Petechiae in children

This guideline does not apply to immunocompromised or clinically unwell children.


  • Petechiae are small (<2mm) purple/red/brown spots which do not blanch under pressure
  • Purpura are larger non-blanching spots (>2mm)
  • Both can appear in clusters and may look like a fine rash
  • They are flat and do not itchy
  • >95% of children with fever and petechiae will not have invasive bacteraemia (i.e. meningicoccal or pneumococcal), this refers to immunised children only

This guideline does not apply to immunocompromised or clinically unwell children.

Petechiae (original from


Bleeding into the skin or mucosa from capillaries. This may be from:

Mechanical causes:

  • Vagal manoeuvres (coughing, straining, vomiting)
  • ↑venous pressure (BP cuff, tight clothing)
  • NAI (Slap/hitting can cause localised petechiae)


  • Bacterial: Neisseria Meningitidis (most common serious bacterial cause), S. pneumoniae, H. influenza, Gp A Strep
  • Viral illnesses (enterovirus, influenza)
  • Returned traveller – dengue

Coagulation/platelet dysfunction/depletion

HSP rash is from a vasculitis.

  • Henoch Schonlein Purpura(HSP)
  • ITP
  • TTP
  • Leukaemia
  • von Willebrand’s disease (vWd)

Risk factors sepsis

  • Unwell looking child
  • Immunocompromised
  • Rapidly progressive symptoms



  • Non-itchy, non-blanching rash


  • Trauma
  • Hepato / splenomegaly
  • Lymphadenopathy
  • Artheritis
  • Abdo. tenderness

Differential Dx

  • Septicaemia (e.g. meningococcal/pneumococcal)
  • Trauma
  • Henoch Schlonein Purpura (HSP)
  • Haemolytic Uraemic Syndrome (HUS)
  • Idiopathic Thrombocytopenic Purpura (ITP)
  • Other infections
  • Malignancy


  • FBC + Film
  • CRP
  • Clotting
  • Blood gas
  • Glucose
  • Cultures
  • Meningococcal PCR
  • Consider LP


Discharge criteria

  • No progression of rash after 4 hours
  • Clinically well
  • Bloods normal
  • Reviewed by registrar / consultant

Content by Dr Jenny Miller, Dr Rory O'Brien, 30/11/2020. Last review Dr ÍOS 24/10/22.