infantile hemangiomas
Hemangiomas are clusters of small blood vessels, and infantile hemangiomas are actually more common that you might think (occurring in almost 10% of infants). Knowing what to expect can help you manage them confidently.
what to know
Here’s a quick timeline of infantile hemangiomas. They initially present in the first few weeks of life; they may start out looking like a bump or scratch. Then they grow rapidly, experiencing most rapid growth somewhere between 1-2 months old - this is called the proliferative phase. They generally reach their full size over the next few months, and then slowly regress over time from 6 months - 18 months old. While every child is different, most hemangiomas flatten and fade by 4-5 years old (sometimes longer). Some fully clear, and others may leave a subtle sign of fatty tissue behind.
Some hemangiomas are considered high risk depending on their location, depth, and specific characteristics. If your child has a high risk hemangioma, the ideal time for treatment is around 1 month old (during the proliferative phase).
what your pediatrician wants to know
Here are some things that are important to know as we classify hemangiomas and decide what, if any, next steps are necessary to manage them.
SIZE. Is the hemangioma small (3/4” inch or less) or larger?
Focal/localized hemangiomas look like small bumps or round circles, with very crisp, clear borders.
Segmental hemangiomas are larger plaques and often have irregular borders and affect a specific segment of the body.
IS IT SUPERFICIAL OR DEEP? Some hemangiomas are superficial (bright red/darker skin color, dome-shaped, raised bumps. Others are deeper in the skin and look a little more rubbery, bluish, and have an overlying area of vessels. Some can be mixed, with features of each.
APPEARANCE. How quickly is it changes? *Tip: take daily photos.
NUMBER. Is there one or many?
LOCATION. Where is it? Certain locations are at higher risk for complications.
on the face (eyes, nose, mouth, jawline)
diaper region or buttocks
arms/legs
along the spine
WHEN IS BABY’S NEXT APPOINTMENT? We like to see babies with higher hemangiomas quickly to decide if they need treatment or not.
what to do
It’s good to know that most small, superficial hemangiomas do improve on their own over time. Here are some things you might expect with your care team if your little one has a hemangioma.
General timeline: It may grow more quickly in the first three months of life and then grow much more slowly until 6-9 months. Around 1 year old or so, you can expect a slow process of involution (when the hemangioma gets smaller + changes color - grey as it fades). Hemangiomas are often 90% better by 5 years old.
Some hemangiomas require imaging to make sure that there are none inside the body, affecting organs.
Clinical pearl: infants with more than 5 hemangiomas are more likely to have lesions in the liver. these may require an ultrasound.
Hemangiomas along the jawline (a ‘beard’ distribution, along the S3 facial segment) may be associated with airway hemangiomas. Your baby may need imaging or follow up with a specialist to make sure.
Segmental hemangiomas (mentioned above) typically require imaging around their area — for example, one along the midline of the back may need an ultrasound of the spine.
Hemangiomas along the midline (of the face, scalp, back, or buttocks) may require imaging of the spine, because these can sometimes be associated with underlying issues in the spine.
You may have more frequent visits, especially in their first few months of life. We like to follow and see how quickly they’re progressing. Treatment, if needed, can be very effective during this time.
In the past, steroids were used for treatment. There have been many advances in hemangioma treatment over time. Here are some ways different hemangiomas can be treated.
Beta Blockers. Beta blockers block the beta adrenergic receptors that exist on blood vessels, making them narrower and thus reducing the amount of blood flowing through them. Topical timolol 0.5% gel-forming solution (or 0.5% solution) can be applied a few times daily. There are also oral beta blockers, which may have more systemic effects requiring monitoring but are another mainstay of treatment.
Laser Therapy. Some hemangiomas respond to laser therapy.
Surgical Removal. This is typically reserved for high-risk hemangiomas that may be causing immediate issues or have the potential for more serious issues.
NOTE: Always talk with your care team about what options make sense for YOUR child.
