Wondering about your infant's skin blotches? Find out which ones to ignore and which to investigate.

baby with birthmark
Credit: Alexandra Grablewski

Ten fingers. Ten toes. Brown hair. A cute little nose. Your baby is perfect. Wait... what's that funny little mark? It's probably nothing to worry about, but still...

It's natural for parents to wonder about anything unusual on their newborn's skin, whether the spot was there from the beginning or shows up a few weeks later. While most birthmarks are harmless, it's smart to have them evaluated at your child's next well visit. But don't panic. We'll help you tell the difference between a harmless little pink dot -- and a possible red flag.


These reddish flat stains or raised growths, also called strawberry marks, are formed by an overgrowth of the cells that line the blood vessels. They may be visible at birth or develop when a child is a few weeks to a few months old. Hemangiomas occur up to five times more often in girls than boys. Many are barely noticeable; others can be quite large. These marks tend to grow, sometimes rapidly, in the first year and then start to shrink and fade. While 10 percent of babies have one by age 1, about 90 percent of hemangiomas have disappeared by age 10. Some leave behind sagging skin, redness, or excess tissue that may not go away.


These birthmarks often grow on the head or neck, and they can sometimes obstruct a child's ability to see, hear, eat, or breathe.


Most hemangiomas require nothing more than observation. But your child might benefit from medication, laser therapy, surgery, or a combination of these three. "Hemangiomas are like snowflakes -- no two are ever alike -- so it's important to have an early evaluation by an expert," says otolaryngologist Gregory Levitin, M.D., a vascular-birthmark specialist in New York City and Los Angeles.

Salmon Patches, Stork Bites, and Angel Kisses

About 70 percent of Caucasian newborns have a small patch of pinkish skin with an irregular border that turns white when pressed gently. These marks, known as salmon patches, usually show up on the back of the neck (where they may be called stork bites) or on the forehead or eyelids (angel kisses). Stork bites may persist into adulthood, but angel kisses are usually gone by around 18 months, says pediatric otolaryngologist Lisa Buckmiller, M.D., a vascular birthmark specialist at Arkansas Children's Hospital, in Little Rock.


These birthmarks are completely harmless.


Leave them alone. If they are still visible when your child is in grade school, laser treatments can lessen the coloration.

Port-wine Stains

Less than 1 percent of newborns have these birthmarks, which commonly appear on the head or neck. Port-wine stains appear pink or red at first and then become more noticeable and gradually get darker. They usually don't fade and sometimes develop rough bumps on the surface over time.


A small percentage of kids who have a port-wine stain on the forehead, scalp, or around the eye are diagnosed with Sturge-Weber syndrome, a neurologic disorder that can cause seizures, developmental delays, and paralysis on one side. Port-wine stains on the forehead or around the eye have also been linked to glaucoma, so a baby with one should be evaluated by an ophthalmologist.


Lasers can lighten or remove the discoloration caused by a port-wine stain. Don't wait: This remedy tends to work best within a child's first year, according to Sheila Fallon Friedlander, M.D., section chief of pediatric dermatology at Rady Children's Hospital, in San Diego.

Cafe-au-lait Spots

Named after the French term for "coffee with milk" that describes their light- to dark-brown hue, these marks can appear anywhere on the body and vary in size from speckles to many inches in diameter. About 10 percent of babies have one. The discoloration, which is permanent, may be very faint at birth and then start to darken within a few years. If more spots show up later in childhood, be sure to mention them to your pediatrician.


A child who has three or more caf?-au-lait spots should be checked right away for underlying genetic disorders, such as neurofibromatosis- 1. About one in 3,000 people worldwide have this inherited disease that can lead to nerve damage, eye abnormalities, and bone defects.


Though these birthmarks themselves don't cause any health problems and can be a challenge to treat, some parents opt to try laser therapy later on if a child has one on the face that's cosmetically unappealing, says Lina G. Rabinowitz, M.D., a pediatric dermatologist at the Pediatric Dermatology & Laser Center, in Mequon, Wisconsin.


Up to 2 percent of babies are born with small, brown-to-black moles, which doctors call nevi. Large ones -- generally classified as bigger than 2 inches in diameter at birth -- occur in less than one out of 100,000 babies. Moles can appear anywhere on the body, tend to grow along with a child, and generally don't go away.


The risk of a small mole becoming cancerous is minimal. There's about a 4 percent chance that a large mole will convert over time, says Dr. Friedlander.


Small moles are generally not a concern. Large ones, which can wrap around the front and back of the body, may be surgically removed. But this often requires multiple procedures, including expanding or grafting skin to cover the excision site.

Mongolian Spots

These flat, bluish-gray or brown patches are generally found on the back or buttocks and have an irregular border. They're common in babies with dark skin and can vary from freckle-size to quite large. Most fade over the course of a few years.


Since they can be mistaken for a bruise, have your doctor make a note of Mongolian spots in your child's health records in case there's ever a question about how it got there.


There's no need to do anything about these harmless marks because they eventually disappear and are usually not a significant cosmetic problem, says Dr. Rabinowitz.

Originally published in the November 2011 issue of Parents magazine.

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