Learning About Propranolol to Treat Hemangiomas in Children

A hemangioma (say "hee-man-jee-OH-muh") is a growth made of extra blood vessels that forms in or under the skin. Most appear in the first few weeks after birth and grow quickly during the first year of life. They are often called "strawberry marks" because they look red and raised. Hemangiomas are the most common benign (non-cancerous) growth found in babies.

Most hemangiomas shrink on their own over time and don't need treatment. But some need care when they are growing fast or causing problems.

Propranolol (say "pro-PRAN-oh-lol") is a type of medicine called a beta-blocker. It has been used for many years to treat heart and blood pressure problems. It can also be used to treat hemangiomas in infants 5 weeks of age and older.

Propranolol is used when a hemangioma is growing fast or causing problems, such as when it's near the eyes, nose, mouth, or airway. It may also be used when a hemangioma is very large, bleeding, or causing an open sore. The goal of treatment is to stop the growth and help the hemangioma shrink before it causes lasting problems.

Experts believe that propranolol works by causing the blood vessels inside the hemangioma to narrow. This reduces blood flow to the growth. Over time, the hemangioma becomes softer, lighter in color, and smaller. Propranolol may also slow the growth of new blood vessels that feed the hemangioma.

Propranolol is given by mouth as a liquid, 2 or 3 times a day. It should be given during or right after a feeding to help prevent low blood sugar. The dose is based on your child's weight. The first dose is usually given in a doctor's office or in a hospital. This is so the care team can monitor your child and watch for any problems. Treatment usually lasts at least 6 months. Do not stop the medicine without talking to your child's doctor first.

Most children respond well to propranolol. Many hemangiomas start to get softer, lighter, and smaller within the first few weeks of treatment. In some cases, a hemangioma may start to grow again after treatment ends. If this happens, the doctor may restart the medicine.

Most side effects are mild. They can include:

• Low blood sugar, which is more likely when a child is not eating well.
• A slow heart rate or low blood pressure.
• Cold hands and feet.
• Sleep problems or unusual nightmares.
• Diarrhea or an upset stomach.
• Wheezing or trouble breathing, especially in children with asthma.

The doctor will review your child's health history before starting treatment. Propranolol is not right for children with certain heart or breathing conditions.

Call 911 anytime you think your child may need emergency care. For example, call if:

• Your child has trouble breathing. Symptoms may include:
  • Shortness of breath.
  • Noisy breathing.
  • Using the belly muscles to breathe.
  • The chest sinking in or the nostrils flaring when your child struggles to breathe.
• Your child has a seizure.
• Your child passes out (loses consciousness).

Contact your child's doctor now or seek immediate medical care if:

• You notice signs of low blood sugar, such as being very sleepy, unusual fussiness, shakiness, pale skin, or poor feeding.

Watch closely for changes in your child's health, and be sure to contact your child's doctor:

• Before you give your child any other medicines, including cold medicines or eyedrops.
• Before any planned surgery, or if your child is sick and not eating well.