What Is Baby Mottling? Causes, Concerns, and When to Worry

Baby mottling is a common skin pattern in infants caused by immature circulation. Learn what’s normal, when to worry, and how to manage it at home.

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By Joey PedrasApr 8, 20250 comments

What Is Baby Mottling?

Baby mottling refers to a distinctive blotchy or marbled pattern that can appear on a newborn’s skin. If you’ve ever noticed your baby’s skin taking on a patchy, lace-like pattern of pinkish-blue or red-purple spots, you’ve seen mottling. The pattern often looks like a web or fishnet under the skin – with areas of paleness intermingled with darker bluish or reddish areas. Mottled skin can sometimes be surprising or alarming to new parents, but it is actually a fairly common observation in infants. In many cases, it is temporary and harmless, but it’s important to understand when it’s normal and when it might signal something more serious.

Doctors sometimes call this normal mottled skin pattern cutis marmorata, which literally means “marbled skin.” This term simply describes the marbled appearance and is not a disease. Another term you might hear is livedo reticularis, which is a broader term for a lace-like discoloration of the skin. In babies, the common form of livedo reticularis is the normal, temporary type related to temperature changes. The key takeaway is that mottling by itself is not a rash or an infection, but rather a color change due to how blood is flowing in the skin.

Why Does Mottling Happen in Babies?

The most common cause of mottling in infants is circulation adjustments and temperature changes. Newborn babies have an immature circulatory system, meaning the system that controls blood flow and temperature regulation in the skin is still developing. In a baby, the tiny blood vessels in the skin (capillaries) may constrict and expand unevenly, especially in response to cold. This uneven blood flow creates the mottled pattern.

Immature blood circulation: In newborns, nerves and blood vessels aren’t fully developed or fine-tuned yet. As a result, a baby’s body might send more blood to vital organs (like the brain and lungs) and temporarily less to the skin in certain areas. This “instability” of blood circulation at the skin’s surface can make the skin look patchy red and pale. As the baby’s nervous system and blood flow regulation mature over the first months of life, this effect usually lessens.
Response to cold: Mottling is often most noticeable when a baby is cold or in a cool environment. Exposure to cold temperature causes the skin’s blood vessels to constrict (narrow) as the body tries to conserve heat. Many parents first see mottling during a diaper change in a cool room or after a bath, when the baby’s skin is exposed to cooler air. The cooler skin temperature triggers that lacy, blue-pink marbling on the arms, legs, or trunk. Warming the baby’s skin usually makes this mottled pattern fade away as blood flow returns.
Normal newborn adjustment: Just being a newborn is a factor – babies are adjusting from the warm environment of the womb to the outside world. Nearly all newborns have some color variations as they adjust. For example, it’s common for a newborn’s hands and feet to appear bluish (a normal condition called acrocyanosis) because of circulation changes. Likewise, a degree of mottling (that red-blue lacy look) can happen simply because a baby’s blood flow is still figuring things out. This kind of mottling is considered a normal physiological response in infancy.

Bottom line: In many cases, mottled skin happens because of an immature circulatory system and temperature changes, not because the baby is in pain or in danger. The pattern often disappears once the baby warms up or calms down. It’s one of those quirks of newborn skin that tends to improve with time.

When Is Mottling Considered Normal?

Mottling in babies is often normal, especially under certain conditions. Here’s how to recognize normal mottling:

