When Shivali Bhatia gave birth to identical twin girls, Aditi and Avani, it was easy for visitors to identify them correctly. Both babies developed an infantile hemangioma, but in different spots; Aditi’s strawberry-red mark appeared on the back while Avani has a prominent one on her cheek. “We didn’t notice anything when they were born at 31 weeks,” says Bhatia, who lives in Toronto. “They were in the NICU and on the third day, I saw a small, pimple-like spot on Avani’s cheek. The next morning, it had grown to a pea-sized boil. Every day, for the first few weeks, it grew a little more until it was the size of a bright red strawberry.”
Dr. John Freedman, pediatrician at the Thornhill Paediatric and Adolescent Clinic, says that a strawberry hemangioma is a growth formed due to an abnormal collection of blood vessels and gradually fades away on its own. “It usually starts developing inside the uterus. It starts evolving and becomes most prominent when the baby is three to five months of age. In 90 percent of the cases, the hemangioma doesn’t need to be treated and goes away on its own.” The name of the hemangioma, also known as a strawberry mark, is self-explanatory because the surface looks bright red like the fruit.
Bhatia and her husband Raj were assured by nurses at the NICU that strawberry hemangiomas are generally harmless and can be left alone. However, they were given the option for a consultation at SickKids Hospital in Toronto. “Since our twins were preemies, we wanted to make sure there was nothing to worry about. The doctors at SickKids assured us that strawberry hemangiomas of this kind are pretty common and are best left alone. There was always a chance of scarring if we tinkered with it, so we decided to let it be.”
Aditi and Avani are now four-and-a-half years old, and while Aditi’s mark on the back is nearly gone, Avani’s still remains visible. “The hemangiomas started shrinking when the girls were a year old. Now, Avani’s can barely be seen. Aditi still has it but the colour has changed from a bright red to brown so it is blending with her skin,” says Bhatia. “It has always been a topic of conversation. Whenever people would visit them as babies, it came up often because Aditi’s hemangioma was so prominently located on the face. At birthday parties and when the girls started preschool, it was always noticed. Some hesitate to ask while others are too outspoken and make it their first question. Little ones sometimes get curious and want to touch it.” Bhatia has also been told, often by complete strangers, that her daughters are considered very lucky because they have birthmarks.
According to Dr. Freedman, all hemangiomas fade by age five or six and are completely gone by age 10. “Unless the hemangioma is in a spot where doctors feel it will interfere with body function, there is no treatment needed. In severe cases, where internal organ functions are involved, a medication called Propranolol is administered,” he says.
For Aditi, the strawberry mark has become a part of her identity, and what makes her unique. When she draws a picture of her family, she ensures her face has the birthmark.
A prominent strawberry birthmark can attract unwanted attention, but there are several ways to address the situation. says Dr. Shudeshna Nag, a pediatrician specializing in pediatric dermatology.
Deal with questions from others directly, and using appropriate terminology. For example, “It’s a hemangioma, a type of birthmark that is going to fade away over time.” As your child gets older, teach them to address questions from curious children in the same manner. Remember, a hemangioma may be more bothersome to you than to your child.
Have a positive attitude. Your child’s own attitude towards it will generally reflect yours so avoid continually drawing attention to it or implying that you can’t wait for it to disappear. Emphasize to your child that it is a natural and harmless spot on the skin, and that everyone has differences about them that make them unique.
Talk to your doctor if you’re concerned. While most hemangiomas are harmless, some (about 12 percent) are problematic in terms of location or skin breakdown, or may simply have a very bothersome appearance to you or your child. Ask your doctor if treatment is a possibility. Topical and oral treatments are available to speed up the disappearance of a hemangioma, and may be prescribed by your child’s pediatrician or a dermatologist. Remember that some treatment options have side effects and may not be advised in your child’s situation.
Originally published in ParentsCanada magazine, Summer 2017.