Ages 0–2 | Child Health + Development | New Baby

Seeing Spots: When to Worry About Birthmarks

When to worry about your child's birthmarksKita Ferrer was born with a 2-inch-long, football-shaped birthmark on her abdomen. Now 18 months old, Kira finds the birthmark interesting — when she finds it at all. But her mother worries that this won’t always be the case and that as Kira grows older, the same birthmark could make her feel self-conscious, or even lead to teasing from peers.

Statistics show that Ferrer is in good company: One out of every 10 babies is born with a birthmark. While about 90 percent of these birthmarks are harmless and may even completely disappear on their own, the remaining 10 percent could require medical treatment.

Different types of birthmarks

Birthmarks — areas of discolored skin — come in two types: vascular and non-vascular. Non-vascular birthmarks are brown, tan or black and typically appear as café au lait spots on the legs, torso or buttocks. Mongolian spots are bluish patches often found on a baby’s back, legs or arms; these usually disappear on their own by puberty. In fact, most non-vascular birthmarks don’t cause any symptoms and don’t need to be treated.

Vascular birthmarks are abnormal clusters of blood vessels located below the skin and are often referred to as stork bites, port wine stains, strawberry birthmarks and hemangiomas.

“We don’t know for certain what causes a vascular birthmark,” says Dr. Linda Rozell-Shannon, president and founder of the Vascular Birthmarks Foundation in Albany, New York, and co-author of the book Birthmarks: A Guide to Hemangiomas and Vascular Malformations. “Some researchers believe that hemangiomas run in families, and that a placenta problem during gestation may be the cause of vascular birthmarks.”

“Vascular birthmarks are often misunderstood because little is taught in the medical schools on the subject,” Rozell-Shannon says. “Don’t be afraid to ask your pediatrician questions and to seek a referral to a specialist.”

Because port wine stains and certain hemangiomas can be disfiguring and embarrassing for children, Rozell-Shannon advises parents to consult with a vascular birthmarks specialist if their child’s birthmark has gotten larger or darker, or isn’t diminishing on its own. “In most cases, birthmarks aren’t cause for concern,” says Dr. Rob Nohle, chief of pediatrics for Group Health Cooperative in Seattle. Nohle’s own daughter was born with a vascular birthmark. “She’s 6 now, and her birthmark has significantly faded over the years to the point where it’s barely noticeable,” he says.

When to see a doctor

The birthmarks that deserve the most attention are the hemangiomas, which aren’t really true birthmarks, since they are often not present at birth, but appear in infancy. These strawberry-colored marks are especially worrisome if they occur near the eye, where they can cause astigmatism or even interfere with vision. Hemangiomas can be quite unsightly and cause tissue distortion if they grow high off the skin. They can also cause problems underneath the skin, according to Dr. Robert Sidbury, dermatology chief at Seattle Children’s. “Hemangiomas around the mouth, neck and chin should be looked at by a specialist,” says Sidbury, “because the birthmark could be growing in and around the vocal cords inside the body.”

“If a child’s birthmark begins to bleed or ulcerate, it’s important for parents to seek medical attention,” Nohle says. “Your child’s pediatrician should monitor your child’s birthmarks for irregularities in size, texture or color.”

Every time Kita has a well-baby checkup, her pediatrician measures her birthmark to see if it has gown or changed. Many physicians, like Sidbury, take photos of birthmarks so they can follow their changes over time.

Your doctor may advocate a wait-and-see approach, but it’s good to be aware of the variety of treatment options that are available, and to know the benefits and risks associated with birthmarks.

Treatment can involve medications (usually steroids), surgical removal or laser therapy. Your doctor will consider your child’s age, along with the severity of the birthmark, when recommending a course of treatment.

Heather Larson is a Federal Way–based freelance writer.

Vascular Birthmarks Foundation

Many insurance companies consider the treatment of vascular birthmarks to be a cosmetic issue rather than a medical necessity and thus deny coverage to families. If you are denied insurance coverage, the Vascular Birthmarks Foundation (VBF) can help your family receive proper treatment and to appeal your insurance company’s rejection. VBF has also partnered with Nancy Roberts, an aesthetician and co-creator of Smart Cover Cosmetics, who helps parents to formulate cosmetic blends that naturally cover birthmarks. In addition, the Web site lists questions for parents to ask their doctor, support groups and other resources for families. For more information, visit VBF.

Great resources for birthmarks

The children’s book Buddy Booby’s Birthmark was written by Evan Ducker, a 12-year-old who has a port wine birthmark, in the hopes of educating other children about what it’s like to live with a birthmark.

The Share A Smile Foundation also lists numerous websites and resources for parents seeking additional information on birthmarks.

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