Hemangiomas are one of the most common diseases in infants and young children, and many parents have a hard time treating their babies. So how to diagnose and how to treat it best? First of all, I suggest parents to find an experienced hemangioma doctor to confirm the diagnosis of the type of hemangioma, so as to lay the most solid foundation for treating hemangioma, choosing the treatment method of hemangioma, and formulating the treatment plan of hemangioma. Because different types of hemangiomas are treated in different ways, it is ideal to treat different patients according to their diseases and give different individualized treatments to different patients. First of all, let’s get to know the types of infantile hemangioma, which is mainly divided into the following types: 1. Strawberry hemangioma: the incidence accounts for about 1\% of the newborn babies, most of them are present at the time of birth, presenting small red spots, and then gradually increase in size, often higher than the skin, with the color of bright red, in the form of foliation, and in the shape of strawberries or prunes. The growth parts are mostly seen in the head, face and trunk. Capillary hemangioma: when newborn, the affected area has a little or a large number of pieces of capillaries protruding out of the skin, the epidermis is uneven, and the development is very fast. If not treated and controlled in time, within a short period of time (half a year old), it will destroy the organs or the surrounding organs that have been affected by hemangioma, and a small portion of them can develop rapidly into mixed hemangioma. 3. Nevus of bright red spot Nevus of bright red spot, also known as nevus of wine or nevus of dilated capillaries, often appears at birth or soon after birth. It often appears at birth or soon after birth, and it is found on the face, neck and scalp, mostly unilateral, occasionally bilateral, and sometimes involves the mucous membrane. At the beginning, the damage is of different sizes or several light red, dark red or purplish red patches, irregular shape, clear boundary, not higher than the skin surface, visible capillary dilatation, partially or completely discoloration when pressed, and the surface is smooth. With age, the color deepens and becomes red and purple, 65% of the patients’ lesions will gradually expand, and can be thickened and appear nodules before 40 years old, easy to bleed after trauma. Nevus erythematosus is a flat and rarely raised plaque composed of numerous dilated capillaries, which is a congenital capillary malformation. The area of the lesion increases accordingly with the growth of the body and does not subside throughout the life. Nevus erythematosus can occur in any part of the body, but it is more common in the face and neck, accounting for 75%-80% of the cases, and it is mostly unilateral and more common in the right side. There is a 15% chance of combining with refractory glaucoma when nevus erythematosus involves both ophthalmic nerve and maxillary nerve. In patients with nevus erythematosus, 1%-2% are associated with ipsilateral molluscum contagiosum vascular malformation, which is called Sturge-Weber syndrome. 4. Cavernous hemangioma: Cavernous hemangioma can be found in any part of the body, which can be located on the surface of the body, or occur in various visceral organs, especially in the limbs, torso and parotid glands. The skin of the tumor body may be normal or dark blue, and it is soft like sponge when touched, and the mass may be compressed when pressed, and the patient complains that the affected limbs are heavy and sore, which is obvious after activities. Part of cavernous hemangioma surface skin can be combined with capillary hemangioma, called mixed hemangioma. Some parotid hemangiomas are combined with capillary hemangiomas on the surface skin of parotid gland or other parts of parotid gland. Therefore, when the cause of pediatric parotid mass cannot be clearly defined, if surface skin capillary hemangiomas are found to exist, the diagnosis of parotid hemangioma should be considered. Mixed hemangioma: At the beginning, most of them are small erythematous spots of different sizes on the skin surface, which are not different from simple strawberry hemangioma. However, with the development of surface hemangioma, it invades into dermis and subcutaneous tissues at the same time, and the range of subcutaneous invasion can exceed the area of the surface lesion, forming a bulging mass, with irregular morphology, which is mostly seen in the face and the limbs. The scope of invasion is sometimes so extensive that the tissues and organs such as eyes, mouth and lips, nose or ears are covered by such expanding vascular tissues, which can cause dysfunction of respiration, eating and drinking, vision and hearing, etc., and so on. Treatment of hemangioma in infants and young children: Hormone therapy: (applicable to infants and young children with natural regression trend of capillary hemangioma, mixed hemangioma, cavernous hemangioma) Hormone injection: interstitial injection of hormone into the local lesion, the effect is better on the treatment of mixed hemangioma, methylprednisolone is chosen, and it is injected into interstitial of hemangiomas with physiological saline or 1 % Lidocaine diluted in the connective tissues of hemangiomas, each time 2 mg/kg (1 time per week〉). Methylprednisolone, diluted with saline or 