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Infantile hemangioma

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of infantile hemangioma are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024) and the American Academy of Pediatrics (AAP 2019). ...
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Classification and risk stratification

Risk stratification
As per AAP 2019 guidelines:
Classify an infantile hemangioma as high risk if there is evidence of or potential for one the following:
life-threatening complications
functional impairment or ulceration
structural anomalies (such as in PHACE syndrome or LUMBAR syndrome)
permanent disfigurement
B
Refer the patient to a hemangioma specialist as soon possible, after identifying an infantile hemangioma as high risk.
B
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Diagnostic investigations

Diagnostic imaging: as per AAFP 2024 guidelines, obtain ultrasound or MRI to evaluate for occult spinal dysraphism in infants with lumbosacral findings, including hemangiomas.
B

Medical management

Oral beta-blockers: as per AAFP 2024 guidelines, offer propranolol 2-3 mg/kg/day for infantile hemangiomas with high-risk features.
A

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Therapeutic procedures

Intralesional corticosteroid injections: as per AAP 2019 guidelines, consider intralesional injection of triamcinolone and/or betamethasone to treat patients with focal, bulky infantile hemangiomas during proliferation or in certain critical anatomic locations (for example, the lip).
C

Surgical interventions

Surgery: as per AAP 2019 guidelines, consider surgery as a treatment option in managing selected patients with infantile hemangiomas.
C

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Patient education

Parent education: as per AAP 2019 guidelines, educate caregivers of infant patients with an infantile hemangioma about the condition, including the expected natural history and its potential for causing complications or disfigurement.
B