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pediatric-skin

Birthmarks in Children: Types, What Is Normal, and What to Watch

Most birthmarks are harmless and require no treatment. A provider should evaluate any birthmark that changes rapidly, bleeds, or appears in a sensitive area.

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Lena Park, PNP — Pediatric NP

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Common vascular birthmarks

Vascular birthmarks involve blood vessels just beneath or in the skin. Salmon patches (also called angel kisses or stork bites) are flat, pink or red marks that typically appear on the nape of the neck, eyelids, or forehead. They are among the most common birthmarks in newborns and usually fade significantly within the first two years of life, though neck patches may persist.

Infantile hemangiomas are raised, bright red growths — often called strawberry hemangiomas — that are not present at birth but typically appear and grow rapidly in the first weeks to months of life, then plateau and gradually involute (shrink) over years. Between 3% and 10% of babies develop a hemangioma of some kind 1. Port wine stains are flat, red-to-purple discolorations that tend to persist and may darken over time. They are caused by a malformation of small blood vessels and, depending on location, may warrant evaluation by a specialist 1.

Common pigmented birthmarks

Pigmented birthmarks involve an excess of melanin pigment in the skin. Congenital dermal melanocytosis (historically called Mongolian spots) consists of flat, bluish-gray patches most often seen over the lower back and buttocks in infants with darker skin tones. They are completely benign and typically fade by school age 1.

Café-au-lait spots are flat, light-brown patches that can appear anywhere on the body. One or two spots are common and usually insignificant; having six or more larger spots may prompt a provider to look more carefully. Congenital melanocytic nevi are moles present at birth or appearing early in infancy. Small, stable moles are usually monitored over time; larger congenital moles warrant regular provider follow-up 2.

Infantile hemangiomas — a closer look

Infantile hemangiomas are one of the most common soft-tissue tumors in infancy and are overwhelmingly benign 2. They are more common in premature infants, in girls, and in multiple-birth pregnancies. Most appear in the first few weeks of life, grow during the first year, and then slowly shrink over several years. Approximately 90% fade significantly by age 10 1.

Most small, uncomplicated hemangiomas do not need treatment and are simply observed. However, a provider should evaluate hemangiomas early if they are large, growing rapidly, near the eye (which can affect vision), near the airway, on the face and causing concern about potential scarring, or beginning to ulcerate (break down and create an open sore). Propranolol is a well-established treatment option for hemangiomas requiring intervention 1.

What changes in a birthmark are worth checking

Most birthmarks change gradually over years, and stable, slow change is normal. Changes worth bringing to a provider's attention include rapid growth over days to weeks, bleeding that occurs without any trauma, a birthmark becoming raised or crusted when it was previously flat, significant color change (especially darkening, new areas of black, or multiple shades), or any mark causing the child pain or itchiness 2.

For moles specifically, the general dermatology guidance for concerning changes applies: asymmetry, irregular border, multiple colors, diameter larger than about a pencil eraser, or any evolving change. The AAD notes that what may appear to be a simple birthmark could in rare cases be the first sign of a skin disease, which is why any unusual or changing mark warrants a provider evaluation 1.

Port wine stains and location-specific considerations

Port wine stains on the face — particularly those near the eye or forehead — are sometimes associated with a condition called Sturge-Weber syndrome, which involves blood vessel changes affecting the brain and eye 2. A child with a port wine stain in this location is generally referred for specialist evaluation to assess whether further monitoring is needed. Port wine stains on a limb can occasionally be associated with tissue overgrowth in that limb.

These associations are not reasons to panic, but they are reasons to establish care with a provider who can determine whether specialist follow-up adds value. Early laser treatment tends to be more effective for port wine stains than treatment started later 1.

Common questions

Will my child's hemangioma go away on its own?

Most infantile hemangiomas do involute — they stop growing, become less vivid, and gradually shrink over years. Approximately 90% fade significantly by age 10. The timeline and degree of resolution vary by size and type.

What is the blue-gray mark on my baby's back?

Blue-gray patches over the lower back and buttocks in infants are typically congenital dermal melanocytosis (historically called Mongolian spots). They are benign, very common in infants with darker skin tones, and usually fade by school age.

Can birthmarks be treated if parents wish?

Some birthmarks are treatable if they cause concern or complications. Infantile hemangiomas in certain locations may be treated with propranolol. Port wine stains can be lightened with laser therapy, though not always eliminated. A pediatric dermatologist can discuss options based on the specific birthmark.

How many café-au-lait spots is too many?

A few small café-au-lait spots are considered normal for many children. The presence of six or more larger spots, particularly if they increase in number over time, is something providers typically note and may prompt additional evaluation. A provider can assess and advise based on what they see.

Talk to a clinician

Lena Park, PNP — Pediatric NP

kids & families. Gale can match you with a licensed clinician for a visit.

Find care →

When to get care right away

  • —A hemangioma near the eye that is growing rapidly and might affect vision
  • —A hemangioma that ulcerates (develops an open sore or bleeds)
  • —A hemangioma on or near the nose or throat with any signs of breathing difficulty
  • —Any birthmark that bleeds without obvious trauma
  • —Rapid growth of any pigmented mark over days to weeks
  • —A port wine stain on the face near the eye — prompt specialist referral is recommended

If a child has a birthmark that bleeds heavily and does not stop, or if there are any signs of breathing difficulty associated with a mark near the airway, call 911 or go to the nearest emergency department.

This article provides general health information for parents and is not a diagnosis or personalized medical advice. Consult your child's provider with specific concerns.

References

  1. 1.American Academy of Dermatology (2024). Birthmarks: Overview. AAD Public Resource. link ✓Between 3–10% of babies develop a hemangioma; 90% of hemangiomas fade by age 10; port wine stain treatment recommendations; propranolol for hemangiomas
  2. 2.American Academy of Dermatology (2024). Birthmarks: Signs and Symptoms. AAD Public Resource. link ✓Types of birthmarks including hemangiomas, port wine stains, café-au-lait spots, Mongolian spots, and congenital moles; signs of concerning change including Sturge-Weber association

2 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.