[2026-09-21] Confidence Among Pediatricians in Managing Infantile Hemangioma With Propranolol

Abstract

Background: Infantile hemangioma (IH) is the most common benign vascular tumor in children. Although several medical societies have published clinical practice guidelines for diagnosis and treatment of IH, delays in treatment or referral still occur, leading to potential sequelae.

Objectives: To explore pediatricians' confidence and practices related to diagnosing and managing IH with propranolol.

Methods: A nationwide online survey was conducted from October 2021 to October 2022, among Thai pediatricians, excluding pediatric dermatologists. Participation was voluntary, and the survey was distributed via QR codes at national pediatric meetings and through social media and email. A 46-item investigator-developed questionnaire assessed experience, practice, and confidence in IH management. Data were analyzed and a P value < .05 was considered statistically significant.

Results: A total of 247 responses were analyzed, most respondents were female (83.8%), worked in government-based settings (39.3%), and were pediatric specialists (59.1%). Although 76.1% had received training on IH diagnosis and treatment, only 21.9% were confident in initiating propranolol independently, a gap likely driven by concerns about medication side effects, dosing, and limited hands-on experience. Confidence increased to 45.3% when expert consultation was available, while 32.8% remained unconfident regardless. General pediatricians reported higher confidence (30.7%) than subspecialists (15.8%), and those with recent IH training were significantly more confident.

Conclusions: Thai pediatricians reported limited confidence in independently initiating propranolol for IH. Confidence was higher among general pediatricians, respondents with recent IH training, and those with access to expert consultation. Structured training and access to expert consultation may help strengthen confidence in IH management.