Michael S. Porter
Eric C. Nordby
When a baby is born with a soft swelling on the head, parents naturally worry. One of the more common causes of this kind of swelling is a condition called cephalohematoma. While the term may sound serious, most cases resolve on their own without causing lasting harm. Understanding what cephalohematoma is, why it happens, and what to expect can help ease concerns and guide families through the early weeks of their newborn’s life.
This page explains cephalohematoma in clear terms, covering its causes, symptoms, potential complications, and typical outcomes. If your baby has been diagnosed with this condition, you are not alone. Many families face the same questions, and reliable information can make a meaningful difference during this time.
What is Cephalohematoma?
Cephalohematoma is a collection of blood that gathers between a baby’s skull bone and the periosteum, a thin membrane that covers the bone. The bleeding occurs when small blood vessels rupture during birth, usually due to pressure or friction as the baby moves through the birth canal.
The swelling typically appears over one of the flat bones of the skull, most often the parietal bone on the side or top of the head. Because the bleeding is confined beneath the periosteum, it stays within the boundaries of that single bone and does not cross the natural lines, or sutures, between skull bones. This feature helps doctors distinguish cephalohematoma from other types of newborn head swelling.
Cephalohematoma is not an injury to the brain itself. The blood collects outside the skull, and the brain remains protected. While the swelling may look alarming, it does not indicate brain damage or developmental problems.
How Common is Cephalohematoma?
Cephalohematoma occurs in approximately 1 to 2.5 percent of all vaginal births. The incidence rises when instruments such as forceps or vacuum extractors are used to assist delivery. In these cases, up to 10 percent of newborns may develop a cephalohematoma.
This condition is considered one of the more frequent birth-related findings and is widely recognized by pediatricians and obstetricians. Its occurrence does not necessarily reflect poor care or preventable error. Many factors during labor and delivery contribute to whether a baby develops this type of swelling.
What Causes Cephalohematoma?
Cephalohematoma results from mechanical pressure or trauma during the birth process. Several factors increase the likelihood of this condition developing.
Prolonged or difficult labor can place sustained pressure on the baby’s head, especially when the head is pressed against the mother’s pelvis for an extended period. This pressure can cause the small blood vessels between the skull and periosteum to tear.
Assisted deliveries using forceps or vacuum extraction are associated with higher rates of cephalohematoma. These instruments apply direct force to the baby’s head to help guide the baby through the birth canal, which can increase the risk of vascular injury.
Larger babies, a condition known as macrosomia, may have more difficulty fitting through the birth canal, leading to increased pressure on the head. Similarly, first-time mothers (nulliparity) are at slightly higher risk, as labor may be longer or more challenging.
Improper positioning of the baby’s head during labor, such as when the head does not rotate normally, can also contribute. In rare cases, underlying bleeding or clotting disorders in the newborn may make the baby more susceptible to bleeding after even minor trauma.
Recognizing the Symptoms
Cephalohematoma is usually not visible immediately after birth. It often becomes noticeable several hours to a few days later, once any initial swelling from labor (called caput succedaneum) begins to subside.
Parents or healthcare providers may observe a firm, raised area on one side of the baby’s head. The swelling feels soft or slightly fluctuant to the touch and is well-defined, meaning it has clear borders. Unlike caput succedaneum, which is diffuse and crosses suture lines, cephalohematoma stays confined to the area over a single skull bone.
The swelling does not typically cause pain, and most babies with cephalohematoma behave normally. They feed well, sleep normally, and show no signs of distress related to the swelling itself.
As the days pass, the cephalohematoma may grow slightly larger before it begins to resolve. This is expected and results from ongoing bleeding that eventually stops on its own. Parents should not be alarmed if the bulge seems more prominent a few days after birth than it was initially.
How is Cephalohematoma Diagnosed?
Most cases of cephalohematoma are diagnosed through a physical examination. A pediatrician or neonatologist will carefully feel the baby’s head and note the location, size, and characteristics of the swelling.
In some situations, imaging may be recommended. An ultrasound of the head can confirm the diagnosis and help rule out other issues. If there is concern about an underlying skull fracture, which can occur in a small percentage of cases, a head X-ray or CT scan may be ordered.
Imaging is not always necessary, especially when the clinical presentation is typical and the baby is otherwise healthy. The decision to pursue additional testing depends on the size of the swelling, whether it is growing unexpectedly, and whether there are other concerning symptoms.
Potential Complications
While the majority of cephalohematomas resolve without incident, there are a few complications that parents and healthcare providers should be aware of.
Jaundice is the most common concern. As the pooled blood breaks down, it releases bilirubin, a yellow pigment that can accumulate in the baby’s bloodstream. Elevated bilirubin levels lead to jaundice, which appears as a yellowing of the skin and eyes. Most cases of jaundice related to cephalohematoma are mild and manageable, but some babies may require phototherapy (light treatment) to help lower bilirubin levels. Parents should watch for increasing yellow color in the skin or whites of the eyes and report this to their pediatrician.
Anemia can occur if the amount of blood collected under the periosteum is significant. Newborns have a limited blood volume, and a large cephalohematoma may result in measurable blood loss. In rare cases, a baby may need a blood transfusion if anemia is severe. Routine monitoring with blood tests can help detect this early.
Infection is an uncommon but serious complication. If bacteria enter the cephalohematoma, an abscess can form. Signs of infection include increased redness or warmth over the swelling, fever, irritability, or poor feeding. Any suspicion of infection warrants prompt medical evaluation and treatment with antibiotics.