Occurs with cold and goes away with warmth: Normal baby mottling (cutis marmorata) typically appears when the baby is chilly and fades once the baby is warmed up. For example, you might see a newborn’s belly or legs look marbled during a diaper change or if the room is cool. Once you swaddle the baby, put on clothes, or bring them skin-to-skin to warm up, the blotchy pattern should resolve within minutes as circulation evens out. This transient nature is a key sign that it’s a normal response to temperature.
Baby otherwise appears well: If the baby has normal skin color (pinkish) in between episodes of mottling, and is acting well – feeding, breathing, and behaving normally – the mottling is likely not a sign of illness. Many healthy infants have cool, mottled hands and feet from time to time, especially in the first days and weeks. Activity level can also affect skin color; sometimes just a stretching or a position change can alter how blood flows in the skin. As long as the baby quickly pinks up again and is alert or comfortably sleeping, it’s usually fine.
Common in first few months: This kind of mottled, blotchy skin is especially common in newborns and young infants. It’s estimated that most newborns (and up to half of all children) will show cutis marmorata at some point in infancy. Parents often notice it off and on during the first 6 months of life. As the baby’s circulatory system matures and the skin gets a bit thicker, these color fluctuations tend to happen less frequently. In fact, mottling usually doesn’t occur past 6 months of age in otherwise healthy babies. If your baby is under six months and the mottling fits the “comes and goes with cold” pattern, it’s likely a normal variant.
No other symptoms: Normal mottling isn’t accompanied by concerning symptoms. The baby’s breathing, heart rate, and temperature are normal. The skin, although blotchy, is warm to touch (once the baby is warmed up) and the baby isn’t extremely pale or blue overall. The mottled patches are usually symmetric (for example, both legs might have a similar marbled look).

It’s helpful to remember that newborn skin can be quite dramatic in its color changes – newborns can flush red when crying, get pale when hungry or cold, have blue hands and feet in a cool room, then look completely normal a short while later. Mottling is one part of that range of normal color changes. If the mottling easily goes away and your infant seems content, it is generally considered a normal occurrence of early infancy.

(Note: Harmless mottling should be distinguished from acrocyanosis, which is a bluish color of the hands and feet, and from true cyanosis, which is a blue color of the face or trunk due to lack of oxygen. It’s normal for hands/feet to be a bit blue in a cool baby, but a baby should never be blue around the lips or face. Blue coloring around the mouth or torso is not mottling and warrants immediate medical attention.)

When Might Mottling Be a Sign of a Problem?

While most mottling in infants is benign, there are times when mottled skin can indicate an underlying issue. It’s important to know the difference. You should be more cautious or concerned about mottling if you notice any of the following:

Mottling at warm temperatures: If your baby’s skin stays mottled even when they are warm and comfortable, or the mottling doesn’t fade away with warming or repositioning, it may signal something abnormal. Persistent mottling (not just fleeting color change) is not typical in a warm, healthy infant.
Baby appears ill or unusual: Trust your parental instincts – if your baby looks or acts sick along with the mottled skin, take it seriously. For example, if the mottling is accompanied by lethargy (excessive sleepiness, difficulty waking), poor feeding, irritability, or a temperature that’s too high or too low, it could mean the baby is unwell. Mottling in a baby who is also feverish or very cold to touch might point to an infection or other systemic problem causing circulation changes. Always check your baby’s temperature if you see unexplained mottling; an abnormal temperature reading together with mottled, pale skin is a red flag that merits a call to the doctor.
Pale or blue overall tone: In concerning cases of mottling, you might notice that in between the blotchy red-blue patches, the baby’s skin is very pale (this is called pallor) or the baby has a general dusky tone. For instance, the Saint Luke’s Health System notes that mottling with overall paleness can be associated with illness in a newborn. If your baby’s complexion looks ashen or whitish with the mottled pattern (instead of the normal rosy tones), it could mean reduced blood flow or oxygen – which is not just the simple cold-related mottling anymore.
Other signs of circulatory or breathing problems: Look for any difficulty breathing, fast breathing, or a blue tinge around the lips (central cyanosis). Mottling combined with trouble breathing or a blue face can indicate a serious problem like a heart issue or lung issue. Also, if the baby’s hands and feet are not just cool but cold and clammy, and the baby is very fussy or very sleepy, this combination could point to poor circulation.
Occurs beyond infancy: If a marbled skin pattern continues frequently beyond 6 months of age, it’s less likely to be the normal infant mottling. Persistent mottling in older babies could indicate an underlying health issue that needs evaluation. For example, unusual mottling that doesn’t improve might be seen with certain conditions (more on this below). As babies grow, their circulatory system becomes more stable, so mottling should diminish. Continuing mottled skin in an older baby or toddler should be brought to a pediatrician’s attention.

