Vascular anomalies are classified as vascular tumors and vascular malformation, common in childhood. The mammalian target of Rapamycin inhibitor sirolimus has proved to be efficacious for many vascular anomalies by inhibiting cell proliferation and angiogenesis. Based on the latest ISSVA classification system, we describe the application of Sirolimus of vascular anomalies in children. The purpose of this paper is to facilitate sirolimus precision dosing in children with vascular anomalies.