Hemangioma in Babies: Signs, Growth Stages, Treatment and When to Worry

Quick Answer

A hemangioma in babies, often called a strawberry mark, is a harmless growth of extra blood vessels in the skin. It usually appears in the first few weeks, grows fastest in the first 3 months, then slowly shrinks over several years. Most need no treatment, but those near the eyes, nose, lips or airway, or that form sores, need early medical care.

Seeing a red lump appear and grow on your baby’s skin within weeks of birth can be frightening, especially when relatives start asking what it is. The good news is that infantile hemangiomas are common, are not cancer and usually fade on their own. This guide explains what to expect month by month, which hemangiomas need attention, and how doctors treat the few that do.

What is a hemangioma in babies?

An infantile hemangioma (also spelt haemangioma) is a soft, benign (non-cancerous) lump made of blood vessels that formed incorrectly and multiplied more than they should. Johns Hopkins Medicine describes it as the most common tumour in babies, and the AAP says it is found in up to 5% of infants.

There are three types, based on how deep the blood vessels sit:

Source: Johns Hopkins Medicine

Hemangiomas are most often seen on the face, scalp, chest or back, though they can appear anywhere, according to Mayo Clinic. Most babies have only one, but some have more.

For other birthmarks your baby may have, see our guide to types of birthmarks in babies.

What causes hemangiomas?

Doctors do not know exactly why the blood vessels clump together, as Mayo Clinic explains. A hemangioma is not caused by anything you ate, did or avoided during pregnancy, and it is not linked to eating strawberries, an eclipse (grahan) or any other belief you may hear from family.

Some babies are more likely to have one:

• Girls

• Babies born prematurely

• Babies with low birth weight

• Twins and other multiple births

• Babies with lighter skin

Sources: Mayo Clinic; Johns Hopkins Medicine; NHS

How does a hemangioma change as my baby grows?

Infantile hemangiomas follow a predictable pattern: they appear, grow quickly, rest, and then slowly shrink. Knowing the stages helps you understand what is normal and when to act.

Sources: Johns Hopkins Medicine; AAP guideline summary; Mayo Clinic

You may read different “fade by” ages online. The NHS says they usually disappear by age 7, while Mayo Clinic says many go by age 5 and most by age 10. These all describe the same slow process: most of the change happens in the first few years, and the last traces can take longer.

Is a hemangioma serious?

Most hemangiomas are harmless and only need watching. A small number are called “high risk” because of where they are, how big they are, or what they may be linked to. These need to be seen by a doctor early.

The American Academy of Pediatrics (AAP) guideline lists these as reasons for early specialist review:

What is PHACE syndrome?

Rarely, a large hemangioma on the head or neck comes with problems in the brain, heart, blood vessels or eyes. This combination is called PHACE syndrome. If your doctor suspects it, they may arrange an MRI scan, a heart ultrasound (echocardiogram) and an eye check, as Johns Hopkins Medicine explains. Most babies with a hemangioma on the face do not have PHACE.

How is a hemangioma diagnosed?

Most hemangiomas are diagnosed simply by looking at them and asking about the baby’s history. Tests are usually not needed, according to Mayo Clinic.

Your doctor may order an ultrasound to look under the skin, especially for a deep hemangioma that is harder to tell apart from other lumps. An MRI may be suggested for large hemangiomas on the head and neck, and an abdominal ultrasound if your baby has five or more hemangiomas.

How are hemangiomas treated?

Most hemangiomas need no treatment and are simply watched as they shrink. When treatment is needed, it works best when started early, during the fast-growth phase. The AAP advises that babies with a potentially high-risk hemangioma are seen ideally by 1 month of age.

Sources: AAP guideline summary; Johns Hopkins Medicine; Mayo Clinic

If your baby is prescribed propranolol

Propranolol is a well-studied medicine for hemangiomas, but it must only be given as prescribed. The AAP guideline summary advises giving it with or after a feed. Mayo Clinic lists possible side effects including changes in blood sugar, low blood pressure and wheezing, and the AAP notes sleep changes.

• Give each dose with or after a feed. If your baby is not feeding or is vomiting, call your doctor before giving the next dose.

