What Parents Should Know about BirthmarksDeborah Bohn
When my first daughter was born, I marveled at her smooth pink skin; I kissed the little fat rolls and rubbed my face against her perfect chubby cheeks. When a thumb print-sized bruise appeared on her upper chest a month or so later, I assumed I’d been holding her too tightly. But as it grew into the size of an egg and developed bright red spots, I knew something was terribly wrong. My pediatrician diagnosed the tumor as a cavernous hemangioma and told me that the best course of action was to do nothing at all. It didn’t hurt her and would simply shrink and fade away over the course of several years. I took his advice, and he was right. Two years later, the birthmark is almost flat with no trace of blue color. The red spots remain, but they should fade to tan or disappear in time. If the spots become a cosmetic issue when she’s older, my daughter can have laser therapy to remove them.
When my second daughter was born with a bright red spot the size of a quarter (a strawberry hemangioma) on her upper thigh, I didn’t give it a second thought. I know a vascular birthmark when I see one, so we’ll just wait this one out too. But some babies aren’t so lucky. Some birthmarks can cause serious health risks, so if your child has one, show it to your doctor for peace of mind. In most cases, the diagnosis is to simply sit back and wait.
Birthmarks and superstitions go hand in hand. The most common myth is that certain birthmarks identify witches, vampires, or werewolves; they’ve even been called the “devil’s mark.” Women in some cultures are told that if they ignore their pregnancy cravings, their children will be born with birthmarks. Japanese woman are warned against looking at fire, lest their babies come out with a “burn.” Some cultures believe that stress or trauma during pregnancy causes birthmarks, while others believe that a birthmark on the right side of a man’s body predicts good fortune and one found on a woman’s chin is a sure sign of riches. And if a woman has a birthmark on her right breast… she’s supposed to have a lot of lovers!
Here are the facts: One in ten babies are born with or quickly develop a birthmark, while one in one hundred cases require medical intervention. Doctors still don’t know what causes some children to develop birthmarks or how they get there. What they do know is that they aren’t caused by anything a mother does during her pregnancy, and there’s absolutely no way to prevent them. The vast majority are harmless and most fade away within weeks or a few years of birth.
Hemangiomas are vascular birthmarks—abnormal clusters of blood vessels beneath the surface of the skin. Nearly one third of babies are born with light pink patches at the napes of their necks, commonly referred to as stork bites. Others have a splash of pink in the middle of their foreheads or eyelids, called angel kisses. These mild hemangiomas often turn bright red during a crying spell, but typically fade before a baby’s first birthday. Those at the base of the neck sometimes persist into adulthood, but are covered with hair, so nobody sees them.
Strawberry hemangiomas are bright red birthmarks of various sizes and shapes that usually appear on the head or neck area. They tend to start out as small bumps, but gradually become larger and redder for the first year to eighteen months of life. In most cases, they then begin a process called involution, where the birthmark slowly shrinks or fades until it’s gone. Involution can take anywhere from one to ten years.
A more serious type of hemangioma is the raised, bluish, puffy kind called a cavernous hemangioma. Although they too are usually benign, these birthmarks can sometimes cause serious problems. “Vascular birthmarks can be life threatening or disfiguring. Life threatening lesions occur on the liver, in the airway or in the brain. Other lesions can block the vision, nose, ears or mouth,” says Linda Shannon, president of the Vascular Birthmarks Foundation and co-author of Birthmarks: A Guide to Hemangiomas and Vascular Malformations, the only existing book on the topic. Even if they don’t pose a physical risk to the child, these large tumor-like birthmarks can result in unwanted stares and teasing, eroding a child’s self esteem and confidence. Fortunately many of these lesions can be removed using treatments such as steroid injections, drug therapies, lasers, and surgery.
Strangely, girls are five times more likely to get a hemangioma. Linda Shannon explains, “Tumors require a hormone to stimulate their growth. My theory is that some form of estrogen receptor is responsible for vascular birthmarks. All children are born with their mother’s immune system for the first nine to twelve months, and that immune system includes the mother’s estrogen. That’s why I think it occurs more often in females; because they get a double dose of estrogen (mom’s and their own).”
Port Wine Stains
Port wine stains are red, dark red, or purplish birthmarks that appear level with the skin and are caused by a deficiency in the nerve supply to blood vessels under the skin. (Former Russian president Mikhail Gorbachev had one on his head and face.) They occur equally among boys and girls in about .3% of births. Unlike hemangiomas, these birthmarks are almost always visible at birth and sadly don’t go away on their own. Though they are treatable with multiple laser treatments, and some even disappear completely, port wine stains will come back eventually; so routine laser maintenance is necessary.
Café au Lait Spots
One in five people can show you their café au lait spot, birthmarks named for their light tan color. They appear at birth, usually on the trunk and limbs and tend to appear darker in babies with dark complexions. These marks are usually harmless and can be successfully removed with laser therapy. But numerous or large café au lait spots can signal a serious genetic disease called neurofibromatosis, so when in doubt, point them out to your pediatrician for an expert opinion.
Mongolian spots are bluish, grey patches typically found on the back, buttocks, and upper legs of Asian, East Indian, Latino, and African children. They are caused by excess pigmentation in the skin and usually fade completely by the time children enter kindergarten.
According to Linda Shannon, “Vascular birthmarks are misunderstood because little is taught in medical schools on the subject.” She says, “Don’t be afraid to question the medical community. As parents of a precious child, it is your responsibility to find out everything you can about any illness or defect your child has.” Shannon advises parents who encounter resistance to treatment from their pediatrician to visit the Vascular Birthmarks Foundation website, the leading birthmark website in the world, to download information. Parents can share that information with their physician or contact any of the doctors listed on the site for further evaluation.