Newborn Cephalohematoma

Quick Answer

A newborn cephalohematoma — sometimes called a newborn hematoma or an infant hematoma — is a birth injury caused by trauma to an infant’s head during childbirth. While many cases of infant cephalohematoma resolve themselves without any intervention, occasionally doctors will need to perform surgery to prevent complications.

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What Is a Newborn Cephalohematoma?

Newborn cephalohematoma is a buildup of ruptured blood vessels in the periosteum, which is the tissue that covers the skull.

In a hematoma, blood pools outside the blood vessels and is visible on the baby’s scalp. The pooled blood puts pressure on brain tissue, which may lead to fatal complications or lifelong disability if not immediately diagnosed and treated.

According to experts from the University at Buffalo and the Thomas Jefferson University Hospital, infant hematomas occur in 0.4% to 2.5% of all live births.

This type of birth injury is relatively uncommon, and many cases will heal on their own. In rare cases, however, severe infant hematomas can lead to complications or death if they are not treated immediately.

IS YOUR CHILD MISSING DEVELOPMENTAL MILESTONES?

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Taking note of your child’s physical, social, and emotional skills can help you determine if they potentially suffered from an injury at birth. An early diagnosis can help your child get the treatment they need as soon as possible.

Q1: How old is your child?

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0-2 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child hold their head steadily on their own?
  • Q3: Can your child push themselves up when they are lying on their stomach?
  • Q4: Has your child started to make smoother movements with their arms and legs?
  • Q5: Does your child smile at other people?
  • Q6: Can your child bring their hands to their mouth?
  • Q7: Does your child turn their head when they hear a noise?
  • Q8: Does your child coo or make gurgling noises?
  • Q9: Does your child follow things with their eyes?
  • Q10: Does your child try to look at their parents or caregivers?
  • Q11: Does your child show boredom, cry, or fuss when engaged in an activity that hasn’t changed in a while?
BACKBACK0-2-years old child

3-4 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child hold their head steadily on their own?
  • Q3: Does your child push down on their legs when their feet are on a flat surface?
  • Q4: Has your child started to roll over from their stomach to their back?
  • Q5: Can your child hold and shake a toy such as a rattle?
  • Q6: Does your child bring their hands to their mouth?
  • Q7: Does your child play with people and start to cry when the playing stops?
  • Q8: Does your child smile spontaneously, especially at people?
  • Q9: Does your child copy some movements and facial expressions of other people?
  • Q10: Does your child babble with expressions and copy sounds they hear?
  • Q11: Does your child cry in different ways to show hunger, pain, or tiredness?
  • Q12: Does your child respond to affection like hugging or kissing?
  • Q13: Does your child follow moving things with their eyes from side to side?
  • Q14: Does your child recognize familiar people at a distance?
BACKBACK3-4-years old child

5-6 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child roll over on both sides (front to back/back to front)?
  • Q3: Has your child begun to sit without support?
  • Q4: Does your child rock back and forth?
  • Q5: Can your child support their weight on their legs (and perhaps bounce) when standing?
  • Q6: Has your child begun to pass things from one hand to the other?
  • Q7: Does your child bring objects such as toys to their mouth?
  • Q8: Does your child know if someone is not familiar to them and is a stranger?
  • Q9: Does your child respond to other people’s emotions, such as a smile or a frown?
  • Q10: Does your child enjoy looking at themselves in the mirror?
  • Q11: Does your child look at things around them?
  • Q12: Does your child respond to sounds they hear by making sounds themselves?
  • Q13: Does your child make sounds to show joy or displeasure?
  • Q14: Does your child respond to their own name?
  • Q15: Has your child started to string vowels together, such as "ah," "eh," or "oh," or started to say consonant sounds such as "m" or "b"?
  • Q16: Has your child begun to laugh?
BACKBACK5-6-years old child

7-9 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child crawl?
  • Q3: Can your child stand while holding on to something to support them?
  • Q4: Can your child sit without support?
  • Q5: Can your child pull themselves up to stand?
  • Q6: Does your child play peekaboo?
  • Q7: Can your child move things from one hand to the other?
  • Q8: Can your child pick small things up, such as a piece of cereal, with their thumb and index finger?
  • Q9: Does your child look for things that they see you hide?
  • Q10: Does your child watch the path of something as it falls?
  • Q11: Does your child show fear when around strangers?
  • Q12: Does your child become clingy with adults who are familiar to them?
  • Q13: Does your child have favorite toys?
  • Q14: Does your child use their fingers to point?
  • Q15: Does your child understand “no”?
  • Q16: Does your child make a lot of repetitive sounds, such as “mamama” or “bababa”?
  • Q17: Does your child copy the sounds and gestures of other people?
BACKBACK7-9 years old child

10-12 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child stand alone with no support?
  • Q3: Does your child walk while holding on to furniture?
  • Q4: Can your child take a few steps without holding on to anything?
  • Q5: Can your child get into a sitting position without any help?
  • Q6: Does your child bang two things together when playing?
  • Q7: Does your child poke with their index finger?
  • Q8: Has your child started to use things like hairbrushes or drinking cups correctly?
  • Q9: Does your child find hidden objects easily?
  • Q10: Does your child play peekaboo or pat-a-cake?
  • Q11: Does your child become shy or nervous around strangers?
  • Q12: Does your child repeat actions or sounds to get attention?
  • Q13: Does your child put out an arm or leg to help when getting dressed?
  • Q14: Does your child cry when a parent leaves the room?
  • Q15: Does your child show that they have favorite things or people?
  • Q16: Does your child show fear?
  • Q17: Does your child say things such as “mama,” “dada,” or “uh-oh”?
  • Q18: Does your child try to say the words you say?
  • Q19: Has your child started to use gestures like waving or shaking their head “no”?
BACKBACK10-12 years old child

