The blue baby presents due to lesions that obstruct right sided outflow obstruction, therefore decreases pulmonary blood flow. These babies present cyanotic, usually within the first 2 weeks of life. The cyanosis will be central– involving the mucous membranes, lips, tongue. Tachypnea, without other evidence of respiratory infection such as nasal congestion, wheeze, rhonchi, should raise your suspicion for CHD. A murmur could be present, but a lack of a murmur does not rule out CHD.