Skull Fractures in Infants

A skull fracture in an infant is one of the most frightening injuries a parent can face. Whether it occurs during delivery, from an accidental fall, or from another cause, understanding what has happened and what to expect can help you make informed decisions and support your baby’s recovery.

This page explains what skull fractures are, how they happen, what signs to watch for, and how doctors diagnose and treat them. Our goal is to provide clear, compassionate information that helps you understand your child’s injury and the path forward.

What Are Infant Skull Fractures?

A skull fracture is a break in one or more of the bones that make up a baby’s skull. Infant skulls are different from adult skulls. They are made up of several flexible bone plates connected by soft seams called sutures. This flexibility allows the skull to mold slightly during birth, which is normal and protective. However, these bones are still fragile and can break if exposed to significant force or trauma.

Skull fractures in infants most commonly happen during difficult deliveries, accidental falls, or in rare and tragic cases, from intentional harm. The good news is that many skull fractures in babies are simple breaks that heal well on their own with careful monitoring.

How Infant Skull Fractures Happen

Understanding how these injuries occur can help families process what happened and, in some cases, take steps to prevent future harm.

Birth trauma is one of the leading causes of skull fractures in newborns. Assisted deliveries that use forceps or vacuum extractors carry a higher risk, especially if the baby is large, the labor is prolonged, or significant force is applied. While these tools can be life-saving, they require skill and careful judgment. Babies in abnormal positions or those born prematurely may also face greater vulnerability during delivery.

Accidental falls are the most common cause of skull fractures in infants during the first year of life. Babies can roll off beds, changing tables, or out of caregivers’ arms. The parietal bones, located on the top and sides of the skull, are the most frequently affected in these situations. While falls are often accidents, they are also often preventable with careful supervision and safe handling practices.

Non-accidental injury must be considered when the story doesn’t match the injury, when fractures appear on both sides of the skull, or when there are multiple fractures or other unexplained injuries. Healthcare providers are trained to recognize patterns that suggest abuse, and they are legally required to report suspected cases to protect the child. If abuse is suspected, a thorough investigation and intervention are essential to prevent further harm.

Other factors that can increase risk include prematurity, complicated or prolonged labor, and medical conditions that affect bone strength or development.

Types of Infant Skull Fractures

Not all skull fractures are the same. The type of fracture affects how doctors monitor and treat the injury.

Linear fractures are the most common type in infants. These are simple, clean breaks in the bone without any displacement or depression. They usually appear as a thin line on imaging and heal on their own without surgery. Most babies with linear fractures recover completely.

Depressed fractures, sometimes called “ping-pong fractures” because the bone looks pushed inward like a dented ping-pong ball, occur when part of the skull is compressed or sunken. Many mild depressed fractures will pop back out on their own as the baby grows. In other cases, a neurosurgeon may gently lift the bone back into place. The decision depends on the severity of the depression and whether the injury is affecting the brain.

Basilar fractures involve the bones at the base of the skull. These are less common but more serious because they can affect nerves, blood vessels, and the brainstem. Basilar fractures often require more intensive monitoring and care.

Diastatic fractures occur when the force of an injury causes the sutures between skull bones to widen or separate. These are also less common and may require closer follow-up to ensure proper healing.

Signs and Symptoms of Infant Skull Fractures

Babies cannot tell us when something is wrong, so recognizing the signs of a possible skull fracture is critical. Symptoms can range from subtle to severe.

You might notice a visible bump, swelling, or soft area on your baby’s head. Sometimes you can feel a depression or ridge along the scalp. Bruising or a collection of blood under the skin, called a hematoma, may also be present.

Behavioral changes are important warning signs. Your baby may be unusually fussy, irritable, or difficult to console. They may cry more than usual or seem lethargic and less responsive. Vomiting, poor feeding, and changes in sleep patterns can also signal a problem.

More serious symptoms include seizures, loss of consciousness, pupils that are different sizes, difficulty breathing, or a bulging soft spot on the top of the head. If you notice any of these signs, seek emergency medical care immediately.

In some cases, especially with simple linear fractures, there may be few or no obvious symptoms at all. That’s why any head injury in an infant should be evaluated by a healthcare provider.

How Doctors Diagnose Skull Fractures

When a skull fracture is suspected, doctors will begin with a careful physical exam and a detailed history of how the injury occurred. They will look for visible signs of trauma, check the baby’s reflexes and responses, and assess for any neurological problems.