In summary, mottling that is persistent, accompanies other symptoms, or just makes your baby look “not right” warrants caution. Occasional cold-induced mottling is one thing, but a baby who is mottled and also ill-appearing needs prompt evaluation. Next, we’ll discuss some specific conditions that can cause abnormal mottling.

Possible Medical Causes of Mottling

While rare in comparison to normal causes, several medical conditions can lead to a mottled appearance in a baby’s skin. If mottling is due to an underlying issue, it’s usually because that issue is affecting the baby’s circulation or oxygenation. Here are some conditions associated with mottled skin:

Severe Infection (Sepsis): A significant infection in the bloodstream can cause a baby’s skin to become pale, cold, and mottled. Sepsis is a medical term for a body-wide infection that can lead to septic shock – a dangerous drop in blood pressure and blood flow. In septic shock, blood is shunted away from the skin toward vital organs, and the lack of blood flow causes a mottled, bluish complexion. If a baby has an infection like sepsis, you might see mottling along with symptoms such as fever or abnormally low temperature, rapid breathing, or extreme lethargy. Blotchy or discolored skin is listed as a warning sign of sepsis in infants. The mottling in this case is a sign of the baby’s circulation being compromised by illness. This is an emergency – immediate medical care is needed if sepsis is suspected.
Congenital Heart Disease: Certain heart defects present from birth can cause a baby’s blood to not circulate or oxygenate properly. For example, serious congenital heart diseases that affect blood flow (like defects that prevent enough blood from reaching the body or the lungs) can lead to a mottled, pale, or bluish skin tone. If the heart isn’t effectively pumping oxygen-rich blood to the skin, a lacy blue-red pattern may appear, especially on the extremities. Newborns with critical heart conditions may have mottled or cool skin as a sign of poor perfusion (blood flow). Often, these babies will also show other signs like trouble breathing, poor feeding, or a blue color around the mouth. Mottling due to heart disease would persist even when the baby is warm, because it’s caused by internal circulation issues rather than external temperature. If a baby has unexplained persistent mottling, a doctor might check for heart murmurs or other indications of a cardiac problem. (Fortunately, most serious heart conditions are screened for at birth with tests like pulse oximetry, but it’s good to stay alert for signs.)
Poor Circulation or Shock: Any situation where a baby has poor circulation can lead to mottled skin. This could be due to dehydration, blood loss, or other forms of shock (where blood pressure drops). In a dehydrated or shocky infant, the body tries to conserve blood for vital organs, and the skin gets less blood flow, becoming pale and blotchy. The skin may feel cold and clammy. For instance, if a baby were extremely dehydrated from vomiting/diarrhea, they might have mottled skin along with sunken eyes and less wet diapers. These scenarios are emergencies – they require medical treatment to restore the baby’s fluids and circulation.
Prematurity: Babies born prematurely often have thinner skin and even less mature control of blood vessels. Mottling is not uncommon in premature or ill babies in the neonatal intensive care unit (NICU), because their bodies are under stress or still developing. In preemies, mottling might be more frequent or pronounced. Doctors and nurses monitor these babies closely, so any persistent mottling would be evaluated in the hospital setting. If your baby was premature, you might continue to see some mottling at home until they grow a bit bigger – but always report if it seems excessive or if the baby seems unwell.
Endocrine or Genetic Disorders: Rarely, mottled skin can be associated with specific medical conditions:
- Congenital hypothyroidism: Babies born with an underactive thyroid gland (a condition usually detected on newborn screening) can have symptoms like persistent cool, mottled skin. Low thyroid hormone can make circulation sluggish and skin dry and mottled. This is uncommon because these infants are typically diagnosed and treated early, but it’s one example of an underlying disorder that can affect skin appearance.
- Genetic syndromes: Certain genetic conditions (such as Down syndrome (trisomy 21) or Edwards syndrome (trisomy 18)) have been noted to show a higher incidence of cutis marmorata in infancy. The mottling itself isn’t harmful, but it might be one of many features associated with these syndromes. If your child had one of these conditions, your pediatrician would likely discuss the various signs with you.
- CMTC (Cutis Marmorata Telangiectatica Congenita): This is a very rare vascular birthmark condition in which a baby is born with a persistent mottled pattern on the skin. Unlike ordinary cutis marmorata, the marbling in CMTC does not go away with warming and can be more intense or localized. A baby with CMTC has a purple, netlike pattern visible on the skin at all times. The pattern might affect one limb, or large areas of the body. CMTC is usually evident at birth or shortly thereafter, and while it often improves as the child grows, it needs evaluation by specialists because it can be associated with other abnormalities in about half of cases. Again, this condition is very rare – most doctors will never encounter it – but it is a specific medical cause of mottling to be aware of in differential diagnosis.

