FIGURE 120.17 Deep hemangioma of face (Courtesy of Andrea L Zaenglein, MD In: Chung EK, Atkinson-McEvoy LR, Lai NL, et al., eds Visual Diagnosis and Treatment in Pediatrics 3rd ed Philadelphia, PA: Wolters Kluwer Health; 2014 With permission.) Because of their natural history of ultimate regression, a combination of watchful waiting and parental reassurance remain the standard of care for most infantile hemangiomas However, active intervention is indicated for lesions that compromise vital structures (airway, eyes, nose); lesions that are susceptible to trauma, hemorrhage, or infection; and those that grow at an alarming rate Infants who present with stridor at to 12 weeks of age may have an undiagnosed laryngeal hemangioma Nearly two-thirds of infants with laryngeal hemangiomas have cutaneous hemangiomas along the mandible and neck region in a “beard” distribution Infants with greater than five hemangiomas warrant imaging for visceral hemangiomas, specifically liver hemangiomas Infants with large cutaneous or liver hemangiomas are at risk for congestive heart failure Large hemangiomas on the face or scalp, usually greater than cm, have been associated with PHACE syndrome Hemangiomas over the lumbar spine or pelvic region may be a marker for underlying congenital malformations of the spinal cord, genitourinary, or anorectal structures Beta blockers may facilitate resolution for infantile hemangiomas, but should not be prescribed in the ED Decisions regarding medical or interventional treatments are best made by a vascular anomalies specialist