A cephalhematoma is a birth injury that results in a reddish colored lump on the baby’s head, usually noticeable at birth or shortly thereafter. It is due to bleeding between the bone and the fibrous material that covers it, called the periosteum. This condition typically resolves itself in a few months, but in rare cases, causes additional physical problems or requires some form of intervention.
Cephalhematoma most often occurs when pressure is exerted on the head due to interventional procedures like vacuum extraction or forceps delivery. It can also develop without these interventions, and situations where the baby’s head is subject to birth canal pressure during labor for a protracted period of time may also result in this condition. When babies have it, a squishy or slightly hardened and reddish lump will be quite obvious, and such marring of the newborn’s head can be shocking at first, especially if the lump is very large. Even large lumps may simply go away over time as the red blood cells are broken down and reabsorbed. The biggest risk of re-absorption can be that a baby will develop jaundice from processing so many red blood cells, which can be helped with treatments like a bili blanket.
If cephalhematoma is present, doctors may still want to run other tests. Sometimes its presence can indicate a mild skull fracture, or a very large collection of blood crosses the sutures or un-joined plates of the baby’s skull, and this could be suggestive of problems. Alternately, instead of receding, the cephalhematoma can start to harden due to calcification or ossification (new bone growth).
In rare cases, calcified lumps may still recede, but ossified lumps where bone has grown into the lump, may need surgery. Another possible complication is continued bleeding, which could result in anemia and might require blood transfusion.
It’s important to restate that the cephalhematoma scarcely ever requires treatment. The presence of a cephalhematoma does not suggest, in most instances, that there is permanent or any form of brain damage. In a way, it can be seen as a specialized form of bruise that will almost always improve and ultimately go away over time, though it can take several months for this to occur.
Equally important, is recognition that one injury to the head during a traumatic birth could indicate others. Children with a cephalhematoma should be watched carefully. Any evidence of a failure to meet developmental milestones should be noted to doctors, and if these failures are common and a child seems not to be progressing at a normal rate, consultation with a pediatric neurologist is recommended.