It’s worth emphasizing that these medical causes are much less common than the everyday benign mottling caused by temperature or immature circulation. However, because conditions like infection and heart disease can be serious, pediatricians take note of mottling, especially if it’s unexplained or comes with other symptoms.

For parents, the key is to observe the context of the mottling: Is the baby simply cold? Or is the baby sick, limp, or struggling? Mottling on its own, in a content baby, is usually nothing to worry about. Mottling with other warning signs should prompt a call to the doctor.

When to Seek Medical Attention

It’s always okay to call your pediatrician or seek medical advice if something about your baby’s appearance concerns you – that includes skin mottling. Here are some guidelines on when to seek medical attention for a mottled skin appearance:

Mottling doesn’t disappear with warming: After you’ve tried gently warming your baby (adding a layer of clothing or a blanket, holding them skin-to-skin, etc.), the mottled pattern should fade. If your baby’s skin stays mottled even after warming up, or the color change keeps coming back quickly despite being warm, let your doctor know. Persistent mottling may need to be checked.
Accompanied by unusual temperature: If your baby’s skin looks pale or mottled and you find that they have a fever (above 100.4°F or 38°C) or their temperature is below about 97°F (36.1°C), you should contact a healthcare provider. Significant changes in temperature in a young infant, together with mottled/pale skin, can indicate an infection or exposure (being too cold or too warm environment) that needs medical evaluation.
Baby seems sick or not “right”: Trust your gut. If the mottling is paired with any behavior that is out of the ordinary (excessive sleepiness, very weak cry, difficulty feeding, irritability, or just “floppy” tone), it’s better to have a doctor assess your baby. Babies can’t tell us they feel ill, but signs like these plus mottled skin could mean reduced blood flow from illness. For example, if your baby is hard to wake and her skin looks patchy and cold, seek medical help. Even if it turns out to be nothing serious, it’s important to err on the side of caution with very young infants.
Signs of breathing trouble or blue coloring: If you ever notice mottled skin with any blue coloration around the lips/face or trouble breathing, treat it as urgent. Call your doctor or emergency services right away. Blue lips (cyanosis) indicate not enough oxygen in the blood, and when combined with mottling it could mean a serious heart or lung problem. Similarly, rapid breathing, grunting, or a pause in breathing with mottled skin are reasons to get immediate medical care.
Gut feeling or persistent worry: As a parent, if you’re simply uneasy about how your baby looks – maybe the mottling just seems very pronounced or something isn’t sitting right with you – it’s perfectly fine to call the pediatrician for advice. Doctors would rather you call and catch a possible issue early than sit at home worrying. They might ask you details about the mottling (when you see it, what helps it, etc.), and they can guide you on whether the baby should be seen right away.

Remember: It’s always better to seek medical attention for an infant if you’re unsure. Babies can sometimes get sick quickly, so prompt checking is advised when there are potential warning signs. Mottling that is linked with any form of illness should be promptly evaluated.

