A cephalohematoma is a birth-related injury appearing as a lump on a newborn’s head. This condition involves a collection of blood pooled beneath the scalp but above the skull bone. The injury is typically harmless, does not affect the brain, and the body naturally reabsorbs the blood collection over time without intervention.
Defining Cephalohematoma
A cephalohematoma is a hemorrhage that occurs in the space between the skull bone and the periosteum, the thick membrane covering the bone. The periosteum is tightly bound at the suture lines, which effectively contains the collected blood within the boundary of a single bone. The swelling is firm and often becomes noticeable hours or a day after birth as slow bleeding continues.
This localization separates it from a caput succedaneum, another common type of newborn head swelling. A caput succedaneum is a softer, generalized swelling of the scalp’s soft tissues that sits above the periosteum. Since a caput succedaneum is not constrained by bone boundaries, it can cross the suture lines and resolves quickly, usually within a few days. In contrast, the cephalohematoma is localized and takes weeks or months to disappear.
The Mechanics of Formation
The cause of a cephalohematoma is the physical pressure exerted on the baby’s head during childbirth. This pressure causes a shearing action that separates the periosteum from the skull bone, rupturing small blood vessels and leading to a slow accumulation of blood.
Risk factors include prolonged or difficult labor. The use of delivery instruments, such as a vacuum extractor or forceps, also increases the likelihood due to concentrated force applied to the scalp. While the injury is primarily to the soft tissue, a small percentage of newborns may have an associated linear skull fracture. The condition itself does not indicate a brain injury.
Observation and Care
The standard medical management for an uncomplicated cephalohematoma is conservative observation. The body’s natural processes are usually sufficient to break down and absorb the trapped blood without the need for medical intervention. Attempting to drain the blood with a needle is avoided because it carries a risk of introducing bacteria and causing infection or abscess.
The most common complication requiring monitoring is neonatal jaundice, or hyperbilirubinemia. As the body breaks down the pooled red blood cells, it releases bilirubin, which accumulates in the bloodstream. If bilirubin levels become too high, the infant may require treatment with phototherapy. Healthcare providers also monitor for signs of anemia, as a large cephalohematoma represents blood lost from the baby’s circulation.
Healing Timeline and Prognosis
The resolution of a cephalohematoma is a gradual process that depends on the volume of collected blood. Most cases begin to noticeably reduce in size within the first few weeks after birth. The complete absorption of the blood collection can take anywhere from a few weeks to several months, with many resolving fully by three months of age.
During the healing phase, it is common for the cephalohematoma to feel firmer as the clot begins to organize and, in some instances, calcify. Calcification involves the formation of a hardened ring or bone deposits around the mass, which may prolong the visible appearance of the lump. Despite this temporary hardening, the long-term prognosis is excellent, as cephalohematomas do not cause lasting neurological damage or developmental delays. The lump will eventually flatten and remodel.