What are the American Academy of Pediatrics guidelines on the diagnosis and treatment of infantile hemangioma?

Updated: Nov 09, 2020
  • Author: Richard J Antaya, MD; Chief Editor: William D James, MD  more...
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Consult with a hemangioma specialist by age 1 month for infants that are high risk.

Infantile hemangioma growth occurs most rapidly from age 1-3 months.

Imaging is not necessary unless the diagnosis is uncertain, there are five or more cutaneous infantile hemangiomas present, or there is suspicion of anatomic abnormalities.

Oral propranolol (2-3 mg/kg/dose) is the recommended first-line treatment for cases requiring systemic therapy.

Counsel about the adverse events of propranolol, such as sleep disturbances, bronchial irritation, and clinically symptomatic bradycardia and hypotension.

Use oral prednisolone or prednisone if there are contraindications or if the propranolol response is inadequate.

Intralesional injection of triamcinolone and/or betamethasone can be recommended to treat focal or bulky infantile hemangiomas in certain critical locations (eg, the lip) or during proliferation.

Topical timolol maleate may be prescribed for thin or superficial infantile hemangiomas.

Surgery and laser therapy may be recommended for certain situations such as ulcerated lesions or lesions that obstruct vital structures.

Caregivers should be educated about infantile hemangioma, the natural history of tumors, and the potential for complications or scarring.

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