Infantile hemangioma

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Counseling

Hemangiomas grow fastest in the first few months, then slowly shrink and fade over several years. Recommended supportive care with an emphasis on gentle skin care, avoiding rubbing, and sending photos if growth seems fast. Return precautions given including rapid growth, a sore or open area, bleeding that does not stop with pressure, a new hemangioma near the eye, nose, lips, or diaper area, noisy breathing, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Open areas on a hemangioma heal with gentle care and treatment from the specialist. Recommended supportive care with an emphasis on petroleum jelly and a nonstick dressing at each diaper change and tylenol as needed for pain. Return precautions given including bleeding that does not stop with pressure, spreading redness or pus, fever, poor feeding, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Infantile hemangioma
• Low-risk hemangioma: small, away from the face, folds, and midline, without ulceration
• Photos taken to track growth
• Observation with serial photos during the growth phase
• Discussed natural history: most growth by 3-5 months, slow fading over years, and possible lasting skin changes
• Follow up in 1 month to recheck growth of the hemangioma

Hemangiomas grow fastest in the first few months, then slowly shrink and fade over several years. Recommended supportive care with an emphasis on gentle skin care, avoiding rubbing, and sending photos if growth seems fast. Return precautions given including rapid growth, a sore or open area, bleeding that does not stop with pressure, a new hemangioma near the eye, nose, lips, or diaper area, noisy breathing, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Risk stratification
Observe, timolol, refer, propranolol per specialist
Liver ultrasound for 5 or more
Educate (KAS 5)

Return precautions in the template

rapid growtha sore or open areableeding that does not stop with pressurea new hemangioma near the eyenoselipsdiaper areanoisy breathing

Sources

AAP Clinical Practice Guideline for Diagnosis and Management of Faltering Weight. Pediatrics 2026;157(4):e2025075764
AAP Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2022;150(1):e2022057988. Recommendations read
Thomas J et al; AAP Section on Breastfeeding. Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report. Pediatrics…
Shaw BA, Segal LS; AAP Section on Orthopaedics. Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics 2016;138(6):e20163107.…
Krowchuk DP et al. Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics 2019;143(1):e20183475. Highlights and selected KAS read
AAP Clinical Report: Prevention and Management of Positional Skull Deformities in Infants (Laughlin, Pediatrics 2011;128(6):1236). Retired February 2018 (not…