Imaging is essential for confirming the diagnosis. A CT scan is the most common test because it provides detailed images of the skull bones and can quickly identify fractures and any bleeding inside the skull. In some cases, an MRI may be used to get a clearer picture of the brain and soft tissues, especially if there is concern about underlying brain injury.

For babies with minor injuries and no concerning symptoms, doctors may decide to monitor closely without imaging, but this decision is always made carefully and with the child’s safety in mind.

Treatment and Management of Infant Skull Fractures

Treatment for a skull fracture depends on the type of fracture, the baby’s symptoms, and whether there is any injury to the brain.

Observation and supportive care are appropriate for most linear fractures. If the baby is alert, feeding well, and has no signs of brain injury, the fracture will usually heal on its own over several weeks to months. Parents may be given instructions on what symptoms to watch for at home and when to return for follow-up.

Surgery is rarely needed but may be recommended for depressed fractures that do not improve on their own or that are pressing on the brain. The procedure is typically straightforward and involves gently lifting the bone back into place. Recovery is usually smooth, and most babies do very well.

Hospital admission may be necessary if there is bleeding inside the skull, seizures, or other signs of brain injury. In these cases, a team that may include pediatric neurologists, neurosurgeons, and intensive care specialists will closely monitor your baby and provide treatment as needed.

Pain management, careful handling, and minimizing stimulation can help keep your baby comfortable during recovery.

Outlook and Recovery

The prognosis for most infants with skull fractures is excellent. Linear fractures heal completely without surgery, and most babies go on to develop normally. Even depressed fractures usually resolve within three to six months, and long-term problems are uncommon.

The key factor in determining outcome is whether there is injury to the brain beneath the fracture. Babies with isolated skull fractures and no brain injury have a very low risk of lasting complications. When there is bleeding or damage to brain tissue, outcomes depend on the extent and location of the injury, but many children still recover well with appropriate care and support.

Babies who have suffered abusive head trauma face more serious risks, including developmental delays, seizures, and long-term disability. Early intervention, therapy, and a safe, nurturing environment are essential for these children.

Your pediatrician will likely recommend follow-up visits to monitor healing and development. If there are any concerns about motor skills, vision, hearing, or development, early intervention services and therapies can make a meaningful difference.

Prevention

While not all skull fractures can be prevented, many can be avoided with careful attention to safety and best practices in both medical and home settings.

In the delivery room, using forceps and vacuum extractors only when truly necessary, applying them correctly, and recognizing when a cesarean delivery is the safer choice can reduce the risk of birth-related skull fractures. Obstetricians and midwives are trained to weigh these decisions carefully, and families have the right to ask questions and understand the reasons behind delivery interventions.

At home, fall prevention is critical. Never leave your baby unattended on a high surface such as a changing table, bed, or couch. Use safety straps when available, and always keep one hand on your baby during diaper changes. Place babies on the floor or in a crib or playpen when you need to step away, even for a moment. As babies become more mobile, gates, corner protectors, and vigilant supervision become even more important.

Recognizing and responding to signs of abuse or neglect is a community responsibility. Healthcare providers, teachers, family members, and neighbors all play a role in protecting vulnerable children. If you suspect a child is being harmed, report it to local child protective services or law enforcement.

Current Standards and Expert Guidance

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists both emphasize the importance of multidisciplinary care for infants with skull fractures. Depending on the situation, this may involve pediatricians, neurologists, neurosurgeons, social workers, and child safety specialists working together.

New York is home to world-class pediatric trauma and neurosurgical programs at hospitals including Mount Sinai, NYU Langone, NewYork-Presbyterian/Columbia, and Albany Medical Center. These institutions offer specialized expertise, advanced imaging, and family-centered support services.

Recent clinical reviews from 2023 through 2025 continue to support conservative management for most simple skull fractures, with surgery reserved for more complex or symptomatic cases. National organizations including the CDC and NIH stress the importance of standardized evaluation for possible abuse in any infant under three years old who presents with a skull fracture, along with careful documentation of how the injury occurred.

Families navigating a skull fracture diagnosis may benefit from ongoing pediatric follow up, developmental screening, and in some cases, physical or occupational therapy. Social workers and care coordinators can help connect families with resources, answer questions, and provide emotional support during recovery.

How We Can Help

At NY Birth Injury, we know how overwhelming it can be to learn that your baby has been injured. Our mission is to provide families with trusted, accurate information that helps you understand what has happened and what comes next. We connect families with qualified medical professionals, support services, and answers to the questions that matter most. You are not alone, and help is available.