What you need to know about baby birthmarks

I’m not a newbie when it comes to skin concerns—I’m fair-skinned with veritable constellations of freckles on my body and I’ve already had several moles and freckles removed. So when each of my two daughters were born with birthmarks, I was worried.

My first daughter arrived with red patches on her forehead and at the nape of her neck. I fretted that they would never fade or might mean she had an underlying medical condition. When my second daughter was born with a distinctive mole on her upper thigh, I worried again. In both situations, our pediatrician talked me through my fears and provided my daughters with easy treatments. He told me my eldest daughter’s birthmark is called a salmon patch (a type of pink birthmark that’s super common) and would probably fade over time—and it did. For my youngest, I had to take a photo of her mole for future reference and have it evaluated by a pediatric dermatologist.

As a new parent—or even second- or third-time one—it’s so hard to know if you should worry about your baby’s birthmarks. Read on for a comprehensive guide to all the different types of birthmarks and everything you need to know about them, including possible treatments.

What are baby birthmarks?

“Birthmarks may appear as any discolored or raised skin that we see at the time of birth or even a few weeks after,” explains Sheilagh Maguiness, an assistant professor of dermatology and pediatrics at the University of Minnesota and vice-president, education and career development, of the Society for Pediatric Dermatology.

Baby birthmarks are very common, though it’s hard to know exactly how many babies each year are born with them. “I examine hundreds of babies each year. The vast majority of babies will have a birthmark somewhere,” says Emily Scott, a newborn care specialist at Indiana University Health.

Should I be worried about my baby’s birthmark?

Even though birthmarks are common, that doesn’t mean parents won’t fret about them. But in most cases, they are not a cause for concern.

But you should keep an eye on the birthmarks and see a dermatologist or a pediatrician if you notice any changes at all. “If they become irritated, are bleeding or changing rapidly, it’s time to see a specialist,” Maguiness says.

Hugh Gilgoff, a pediatrician at the Mount Sinai Doctors of Brooklyn Heights in New York agrees. “While there are so many baby rashes or birthmarks that are benign, self-limiting and harmless, there are times when a birthmark can signify an underlying condition or require more monitoring and treatment.” If you’re unsure, he says it’s always best to make sure your pediatrician addresses the marks and advises you about which ones to keep an eye on and when to see a dermatologist.

The types of baby birthmarks

There are two main forms of birthmarks: vascular and pigmented.

Vascular birthmarks:

About five percent of babies are born with vascular birthmarks. The vascular system includes the capillaries, which are a form of blood vessel, and when a bunch of blood vessels clump together on a baby’s skin, they cause a distinct birthmark. They can appear as anything from pink spots to rough, red bumps.

Here are three common types of vascular birthmarks:

1. Infantile hemangioma

These birthmarks, which appear on almost five percent of newborns, are sometimes referred to as “strawberry birthmarks” although Maguiness says doctors don’t really use that term anymore. Caused by collections of extra blood vessels, these marks are benign and typically appear within the baby’s first few weeks of life. Most hemangiomas appear on the face, head or neck.

Hemangiomas come in two forms: superficial and deep. A superficial hemangioma will be bumpy or raised and start white, pink or red in color then quickly change to a bright-red lesion (within the first few weeks of baby’s life). Deep hemangiomas are deeper under the skin than superficial ones and are smooth to the touch. They appear blue or purple. Most often, hemangiomas start to fade when your baby turns six months old and are dramatically improved by age five. Usually, they are nearly gone by the time a child is 10 years old. 

In rare cases, hemangiomas might be large enough to interfere with a baby’s vision or breathing—which is obviously quite alarming for parents—and might develop into sores or bleed due to ulceration. Even under these rare circumstances, though, hemangiomas are manageable. “If there’s a problem with a hemangioma and parents start their baby on treatment between five and seven weeks of age, there’s a great prognosis,” says Maguiness, adding that the prognosis is still good if your baby starts when they’re a bit older, around four to five months. Propranolol, a beta blocker, is usually the first line of treatment for more complicated hemangiomas on a baby’s head or neck, explains Maguiness. It’s an oral medication usually taken twice daily. Surgery is usually not necessary, but may be required if the hemangioma leaves behind any residual stretched skin, or if there is any scar tissue that needs to be removed.