1% lidocaine, was injected into the connective tissue of hemangioma at 2mg/kg per time (once a week〉, and every 4 times was a course of treatment. Usually, 20~3Od after one course of treatment, the hemangioma shrinks significantly and re-expands, so that one course of treatment can be repeated after an interval of 3 months, and oral prednisone treatment can also be used. Some people reported that oral prednisone or local interstitial hormone injection for hemangioma was used immediately after the symptoms improved. However, the first and foremost concern in the treatment of infantile hemangioma with hormonal therapy is the long-term effect of prolonged administration of large amounts of hormones on the infant’s metabolism, as long-term hormonal therapy may lead to growth and developmental disorders in the child. Hormone therapy is suitable for infantile capillary hemangiomas, mixed hemangiomas and cavernous hemangiomas that have a tendency to subside naturally. For older children, the therapeutic effect is poor, and hormone therapy is not suitable for hemangiomas that do not have a tendency to heal on their own. Laser treatment: (applicable to superficial capillary hemangioma and nevus with bright red spot) There are several types of lasers, including traditional carbon dioxide laser, single-wavelength laser, photodynamic laser, dual-wavelength vascular lesion workstation, etc. The principle of CO2 laser treatment is that through the photothermal reaction produced by tissues absorbing high-energy laser light, the local temperature suddenly rises to hundreds of degrees or higher within seconds, and the tissues undergo coagulation and necrosis, so the skin will be broken and the skin will not be able to heal. The tissue undergoes coagulation and necrosis, so the skin will be broken, and it is also easy to cause infection, scarring and other consequences. Although single wavelength laser has improved compared with traditional carbon dioxide, the trauma is not so serious and the risk of scarring is reduced, but due to the limited depth of its treatment, it is difficult to achieve the effect of thorough treatment for the deeper location of the vascular malformation. Photodynamic laser is a treatment plan with relatively good efficacy in the treatment of capillary hemangioma in recent years for the treatment of nevus erythematosus, but photodynamic for children, general anesthesia is needed, and injection of photosensitizer, there is trauma after the operation, and it will be edematous, so it needs to be hospitalized for observation, and then it has to be avoided for a month, the process is relatively more complicated. In addition, there is a kind of dual-wavelength vascular lesion workstation is the latest treatment technology for nevus bright red, from the domestic and foreign literature report seems to have good therapeutic effect, because our hospital has not yet carried out this technology, the specifics are not good to comment. Nuclein therapy: (applicable to capillary hemangioma) Nuclein is a better program among capillary hemangioma treatment methods, especially for infants and young children with strawberry capillary hemangioma, which can be cured perfectly without pain, trauma, scars and side effects. There are two kinds of nuclides commonly used in capillary hemangioma treatment, 32 phosphorus and 90 strontium, of which 32 phosphorus is basically replaced by 90 strontium due to its short half-life, inconvenient treatment and other shortcomings. Nuclide 90 strontium belongs to the weakest of the five types of radioactive sources. 90 strontium only releases a tiny amount of pure beta rays after decay, and its effective distance is only 3-4 millimeters. Compared with other radioactive elements, 90 strontium’s amount of beta rays is small, and each treatment time is very short, which will not constitute a serious impact on the human body structure. Cardioplegia treatment: In 2008, Léauté-Labrèze et al. from the Children’s Hospital of Bordeaux, France, reported that when they used propranolol to treat a child with cardiomyopathy associated with severe hemangiomas and another child with hemangiomas associated with an increase in cardiac output, they found that the hemangiomas unexpectedly shrank and became smaller. With the consent of the parents, they administered propranolol to 9 other children with maxillofacial hemangiomas, all of whom had lighter-colored hemangiomas with varying degrees of reduction in size 24 h after administration of the drug. Since 2009, our hospital has also conducted a prospective study of small-dose (1 mg/kg/d) propranolol in the treatment of infantile hemangiomas, and found that oral small-dose cardioplegia (propranolol) in the treatment of infantile hemangiomas has good efficacy in the near future, with mild adverse effects, and can replace the traditional prednisone regimen as a first-line therapeutic agent for infantile hemangiomas. Because of the small dosage of medication for infants and young children, it needs to be used under doctor’s supervision. Surgery: Because infants and young children have a low tolerance for anesthesia and surgery, we do not recommend aggressive surgical treatment for children under 3 years of age. Surgery is not recommended for children under 3 years of age unless the tumor is growing rapidly, severely affecting the infant’s development and life, and other treatment options have failed.