Vascular birthmarks in children
Distinguishing infantile haemangioma from capillary malformation and identifying urgent referral features.
Updated: 2026-09-13
Written for clinicians and medical students
This section is a teaching reference for doctors, residents and medical students. It is not patient guidance and not a substitute for clinical examination, and it must not be used for self treatment.
Haemangioma or malformation?
- Infantile haemangiomas are usually absent or subtle at birth, proliferate during early infancy, then involute over years. Capillary malformations are present at birth and grow proportionately without spontaneous involution [1,2].
- Segmental facial haemangiomas raise concern for PHACE syndrome; large lumbosacral lesions can signal spinal, genitourinary or anorectal anomalies [1].
- Ultrasound is reserved for diagnostic uncertainty or suspected structural involvement. MRI is preferred when associated anomalies are suspected [1].
Referral priorities
- Refer early for lesions threatening vision, airway, hearing or feeding, for ulceration, rapid growth, functional risk, or a high risk of permanent disfigurement [1].
- Oral propranolol is first-line for problematic infantile haemangioma and requires weight-based prescribing, contraindication screening and counselling about feeding and hypoglycaemia [1].
- A facial capillary malformation involving the forehead or upper eyelid requires assessment for ocular and neurologic associations. Pulsed dye laser can lighten lesions but does not remove syndrome risk [2].