What is a haemangioma?
An infantile haemangioma is a common type of birthmark made up of a collection of small blood vessels. It may also be known as a strawberry naevus.
They appear shortly after birth and grow over the first few months of life but then gradually shrink over time.
What is propranolol?
Propranolol is a type of drug called a beta-blocker and is given as a liquid. It helps to stop haemangiomas from growing and can speed up the shrinking process.
It has been used for many years for heart conditions and high blood pressure but is now commonly used to treat haemangiomas.
Why does my child need treatment?
Haemangiomas often get better without any treatment. Sometimes, they can cause problems that need treatment, for example if it is near your child’s eye, it may affect their vision.
They may also bleed, become infected and painful. If this happens, treatment with propranolol can improve your child’s symptoms.
Is it safe?
Many children around the UK are using this treatment as it is thought to have fewer side effects than other treatments. Propranolol has been used safely and effectively for many years in much higher doses in children for heart problems.
Propranolol should not be given to children with certain health problems, for example asthma. Your doctor will discuss this with you before starting any treatment.
We ask for your child to come into hospital when they have the first dose so that if any side-effects do develop, they can be treated straight away.
How long will my child need to take propranolol?
Your child will need to be treated with propranolol during the growing phase of the haemangioma. This is normally until your child is one year of age.
If propranolol is stopped too early, then the haemangioma may start to grow again. If this happens, the propranolol treatment can be restarted.
What are the side effects?
Most children do not have any side effects, but sometimes it can cause:
- Disturbed sleep
- Tummy ache
- Blue fingertips and cold hands/feet
- Wheeze and cough
- Slow heart rate
Rarely, propranolol can cause children to develop low blood sugar levels, causing:
- Irritability or restlessness
- Tiredness or inactivity
- Increased sweating
- Shakiness
- A big increase or drop in hunger levels
If you are worried that your child is showing any of these symptoms, see your GP or local Emergency Department immediately.
How should I give propranolol to my child?
Your child’s dose of propranolol is chosen carefully and adjusted according to their weight and response to treatment. Your doctor will tell you how much propranolol you should give at home and how to measure this out.
Always give the exact amount prescribed and never increase the dose without discussing with your child’s doctor. Use the measuring syringe provided by the ward to help you measure the correct amount.
Stay with your child until they have swallowed the dose of medicine. Give it to your child with or immediately after food to prevent low blood sugar.
The propranolol should be given every 12 hours (two times per day) and at the same time each day. For example 6am and 6pm each day or 7am and 7pm each day. Pick times that work well with your child’s sleeping and feeding schedule.
As your child grows, they will be reweighed in clinic and the dose adjusted according to how much weight they have gained. You may also be asked to weight the child at home in kilograms and adjust the dose.
What can I do to avoid low blood sugar levels?
Give the propranolol with a feed or meal to help avoid your child’s blood sugar becoming low.
Avoid long periods without giving a feed or something to eat. You may find that your child is more hungry once propranolol treatment has started.
If your child is less than three months old, try to make sure they feed at least once every five hours. If they are over three months old, make sure they feed or eat at least every eight hours.
What if my child has another illness while taking propranolol?
Propranolol may need to be stopped temporarily if they develop a cough or cold causing wheeziness, if they are not eating or drinking well or if they are vomiting.
If your child vomits a dose or propranolol, skip that dose. Never re-dose or double up doses. Wait until the next scheduled time and give the regular dose.
Do not give propranolol if your child is:
- Not eating (fasting) before surgery or for any other reason
- Unable to eat or eating much less than usual
- Vomiting / being sick
- Unusually tired or has poor energy
- Cool or clammy to the touch
- Wheezing or having trouble breathing
Can my child take other medicines at the same time?
Ask your doctor before giving other medicine while they are taking propranolol. Teething gels containing lidocaine should be avoided while taking propranolol. Some asthma medicines will not work if your child is taking propranolol.
What happens next?
We will arrange for your child to be admitted to Ward 11 (Great North Children’s Hospital) for their first dose. Your child will be weighed and have their blood pressure and heart rate checked.
Photographs will be taken of their haemangioma.
They will be seen by a doctor, who will examine your child’s heart and chest. We may also check their blood glucose level. We will then monitor your child for four hours after they have taken the medicine.
If they don’t have any side effects, you will be able to give your child the propranolol at home (twice a day with food) starting the next day.
After two weeks, your child will be seen once again on Ward 11 to check their progress. We will see them every few months to check how well the treatment is going.
Questions or concerns
If you have any questions or concerns, please contact your child’s Consultant on the telephone number below.
Alternatively contact Ward 11 at the Great North Children’s Hospital or your child’s GP.
Plastic surgery secretary
Telephone: 0191 282 5336
Ward 11 (Great North Children’s Hospital)
Telephone: 0191 282 6011
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