Infantile hemangiomas are common benign tumors consisting of actively proliferating endothelial-like cells. Their growth rate varies widely among individuals, with some growing slowly and others growing rapidly. Although most hemangiomas do not require treatment, approximately 12% of cases present with complex presentations and a range of complications, including malformation, ulceration, hemorrhage, visual impairment, respiratory congestion, congestive heart failure, and even death, requiring aggressive treatment. Currently, there are more drugs used to treat hemangiomas with varying efficacy. Since the first report of oral propranolol for the treatment of hemangioma in 2008, a large number of clinical studies have evaluated its efficacy and safety, and found that it is rapidly effective in hemangioma, well tolerated by patients, and induces the regression of hemangioma better than other treatment methods. In recent years, I have used oral propranolol, combined with other methods of comprehensive treatment, and received good therapeutic results. 1.Treatment timing: When patients with hemangioma develop complications, such as ulceration, bleeding, visual impairment or deformity, they should be treated promptly. Treatment of PHACE syndrome: PHACE syndrome is a cutaneous neurovascular syndrome that occurs in about 1/3 of patients with large facial hemangiomas, characterized by large, segmental hemangiomas of the head and neck, congenital brain, heart, eye and/or chest wall malformations. The administration of propranolol in such patients has the potential to cause acute ischemic shock, and MRI or MRA of the head and neck, as well as cardiac imaging, should be performed prior to treatment. If the advantages outweigh the disadvantages, it is recommended to use the smallest dose, gradually increase the dose, and hospitalization for close observation. 2. Contraindications and history taking: Before treatment, the patient should be evaluated for potential risks and a careful history should be taken to test heart rate, blood pressure and cardiopulmonary function. History taking should focus on feeding status, presence of dyspnea, shortness of breath, sweating, croup, heart murmur, heart block or family history of arrhythmia. Relative contraindications include heart failure, cardiogenic shock, sinus bradycardia, hypotension, first-degree or higher conduction block, bronchial asthma, drug allergy, etc. 3.Electrocardiogram (ECG) examination: ECG examination is not recommended for all children, but should be considered in the following cases: (1) newborns (<1 month) with heart rate <70 beats/min, infants (1-12 months) with heart rate <80 beats/min, and children (>12 months) with heart rate <70 beats/min; (2) congenital history; (3) history of arrhythmia or auscultation of arrhythmia. 4. Medication regimen: According to the age, patients were divided into 2 groups and treated in hospital or in outpatient clinic. Infants aged ≤ 8 weeks with poor social security or other concomitant diseases affecting the cardiovascular system, respiratory system (including respiratory angiomas) or the need to maintain blood glucose levels were recommended to be hospitalized. Infants aged > 8 weeks with good social security and no serious concomitant diseases may be treated on an outpatient basis with regular monitoring. 5 .Cardiovascular system monitoring: Changes in heart rate and blood pressure are most evident 1 to 3 h after oral propranolol. Heart rate and blood pressure changes should be monitored before treatment, 1 h and 2 h after starting the drug, and at each dose increase (0.5 mg/kg?d), including at least 1 test when the target dose is reached. If heart rate and blood pressure are abnormal, they should be monitored until they are normal. The therapeutic effect is usually most pronounced after the first dose; therefore, repeated cardiovascular monitoring is not necessary without dose changes or concomitant disease. Bradycardia needs to be detected early because it is not easy to detect blood pressure in children, while it is relatively easy to measure heart rate and it is possible to determine whether bradycardia is present based on heart rate changes, with the following criteria for determination: ① <70 beats/min in newborns (<1 month), <80 beats/min in infants 1 to 12 months, and <70 beats/min in children >12 months. Blood pressure in infants varies greatly between 1 and 6 months, and there is no standardized data. Moreover, most forms of normal blood pressure in children are based on auscultatory measurements for the evaluation of hypertension or hypotension. Oscillometric instruments, although easy to use, do not give consistent readings with auscultation; therefore, obtaining accurate blood pressure values in newborns and infants is difficult and requires the assistance of an experienced specialist. Infants should be placed in a warm room, at rest, awake or asleep. An appropriately sized cuff is required, with the inflated portion of the cuff covering at least 75% of the upper extremity and at least 2/3 of the length of the upper extremity. systolic blood pressure below the following should be considered abnormal (i) newborn: <57 mm Hg (5-point oscillometric value) or 64 mm Hg (2 auscultations); (ii) 6 months: <85 mm Hg (5-point oscillometric value) or 65 mm Hg (2 auscultations); (iii) 1 year: <88 mm Hg (5-point oscillometric value) or 66 mm Hg (2 auscultations). Children whose heart rate and systolic blood pressure are lower than the above-mentioned indicators during the initiation of drug administration or dose increase should be closely monitored as a high-risk group. Heart rate and blood pressure should be monitored 1 or 2 h after each dose increase, and ambulatory ECG monitoring (Holter monitoring) should not be used as a routine monitoring tool. 6. Prevention of hypoglycemia: Although the signs or symptoms of hypoglycemia need early intervention, measures should be taken to reduce the risk of hypoglycemia. Because the occurrence of hypoglycemia varies greatly among individuals and cannot be predicted, routine blood glucose monitoring is not recommended. Propranolol should be given after daytime feeding and should be given at least once every 4 h for infants <6 weeks, once every 5 h for infants 6 weeks to 4 months, and once every 6-8 h for infants 4 months of age. If serious illness occurs during the course of the drug, especially if oral feeding is restricted, the drug should be discontinued. If sedation requires fasting for surgical operations or imaging examinations, glucose-containing fluids should be administered sedately. Special caution should be taken with propranolol in premature infants or those taking other drugs that affect blood glucose levels at the same time.