My nephew

As you all know my son has thal major - my daughter is not affected by thal at all.  My husband and I both have thal trait. 

My brother also has thal trait.  He and his wife had a baby about a month ago.  He is a healthy happy baby.  (as was my son the first 3 months).  My sister in law is not thal trait, so we have assumed that their baby is safe from thal.  Recently I have heard people mention that other genes can cause thal intermedia etc when combined with thal minor. 

My nephew looked a little pale to me - his lips were not very pink.  Should I be concerned?  Could he have thal related issues even if his parents are not both thal minor?   What are your thoughts Andy?

My initial thoughts are that he is too young to make any judgments. I do have a couple questions. Is your sister-in-law from an ethnic or racial background where thal is more common? Is the baby breastfeeding? Breastfed babies tend to have more color in their faces, as they work their facial muscles harder than bottle fed babies. They also have better color in general because mother's milk provides ideal nutrition.

There are many gene abnormalities that can have an effect on the beta thal gene. Many are not found without DNA testing. For those in high risk groups who marry a carrier, testing for other genetic variants is advisable before conceiving children. A good example is the alpha thal genes which are very difficult to diagnose in carriers without DNA testing. If your sis-in-law is from a high risk group, it would be worth having a DNA test if the baby develops any problems.

My sis in law is also East Indian.  The baby is breast fed (but she mostly pumps and feeds him with a bottle - just worked out best that way). 
He is gaining weight nicely and is well otherwise. When he was born he appeared more rosy than he does now.  He is a very fair baby - much of our family is very fair with light eyes (hazel or blue) which can explain some of the paleness.

His lips were of concern to me, because I can usually judge when my son's hg is low by his lips - if they are crimson red then his hg is good but if they appear pale then his hg is low.  The baby's lips appeared someonewhat pale to me.  I don't want to alarm his parents so I did not say anything to them.  I know that my sis in law does not have any issues with anemia - her hg was great - even throughout her pregnancy. 

Could thal minor cause the baby to be a little anemic and therefore pale?  Thanks for your help Andy, I am hoping to be properly informed before mentioning anything to my brother. 

At one month, the amount of fetal hemoglobin will still be quite high so the symptoms of thal minor would not yet be evident. The HbE gene is somewhat common among east Indians, so if this hasn't already been ruled out, it should be tested for if any symptoms develop in the child.

As long as the baby grows and develops normally, there probably is no cause for concern.

Thanks again Andy,
I suggested to my brother to have the baby tested for thal related issues - including HbE.  He said the he would do a comprehensive test when the baby is 3mos.  Thank you for the information.

Sharmin