Cephalohematoma in a newborn refers to a collection of blood that gathers under the baby’s scalp. This swelling occurs specifically between the skull bone and its protective covering, known as the periosteum. It is a common occurrence following birth, affecting between 0.4% and 2.5% of all live births. While its appearance can be alarming to new parents, a cephalohematoma is typically harmless and generally resolves without medical intervention.
Understanding Cephalohematoma
A cephalohematoma presents as a localized, often firm, and well-defined swelling on a newborn’s head. This bulge is a collection of blood that has accumulated in the subperiosteal space, directly beneath the periosteum. The bleeding happens due to the rupture of small blood vessels that cross the periosteum.
Because the blood is contained by the periosteum, a distinguishing characteristic is that its boundaries are limited by individual skull bones. This means the swelling does not cross the suture lines, which are the fibrous joints between the skull bones. The swelling may not be immediately apparent at birth, often becoming noticeable hours or even days later.
How Cephalohematomas Develop
Cephalohematomas form when small blood vessels rupture due to friction or pressure exerted on the baby’s head during the birthing process. This pressure can occur as the baby’s head passes through the birth canal. The shearing forces can separate the periosteum from the underlying skull, leading to bleeding.
Certain factors can increase the likelihood of a cephalohematoma developing. Prolonged labor is a common risk factor, as is the use of assistive devices such as forceps or vacuum extractors during delivery. While these situations can heighten the risk, cephalohematomas can also occur in births that are not considered complicated.
Identifying a Cephalohematoma
The swelling typically appears hours to days after birth, differentiating it from other birth-related head swellings like caput succedaneum, which is usually present at birth. A key feature is that a cephalohematoma does not extend beyond the skull’s suture lines, remaining confined to a single cranial bone. In contrast, caput succedaneum, a more superficial swelling, does cross these lines.
Initially, the bump may feel soft, but it can become firmer as the blood begins to calcify over time. The overlying skin usually does not show discoloration or injury. Healthcare providers diagnose a cephalohematoma through a physical examination. Imaging studies, such as X-rays or CT scans, are rarely necessary unless there is suspicion of an underlying skull fracture.
Care and Resolution
Most cephalohematomas do not require specific medical treatment and resolve on their own. The body gradually reabsorbs the collected blood, a process that can take several weeks to months. As the swelling diminishes, the center of the mass may resolve first, giving it a temporary crater-like or ring-shaped appearance.
While generally harmless, there are a few rare complications. Jaundice can occur if a significant amount of blood breaks down, leading to increased bilirubin levels. Infection is another rare concern, especially if the skin over the hematoma is broken. If the accumulated blood persists for an extended period, it can calcify and form hardened bone deposits. Parents should seek medical attention if they observe signs of infection like redness, warmth, fever, or if the swelling rapidly increases in size.