When to get help

Most birthmarks need nothing at all. Ask for a prompt appointment, and say the word haemangioma if it applies, for any of these:

A raised red mark growing near the eye, nose, lip, mouth, ear or the airway, or in the nappy area. Position matters more than size, because a mark near the eye can obstruct vision while it grows and one near the airway can obstruct breathing.
A mark that is growing quickly over days and weeks in the first months.
A mark that breaks down, ulcerates, bleeds or looks infected.
Five or more raised red marks on the skin, which can prompt checks for marks elsewhere in the body.
A large flat purple-red mark covering part of the face, particularly around the eye and forehead.
Any mark that is painful, or a lump under the skin that is enlarging.

Call emergency services if a birthmark bleeds heavily and does not stop with firm pressure, or if a baby with a mark near the airway develops noisy or laboured breathing.

Infantile haemangioma, the strawberry mark

This is the one that generates most questions. A haemangioma is a collection of extra blood vessels. It is often not visible at birth, appears in the first weeks as a red patch or a pale area, then grows — sometimes fast — over the first months before slowing, stopping and gradually shrinking over several years.

Great Ormond Street Hospital describes haemangiomas as common and usually harmless, and most are left alone because they fade without treatment. What decides whether to treat is position, size and behaviour. Marks that threaten vision, feeding or breathing, marks that ulcerate, and very large facial marks are treated, usually with an oral medicine started in the first months while the mark is still growing.

The timing point is the practical one. Treatment works best during the growth phase, so a referral at six weeks is far more useful than one at six months. If you are unsure, ask early; being told it needs nothing is a good outcome.

Salmon patches, storks and angels

Flat pink or red patches on the eyelids, between the eyebrows, on the forehead or on the nape of the neck are extremely common in newborns. They are sometimes called stork marks or angel kisses. They darken when a baby cries or gets hot, and they fade over the first year or two, although those on the back of the neck often persist and are simply hidden by hair.

They need no treatment and no investigation.

Port wine stains

A port wine stain is a flat mark, present at birth, usually pink or red at first and darkening to a deeper red or purple over years. Unlike salmon patches it does not fade, and it grows in proportion with the child.

Most are cosmetic only, and laser treatment is available. The reason they are assessed is location: a port wine stain covering the forehead and upper eyelid can be associated with conditions affecting the eye and the brain, so those are checked rather than assumed.

Congenital dermal melanocytosis

These are the blue-grey patches, most often over the lower back and buttocks, seen commonly in babies with brown and black skin and in babies of Asian, Mediterranean and mixed heritage. They are entirely harmless and usually fade during childhood.

They are frequently mistaken for bruises, including by professionals who see them rarely, which is why it is worth asking for them to be documented in your baby's records at the newborn check or first review. That one sentence in the notes saves awkward conversations later.

Café-au-lait spots and moles

Café-au-lait spots are flat, light brown patches. One or two are common and mean nothing. Several large ones together are worth mentioning at a routine review, because they can occasionally be part of a wider condition.

Moles present at birth, congenital melanocytic naevi, vary from small to very large. Small ones are usually watched. Large ones are referred so that a plan can be made, and any mole that changes shape, colour or texture, bleeds or becomes itchy should be looked at regardless of size.

How to keep track

Photograph each mark every month, in the same light, with a ruler or a coin beside it for scale. The question a clinician will ask is whether it is growing, and photographs answer that far better than memory. Note the date it first appeared, because a mark present at birth and a mark appearing at three weeks are different things.

Protect birthmarks from the sun as you would any of your baby's skin: shade and clothing under six months, and sunscreen with a hat and shade after that. Areas of thinner skin over a mark burn more easily.

Caring for a mark that has broken down

Ulceration is uncomfortable and needs proper dressings, so it is a reason to be seen rather than to manage at home. In the meantime keep the area clean with water, avoid rubbing, change nappies frequently if the mark is in the nappy area, and do not apply antiseptics or creams that have not been advised.

The part nobody prints

Visible birthmarks on a baby's face attract comments from strangers, and parents describe that as harder than the mark itself. Having one sentence ready — it is a birthmark, it is harmless, it will fade — ends most conversations. Ask your clinician for written information you can give to nursery and family, and ask whether a support organisation exists locally; both save a great deal of repeating yourself.

Birthmarks in Babies