• Tell your doctor if your baby is wheezing, has a cold with breathing trouble, or is unusually sleepy.

• Do not stop or change the dose without asking your doctor.

How do I care for a hemangioma at home?

Most hemangiomas need no special care. Gentle, everyday skin care is enough.

• Wash gently and pat dry. Our daily baby skin care routine covers the basics.

• Do not apply lemon, haldi, toothpaste, ice, bleaching creams or any home remedy to try to shrink it. These can irritate the skin and cause sores.

• Keep your baby’s nails short so they do not scratch it.

• If the hemangioma is in the nappy area, change nappies often and keep the area dry.

• Take a photo with a ruler or coin next to it every week or two during the first few months, so your doctor can see how fast it is growing.

• If it gets a small knock and bleeds, press gently with a clean cloth until it stops, and tell your doctor.

When should I see a doctor?

Show every new hemangioma to your paediatrician, ideally in the first month of life. See your doctor promptly if the hemangioma:

• Is on or near the eye, nose, lips, ear or in the beard area of the jaw and neck

• Is growing very fast

• Bleeds and does not stop with gentle pressure, or forms an open sore

• Looks infected (yellow discharge, spreading redness, fever) or seems painful

• Is large, especially on the face, scalp or lower back

• Is one of five or more hemangiomas on the body

Get urgent medical help if your baby has noisy breathing or difficulty breathing, especially with a hemangioma in the beard area, or if bleeding is heavy.

Sources: Mayo Clinic; AAP guideline summary

Frequently asked questions

How serious is hemangioma in babies?

Most hemangiomas in babies are not serious. They are benign, do not turn into cancer and shrink on their own. A small number need treatment because of where they are, such as near the eye or airway, because they form painful sores, or because they are very large. Your paediatrician can tell you whether your baby’s hemangioma is low or high risk.

How can a hemangioma be treated?

Most need no treatment. When treatment is needed, the first choice is usually an oral beta-blocker medicine called propranolol, prescribed and monitored by a specialist. Small, thin hemangiomas may be treated with timolol gel on the skin. Steroids, laser and surgery are used in some cases, usually for problem hemangiomas or leftover skin changes after shrinking.

Can hemangioma spread?

No. A hemangioma is not cancer and does not spread to other parts of the body. It can grow larger in the first few months, which is part of its normal pattern, and some babies have more than one. If your baby has five or more hemangiomas on the skin, your doctor may check for hemangiomas in the liver.

How quickly do hemangiomas grow?

They grow fastest between about 1 and 3 months of age, and by 3 months most have reached about 80% of their final size, according to Johns Hopkins Medicine. Most stop growing by about 5 months.

Will my baby’s hemangioma go away completely?

Many fade completely, but up to half leave some mark behind, such as loose skin, slight scarring or tiny visible blood vessels, says Johns Hopkins Medicine. These can be improved later with laser or minor surgery if they bother your child.

Is a hemangioma painful for my baby?

Usually not. A hemangioma is normally painless. It can become sore if it forms an open wound (ulcer), which is the most common complication. An ulcerated hemangioma needs medical treatment to heal and to manage pain.

Can a hemangioma bleed?

It can bleed if it is scratched, knocked or forms an ulcer. Most bleeding is light and stops with gentle pressure from a clean cloth. See your doctor if bleeding does not stop, keeps happening, or if the area looks infected.

Is a hemangioma the same as a port wine stain?

No. A hemangioma appears after birth, grows and then shrinks. A port wine stain is a flat pink, red or purple mark present from birth that does not fade on its own. Read more in our guide to port wine stain birthmarks.

References

1. Johns Hopkins Medicine. Infantile hemangioma.

2. Mayo Clinic. Hemangioma: symptoms and causes.

3. Mayo Clinic. Hemangioma: diagnosis and treatment.

4. American Family Physician. Infantile hemangioma: AAP releases guideline for management. 2019.

5. American Academy of Pediatrics, HealthyChildren.org. Your newborn’s skin: birthmarks and rashes.

6. NHS. Birthmarks.

Disclaimer: This article is for general information and does not replace advice from your paediatrician or dermatologist. If you are worried about your baby’s hemangioma, contact your doctor.