Café-au-Lait Spots in Children

Café-au-lait spots are very common in children. They're harmless, but you should make sure that they're not part of a genetic condition.
Café-au-Lait Spots in Children
Maria del Carmen Hernandez

Reviewed and approved by the dermatologist Maria del Carmen Hernandez.

Last update: 22 December, 2021

Café-au-lait spots are light brown spots of a regular shape, and 25 percent of children have them. The number of spots and their shape may vary, but they’re normal and harmless. However, they may be associated with neurofibromatosis type 1.

What are café-au-lait spots?

These types of hyperpigmented flat spots are an increase in melanin content, which is a skin pigment.

When children grow, these café-au-lait spots may grow as well. Furthermore, you can find them anywhere on the body, especially on the trunk or limbs.

In addition, these spots are more common on dark-skinned people, but they’re still present on people with lighter skin.

Café-au-lait spots.

The size of these spots may go from 0.2 to 20 cm. Besides, they’re usually lighter at first and they become darker as time goes by.

Why do these café-au-lait spots appear?

Café-au-lait spots may be congenital or they may develop over time. They’re associated with different types of genetic disorders, such as:

  • Neurofibromatosis type 1.
  • Neurofibromatosis type 2.
  • McCune-Albright syndrome.
  • Legius syndrome.
  • Tuberous sclerosis.

If these café-au-lait spots are between 0.5 and 1.5 cm before puberty and if they’re bigger than 1.5 cm after puberty, it might be a case of Neurofibromatosis type 1.

Neurofibromatosis type 1 or Von Recklinghausen disease

Neurofibromatosis type 1 is one of the most common neurofibromatosis since it affects approximately one out of 3,500 babies.

Their genetic origin is due to a mutation in the NF1 gene, with an autosomal dominant pattern of inheritance. According to the Spanish Pediatrics Association, café-au-lait spots, plus two of the following symptoms, are required to diagnose Neurofibromatosis type 1:

  • Plexiform neurofibroma.
  • Freckles in the axillar or inguinal area.
  • Six or more café-au-lait spots.
  • Optic gliomas.
  • Distinctive bone injury.
  • Two or more Lisch nodules.
  • A direct family member who presents the previous symptoms.

Furthermore, there could be cases of learning disabilities, attention deficit disorder, short stature, precocious puberty, high blood pressure, scoliosis, headache, and an overly large head.

Neurofibromatosis’ symptoms may be mild or serious depending on the child. What’s more, symptoms may vary among different family members.

Can you prevent café-au-lait spots?

As regards the prevention of these benign pigmented marks, there’s no recommendation whatsoever. This is because, they’re not like nevi, which are the result of frequent sun exposure.

On the contrary, some of these spots are congenital or appear during the first days of life, a period in which babies aren’t exposed directly to sunlight.

Café-au-lait spots treatment

Since these spots don’t transform into malignant tumors, patients don’t need a specific treatment for them. However, in the case of aesthetic choices, people may try to remove them.

Child with pediatrician.

Laser therapy

Laser therapy is the first choice for those who want some kind of treatment. As a result, the spots become lighter, but they may return after treatment.

This kind of treatment requires several sessions. And, people may face the same risks as in any case of laser therapy:

  • Temporal or permanent hyperpigmentation.
  • Hypopigmentation.
  • Sensitive skin.
  • Residual scars.

In most cases, sessions last a few minutes and you have to wait from six to eight weeks between sessions.

When should you visit the pediatrician?

If your children have café-au-lait spots, you should visit the pediatrician to dismiss a genetic condition. Thus, the doctor will ask questions regarding family history. And, if they’re necessary, the doctor will ask for the correspondent analysis.

Finally, if your children only have a few spots, the doctor will examine their evolution (size and number). And, they’ll ask the parents to be alert in case new symptoms, related to the associated disorders, arise.


All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Hamm H, Emmerich K, Olk J. Pigmentierte Flecken als mögliche Frühzeichen genetischer Syndrome [Pigmented macules as possible early signs of genetic syndromes]. Hautarzt. 2019 Jul;70(7):506-513. German. doi: 10.1007/s00105-019-4416-6. PMID: 31076812.
  • Shah KN. The diagnostic and clinical significance of café-au-lait macules. Pediatr Clin North Am. 2010 Oct;57(5):1131-53. doi: 10.1016/j.pcl.2010.07.002. PMID: 20888463.
  • BURMAN M. The significance of the café au lait spot. Bull Hosp Joint Dis. 1950 Oct;11(2):140-50. PMID: 12978537.
  • Jha SK, Mendez MD. Cafe Au Lait Macules. 2020 Oct 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 32491424.
  • Burwell RG, James NJ, Johnston DI. Manchas café con leche en escolares. Arch Dis Child . 1982; 57 (8): 631-632. doi: 10.1136 / adc.57.8.631

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.