When does an infantile hemangioma need medical review?

What does the evidence show for infantile hemangioma?

• Superficial infantile hemangiomas may look bright red and raised, while deeper ones can look bluish or swollen. Growth is often fastest in early infancy. Early assessment is useful because waiting for eventual fading can miss the best time to address a high-risk location. 1
• Not every red birthmark is an infantile hemangioma. Newborn skin findings include several vascular and pigmented marks with different courses. Ask for identification of the actual lesion rather than applying one birthmark’s expected timeline to another. 2
• Management depends on size, location, speed of change, number of lesions and whether the surface breaks down. Some need observation only; others need specialist care and monitored prescription medicine. Do not apply an adult blood-pressure medicine or leftover skin prescription to the mark. 1
• A drooping eyelid, apparent difficulty seeing or an eye that is not aligned deserves attention. For a mark near the eye, describe any change in opening the lid or tracking a face so the pediatrician can arrange appropriate eye assessment. 3
• A young infant with fever needs immediate medical advice even when an open or irritated birthmark seems to explain it. In babies under three months, a rectal temperature of 100.4°F or higher should not wait for the next routine skin appointment. 4

When should I call my provider about infantile hemangioma?

Seek prompt care for a rapidly enlarging mark near an eye, nose or mouth, a painful open sore, bleeding or feeding difficulty. Breathing trouble requires emergency help. An infant under three months with a rectal temperature of 100.4°F or higher needs immediate medical advice, regardless of the skin finding.