A cephalohematoma is a collection of blood under a newborn’s scalp. This condition is a common birth injury, occurring in up to 2.5% of live births, resulting from pressure on the baby’s head during delivery. Although the lump may be concerning, a cephalohematoma typically resolves completely on its own without medical intervention. This localized bleeding does not affect the brain and rarely leads to long-term health issues.
What Exactly Is a Cephalohematoma?
A cephalohematoma is a collection of blood that forms between the skull bone and the periosteum, the thick membrane covering the bone. The bleeding is contained within this subperiosteal space. Since the periosteum attaches firmly at the edges of each skull bone, the blood cannot spread across the suture lines where the bones meet. This restriction means the swelling is firm, well-defined, and limited to the area of a single skull bone, often the parietal bones.
This presentation differentiates it from caput succedaneum, a similar but less concerning condition. Caput succedaneum is a generalized, softer swelling involving serous fluid, not blood, and it can cross suture lines. Caput succedaneum is usually present immediately at birth and disappears within a few days, while a cephalohematoma may not become noticeable until hours or days after delivery because the bleeding is gradual.
How Cephalohematomas Form
A cephalohematoma forms when tiny blood vessels rupture between the skull bone and the periosteum. This rupture occurs when significant pressure is applied to the baby’s head during labor and delivery. The pressure forces the periosteum to separate from the skull bone, tearing the small connecting vessels.
Factors that increase pressure on the fetal head raise the likelihood of this injury. These include a prolonged second stage of labor, excessively strong uterine contractions, or a relatively large baby. The use of assistive devices, such as a vacuum extractor or forceps, is also a recognized cause, as these tools increase mechanical stress. This trauma causes a slow, self-limiting bleed beneath the periosteum.
Diagnosis, Management, and Healing Timeline
Diagnosis usually occurs through a physical examination shortly after the lump appears. Imaging tests, such as X-rays or ultrasound, may be used to confirm the diagnosis, check for an underlying skull fracture, or measure the hematoma size.
Management is conservative, involving “watchful waiting” while the body naturally reabsorbs the collected blood. Medical professionals advise against draining or aspirating the cephalohematoma due to the risk of introducing infection. The body slowly breaks down and clears the pooled blood over time.
The healing timeline is variable; smaller hematomas may resolve within two weeks, while larger ones can take up to three months. During healing, the mass may feel harder as calcium deposits form around the edges, a process called calcification. This hardening is a normal part of resolution and typically requires no treatment.
Monitoring for Potential Complications
While a cephalohematoma is usually benign, its presence introduces secondary risks that require monitoring. The primary potential complication is neonatal jaundice, resulting from the breakdown of red blood cells trapped within the hematoma. This process releases bilirubin, which the newborn’s liver must process. If the liver cannot process the influx quickly, the baby may develop jaundice, potentially requiring treatment like phototherapy.
A less common risk is infection at the site, especially if the overlying skin is broken. In rare cases, extensive calcification may leave a hard lump after the blood is absorbed, though this rarely causes long-term issues.
Parents should contact a physician immediately if they observe signs of infection (redness, increased warmth, or swelling) or severe jaundice (fever, lethargy, poor feeding, or increased irritability). Regular follow-up appointments are important to monitor the hematoma size and ensure healing progresses as expected.