, but clearly that's not the case. Do you know what was the source for the nitrate contamination in your well water?

By the way, the blue baby disease or syndrome can also be caused by a genetic abnormality with the heart. If the heart isn't functioning properly or if there is an issue with the blood vessels, this can affect the oxygen in the blood and cause blue baby syndrome too.

If that's they case, I guess the only treatment is surgery and medications to fix the abnormality. But I imagine that doctors would first want to cross out nitrate poisoning from the list before they check for heart issues.

It's always a good idea to make sure that the baby is having clean food and drinks and to visit the hospital as soon as possible.


My sister lives in a rural area and my nephew had blue baby syndrome because the well water they were using had too much nitrates. They weren't aware of this because they had never gotten affected or sick by it themselves. But when my nephew's mouth and eye area started to turn purple, they took him to the doctor right away who said that there was less than desired amount of oxygen in his blood.

The well water was tested that week and they discovered that it is high in nitrates. The whole family switched to store-bought water after that and my nephew's color went back to normal in a couple of days.

I think he was lucky because the condition wasn't serious and it was caught early on.

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