2. Nevus simplex (or salmon patches)

These birthmarks are very common (80 percent of newborns have them), but you’ve probably heard them called “stork bites” when they’re on the neck and “angel kisses” when they’re on the face, eyelids or forehead.  Nervus simplex birthmarks can be salmon-colored, pink or red and they are always flat.

“Don’t be surprised if when your baby cries these birthmarks become darker,” says Scott.

Most patches fade by baby’s second birthday and they aren’t cause for concern.

3. Capillary malformation

Capillary malformations, or port wine stains, occur in about one in 300 newborns and are flat, dark-red birthmarks. They are caused by the overgrowth of capillaries in the skin. They tend to be larger than other baby birthmarks and are often found on the face, arms or legs. Unlike salmon patches, port wine stains do not go away as a baby grows up—but they are typically not harmful. Usually these birthmarks don’t require treatment, but they may need to be regularly evaluated by a dermatologist to see if there are any changes. In some cases, families may be worried about these birthmarks for cosmetic reasons. In general, most pediatric dermatologists advocate for early treatment of port wine stains with laser therapy to lighten them, says Maguiness. A pulsed dye laser is the gold-standard treatment and is typically done right away, usually in the first few months of life. With several treatments, a laser can lighten the stain, but it is not possible to fully remove it.

Rarely, some port wine stains can be associated with genetic syndromes like Sturge-Weber Syndrome, which is a neurological disorder, explains Maguiness. This is why it’s always important for doctors to carefully assess a newborn with one of these birthmarks. And “if a port wine stain is located on a baby’s eyelid or forehead, the baby will need to see an ophthalmologist to rule out something more serious like glaucoma,” says Scott.

Pigmented birthmarks:

These birthmarks are made up of extra pigment or pigment cells in the skin. The color of the birthmark depends on the type, but they can run the gamut from light brown to dark blue.

Here are the three common types of pigmented birthmarks.

1. Congenital nevi or (moles)

About one percent of babies are born with some type of mole. Medically called congenital nevi, moles appear as small, dark, flat or bumpy spots on the skin. Small moles (less than half an inch in size) can typically just be observed at regular checkups and are usually nothing to worry about. However, a baby’s pediatrician will want to watch these as the child ages to ensure that they don’t grow or change.

Larger moles (bigger than an inch) that appear on baby’s skin at birth should be evaluated by a pediatric dermatologist. These moles may be raised or even have little hairs growing out of them. These larger moles are more likely to develop a skin cancer with time, so they need to be observed periodically by a pediatric dermatologist, Maguiness explains.

All in all, the majority of congenital nevi are benign and do not need to be removed. If you are worried about a mole for cosmetic reasons, you can take your child to a dermatologist to talk about removal options. If your baby is born with multiple moles, you should take them to a pediatric dermatologist to be checked as it might indicate other issues like neurocutaneous syndromes (a group of neurological disorders that can cause tumour growth).

2. Cafe au lait macules and patches

In French, café au lait literally means “coffee with milk,” which describes the light-brown color of these birthmarks. They appear in about 20 percent of newborn babies, and are flat spots on a baby’s skin. Your baby will have them for life and they are almost always nothing to worry about. However, if a pediatrician notices five or more café au laits on a child’s body, the child should be evaluated by a specialist for genetic conditions like Neurofibromatosis type I, which causes tumors under the skin, explains Maguiness.

3. Dermal melanocytosis

Mongolian spots, or congenital dermal melanocytosis, are very common baby birthmarks that are frequently found on the baby’s bottom or back (but can occur anywhere on the body). They are dark blue and can even resemble a bruise.  This birthmark is especially common in babies with darker skin tones. They can be rather large, but will fade over time and many even disappear by the time the child enters elementary school.  There is no treatment needed for Mongolian spots.

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Newborn care: Everything you need to know about grooming baby