On the other hand, if your baby is rosy, alert, and only mildly mottled once in a while when chilly, you can usually just mention it at your next routine doctor’s visit rather than treating it as an emergency. Your pediatrician can examine the baby and reassure you if everything else is normal.

Managing and Preventing Normal Mottling

For normal mottling that occurs due to cold or an immature circulatory response, here are a few basic management tips and precautions:

Keep your baby comfortably warm: Since cold is a common trigger, make sure your baby is dressed appropriately for the ambient temperature. Newborns generally need one more layer of clothing than adults would wear in the same environment. If you notice your baby’s skin getting blotchy, check if the room is too cool or if the baby might have been uncovered. Swaddling or adding a blanket can often resolve mottling within minutes by warming the skin. After baths, pat the baby dry and wrap them in a warm towel promptly. Avoid excessive cold exposure – for instance, in air-conditioned rooms or outside on a chilly day, use mittens, socks, and blankets as needed. (Caution: while keeping warm is important, also avoid overheating your baby. The goal is a comfortably warm, not hot, baby.)
Skin-to-skin contact: One of the best ways to regulate a newborn’s body temperature is skin-to-skin contact (also called kangaroo care). If you see your infant has mottled skin from being a bit cold, you can hold them against your chest, skin to skin, and cover both of you with a blanket. Your body heat will help warm the baby and often the coloring will return to normal. Plus, the baby will likely find it calming!
Monitor the indoor environment: Try to maintain a moderate room temperature (around 72°F or 22°C, for example) in your baby’s room. Avoid direct drafts from fans or AC on the baby. If you take the baby out in cooler weather, dress them in layers and use a blanket or stroller cover. By preventing your baby from getting too cold, you can reduce episodes of physiologic mottling.
Check your baby’s temperature and circulation: It’s a good habit to feel your baby’s skin – if the hands and feet are very cool, it might be a sign to bundle them a bit more. You can also do a quick check by touching the baby’s chest or back (which should feel warm). If you’re ever unsure, take your baby’s axillary (underarm) temperature with a baby thermometer to see if they’re in a normal range. Normal newborn temperature is about 97.5–99.5°F (36.5–37.5°C). If your baby’s on the low side, warming them up should help not just the number but the mottling, too. If it’s high (fever), that’s a different issue – consult a doctor.
No specific treatment needed for normal mottling: Because benign mottling (cutis marmorata) is a normal phenomenon, you don’t need medicated creams or special interventions. Do not rub or scrub the skin – remember, it’s not a stain or rash, but an internal color change. Gentle massage or light exercise (like moving the baby’s limbs) could promote circulation if the baby enjoys it, but usually just warming is sufficient. The mottling will resolve on its own. Over the next months, you will likely notice it happening less frequently. There is no lasting effect on the skin from these temporary color changes, and they do not cause the baby any pain.

If your baby has an underlying condition (for example, if they were diagnosed with a heart murmur or a thyroid issue), follow your pediatrician’s guidance on managing those conditions – as treating the underlying issue will usually improve any associated mottling. But for the vast majority of infants with occasional mottled skin, keeping them warm and ensuring they’re otherwise healthy is all that is needed.

Final Thoughts

Seeing your baby’s skin turn blotchy and purple-looking can be unsettling, but understanding baby mottling can help put your mind at ease. In most cases, it’s simply a sign of your baby’s immature circulation adjusting to the environment – a normal quirk of infancy that they will outgrow with time. Always pay attention to context: a warm, happy baby with a bit of mottling is usually fine, whereas a mottled baby who seems unwell needs prompt medical attention.

As new parents, don’t hesitate to reach out to healthcare professionals with any concerns about your baby’s skin color or health. It’s always better to ask and be sure. With each passing month, you’ll likely see your baby’s skin become more consistently warm and pink as their circulation matures. Until then, keep them cozy, enjoy plenty of cuddles, and know that you’re observing a normal part of many babies’ early days.

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