Calcification may occur if the cephalohematoma does not fully reabsorb. In rare instances, the pooled blood begins to harden, forming a bony lump on the skull. This process is usually harmless and cosmetic, but in some cases, surgical removal may be considered if the lump is large or persistent.
Underlying skull fracture is present in a small percentage of babies with cephalohematoma. Most skull fractures in newborns are linear, meaning they are simple cracks without displacement of bone. These fractures typically heal on their own without intervention. However, they do require monitoring to ensure proper healing and to rule out any complications.
Treatment and Management
The cornerstone of cephalohematoma management is careful observation. More than 90 percent of cases resolve naturally as the baby’s body gradually reabsorbs the blood. This process can take several weeks to a few months, depending on the size of the hematoma.
No immediate intervention is usually required. Doctors do not routinely drain or aspirate cephalohematomas because doing so carries risks of infection and bleeding. In almost all cases, the body handles the reabsorption process effectively without help.
Parents are encouraged to monitor the swelling at home and attend regular follow-up appointments with their pediatrician. These visits allow the healthcare team to track the size of the cephalohematoma, check for signs of jaundice or anemia, and answer any questions.
If jaundice develops, the baby’s bilirubin levels will be checked through a simple blood test. Mild jaundice often resolves on its own, but if levels are elevated, phototherapy may be recommended. This treatment involves placing the baby under special lights that help break down bilirubin in the skin.
In cases where the cephalohematoma is unusually large or persists beyond several months, a specialist such as a pediatric neurosurgeon may be consulted. Drainage or surgical intervention is considered only in rare situations where complications arise or the swelling does not improve.
Education and reassurance are essential parts of care. Pediatricians should explain what to expect, how long resolution may take, and what symptoms should prompt immediate attention. Parents who understand the condition and its natural course are better equipped to manage their concerns and care for their baby confidently.
What to Watch For at Home
While cephalohematoma itself is generally benign, parents should be aware of certain signs that warrant a call to the pediatrician or a visit to the emergency room.
Contact your healthcare provider if you notice any of the following:
- Increasing yellowness of the skin or eyes
- The baby becomes unusually sleepy or difficult to wake
- Poor feeding or refusal to eat
- Fever or signs of illness
- The swelling becomes red, warm, or tender
- The cephalohematoma grows rapidly or changes in appearance
- Any new or unusual symptoms that concern you
Trust your instincts. If something does not seem right, it is always appropriate to reach out for guidance.
Prognosis and Long-Term Outlook
The prognosis for babies with cephalohematoma is excellent. The vast majority of infants recover completely without any lasting effects. The condition does not affect brain development, intelligence, or motor skills.
As the swelling gradually resolves, the baby’s head shape returns to normal. In rare cases where calcification occurs, a small bony prominence may remain, but this is typically cosmetic and does not interfere with health or function.
Parents often worry about whether cephalohematoma will cause problems later in life. Research and clinical experience show that complications are uncommon and that most children who had cephalohematoma as newborns grow and develop just like their peers.
Clinical Guidelines and Standards of Care
Healthcare providers in New York and across the United States follow evidence-based guidelines established by leading medical organizations. The American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the World Health Organization (WHO) all emphasize the importance of early identification, parent education, and appropriate monitoring.
Major medical centers, including Mount Sinai, NYU Langone Health, NewYork-Presbyterian/Columbia, and Albany Medical Center, have protocols in place for managing newborn cephalohematoma. These protocols ensure that babies receive consistent, high-quality care based on the latest medical evidence.
Multidisciplinary teams, including obstetricians, pediatricians, neonatologists, and specialists, work together when complications arise or when additional expertise is needed. This collaborative approach helps ensure the best possible outcomes for newborns and their families.
Support and Resources for Families
Navigating any birth-related condition can feel overwhelming, especially in the early days of parenthood. Access to clear information and compassionate support makes a meaningful difference.
Your baby’s pediatrician is your primary resource for medical guidance and reassurance. Regular check-ups allow for ongoing monitoring and give you the opportunity to ask questions and discuss any concerns.
If complications such as jaundice, anemia, or infection develop, specialists in pediatric hematology, infectious disease, or neurosurgery may become involved. These providers work closely with your pediatrician to coordinate care and keep you informed.
Support groups, both online and in-person, can connect you with other parents who have experienced similar situations. Sharing stories and advice can reduce feelings of isolation and provide practical tips for managing day-to-day care.
At NYBirthInjury.com, we are committed to providing families with trusted, accurate information about birth injuries and related conditions. Our goal is to help you understand what has happened, what to expect, and where to turn for support. We connect families with qualified medical resources and provide clear, compassionate explanations to guide you through challenging times.
What to Do Next
Cephalohematoma is a common birth-related condition that, while concerning to parents, usually resolves on its own without causing lasting harm. Understanding the causes, symptoms, and expected course of the condition can help ease anxiety and empower families to participate actively in their baby’s care.
If your newborn has been diagnosed with cephalohematoma, know that you are supported by a healthcare team trained to manage this condition and that most babies go on to thrive. Stay informed, stay connected with your pediatrician, and trust that with time and appropriate care, your baby will heal. If you have questions about whether medical care during labor and delivery met accepted standards, you can reach out to us to discuss your situation and explore your options.