When a Child Looks Yellow

I saw a toddler the other day with the mom's chief complaint of "my child looks yellow". On first glance I too noticed the child's "glowing" yellow skin, but it was quickly evident that this child was not jaundiced, but rather was carotenemic.  

Carotenemia is a clinical condition caused by an increased level of carotene in the blood. It is commonly seen in infants and toddlers who eat excessive amounts of baby food carrots, sweet potatoes, squash and peaches. Children actually metabolize carotene more slowly than adults, which is why it is more commonly seen in children. 

Many of the commercially prepared baby foods, especially vegetables and fruits, have a high carotene content as carrot and carrot rich ingredients may routinely be added to strained baby foods. 

Carotenes are present in all pigmented vegetables and fruits, and the carotene may be masked by the green color of chlorophyll in these foods as well. Foods with a high carotene content include not only carrots and squash, but apricots, beans, peas, spinach, sweet potatoes, mangoes, oranges, tomatoes, and papaya. 

In general, vegetables that are deeper green or yellow contain the most carotene. Human milk may also be a source of carotene if the maternal serum carotene is high. 

Upon further questioning, the child's mother told me that her daughter was otherwise healthy. She did not have any fever, was not vomiting and did not have any change in the color of her urine. She was a happy baby and was just starting to walk. 

Her daughter was beginning to drink whole milk and was still eating baby foods. On the child's exam her eyes were not yellow in appearance and she did not have an enlarged liver. The mother was happily relieved to hear that the problem was actually not jaundice, as several of her relatives had suggested.  The mother and I discussed the diagnosis of carotenemia, and also discussed transitioning her daughter from pureed foods to table foods. Not only was it important and age appropriate for her child to begin feeding herself mushy table foods, there is an inverse relationship to carotene levels in smaller particle foods rather than table foods. 

The mother left relieved and her daughter just looked a bit too golden but healthy! 

That's your daily dose for today.  We'll chat again tomorrow.

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