A tiny red spot that was barely visible at birth and then turns into a raised bump within weeks is worrying to see. Infantile hemangiomas, often called strawberry birthmarks, are the most common benign growth of infancy. Most shrink over time, but some are best looked at early.
Why It Happens
The American Academy of Pediatrics (AAP) 2019 clinical practice guideline notes that infantile hemangiomas occur in as many as 5% of infants. Cells that line blood vessels multiply quickly in the baby’s skin for a period of time, which makes the area look red and raised. The exact trigger is not fully understood, and nothing a parent did during pregnancy is known to cause one. They are described as more common in premature babies, babies with low birth weight, and girls.
How It Looks at Different Ages and Stages
A hemangioma is often very small or hard to see at birth, then tends to grow fastest in the first weeks to months, often around 2 to 3 months of age. Many then level off at around 8 to 12 months and slowly shrink, a process that can take years. Because of this early growth, the AAP guideline advises that any infant whose birthmark seems to be changing in the first 2 months of life be evaluated promptly, in person or by photos, and describes about 4 weeks of age as the ideal time for a specialist’s input when a hemangioma might need treatment. Treatment tends to work best before the mark has grown large.
Home Care
Small hemangiomas in low-risk places are often simply watched together with a pediatrician. At home, you can take a photo every two weeks or so in the same light and from the same angle, with a ruler beside it, so changes are easy to show at the visit. If the spot rubs against clothing or a diaper, ask your doctor whether a thin layer of petroleum jelly is appropriate. Squeezing, rubbing, or home remedies can cause wounds and infection and are not recommended. When treatment is needed, the AAP guideline and AAD describe oral propranolol as the first-line therapy, usually continued for at least 6 months and often until the baby is about 12 months old.
Common Parent Misconceptions
Because hemangiomas usually go away on their own, some parents assume every one can be watched, but the guideline stresses that those near the eyes, mouth, or airway, or ones that ulcerate, should be treated early. Others are frightened because propranolol is a heart medicine, yet doctors check the baby’s health, choose the dose, and monitor the response. It is also easy to think that growth means the mark is getting worse, when growing during the first months is part of the usual course.
Signs That Need Medical Care
See a pediatrician or dermatologist promptly if a hemangioma is on or near the eyelid and might block vision, around the lips, nose, or ears, covers a large part of the face, or if there are several at once. A surface that cracks, hurts, bleeds, or forms an open sore needs to be checked. If a hemangioma sits on the lower face or front of the neck and your baby has noisy breathing, a hoarse cry, or trouble breathing, go to the emergency department right away. This information is general guidance based on US sources; if you live in another country, please talk with your local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.