13-18 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child walk by themselves?
  • Q3: Does your child walk up stairs and run?
  • Q4: Does your child pull toys while walking?
  • Q5: Can your child drink from a cup on their own?
  • Q6: Can your child eat with a spoon on their own?
  • Q7: Can your child help undress themselves?
  • Q8: Does your child have occasional temper tantrums?
  • Q9: Does your child show affection to familiar people?
  • Q10: Does your child become clingy in new situations?
  • Q11: Does your child explore their environment alone with parents close by?
  • Q12: Can your child say several single words?
  • Q13: Can your child say and shake their head “no”?
  • Q14: Does your child point to show things to other people?
  • Q15: Does your child scribble?
  • Q16: Does your child know what ordinary products such as phones, spoons, and brushes are used for?
  • Q17: Can your child follow one-step commands such as “sit down” or “stand up”?
  • Q18: Does your child play with a doll or stuffed animal by pretending to feed it?
BACKBACK13-18 years old child

19-23 MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Has your child begun to run?
  • Q3: Has your child kicked a ball?
  • Q4: Can your child climb down and onto furniture on their own?
  • Q5: Can your child walk up and down stairs while holding on?
  • Q6: Can your child stand on their tiptoes?
  • Q7: Has your child thrown a ball overhand?
  • Q8: Does your child copy others, especially people older than them?
  • Q9: Does your child get excited around other children?
  • Q10: Has your child shown more independence as they've aged?
  • Q11: Does your child do what they were told not to do and become defiant?
  • Q12: Does your child point to things when they are named?
  • Q13: Does your child know names of familiar people or body parts?
  • Q14: Does your child say 2 to 4-word sentences?
  • Q15: Does your child repeat words they hear?
  • Q16: Does your child complete sentences and rhymes in familiar books?
  • Q17: Does your child name items in books, such as dogs, cats, and birds?
  • Q18: Does your child play simple pretend games?
  • Q19: Has your child started to use one hand more than the other?
  • Q20: Has your child begun to sort shapes and colors?
  • Q21: Does your child follow 2-step instructions, such as “pick up your hat and put it on your head?”
BACKBACK19-23 years old child

24+ MONTHS DEVELOPMENTAL MILESTONES QUIZ

  • Q2: Can your child run easily?
  • Q3: Can your child climb?
  • Q4: Can your child walk up and down stairs with one foot on each step?
  • Q5: Can your child dress and undress themselves?
  • Q6: Does your child show affection for friends without being told?
  • Q7: Does your child take turns when playing games?
  • Q8: Does your child show concern when others are crying?
  • Q9: Does your child understand the idea of “mine" and "theirs"?
  • Q10: Does your child show many different emotions?
  • Q11: Does your child copy adults and friends?
  • Q12: Does your child separate easily from their parents?
  • Q13: Does your child get upset when there is a major change in their routine?
  • Q14: Does your child say words such as “I,” “me,” “we,” “you,” and some plural nouns?
  • Q15: Can your child say their first name, age, and gender?
  • Q16: Can your child carry on a conversation with 2 to 3 sentences?
  • Q17: Can your child work toys with buttons and other moving parts?
  • Q18: Does your child play pretend with dolls, animals, or people?
  • Q19: Can your child finish 3 or 4 piece puzzles?
  • Q20: Can your child copy a circle when drawing?
  • Q21: Can your child turn pages of a book one page at a time?
  • Q22: Can your child turn door handles?
BACKBACK24 months + old child

Types of Newborn Cephalohematomas

There are two categories of infant hematoma:

  • Acute Infant Hematoma: Symptoms will appear immediately or within hours of delivery
  • Chronic Infant Hematoma: Symptoms may not appear until days or weeks after birth

If acute infant hematoma is not treated properly, it can lead to chronic infant hematoma.

According to researchers from the Department of Neurosurgery at Kaohsiung Medical University Hospital, over 60% of infants treated for acute hematomas had positive results. Diagnosing the condition early on may improve the outcome of the hematoma. Without proper diagnosis and treatment, severe damage or even death may occur.

Cephalohematoma vs Caput Succedaneum

Unlike newborn cephalohematoma, which involves ruptured blood vessels under the scalp, caput succedaneum is classified as swelling of the scalp itself.

Caput succedaneum usually occurs from the pressure during a head-first delivery. It is more common in long or difficult deliveries and/or when vacuum extraction is needed. Unlike newborn cephalohematoma, caput succedaneum usually requires no treatment and disappears by the third day of life.

What Causes Newborn Cephalohematomas?

Head injuries that take place during childbirth cause newborn hematomas. These injuries may occur because the baby’s head was pushed against their mother’s pelvis.

Other times, newborn hematomas happen due to the use of forceps or vacuum extraction complications.

Overall, newborn cephalohematoma is usually a sign of difficult labor. The longer it takes to deliver a baby, the longer the baby’s head may be compressed by the birth canal, increasing the risk of a newborn hematoma.

Infant hematomas may also occur due to infant size, assisted delivery devices, and medical negligence. Do you suspect your child’s birth injury was caused by medical malpractice?

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Infant Size

If a fetus is large, newborn cephalohematoma is more likely to occur. As with a long labor, this may occur from increased stress and compression on the baby in the birth canal. Additionally, average-sized fetuses can experience increased compression if the mother has a smaller than normal pelvis.

Newborn cephalohematomas occur more in male infants and in large infants.

Assisted-Delivery Devices

Doctors sometimes decide to use devices such as forceps or a vacuum to aid in deliveries that are longer or more difficult than usual. These tools may put more pressure on the baby’s head, increasing the risk of newborn cephalohematoma.

Medical Negligence

Doctors are trained to detect and reduce the risks of newborn cephalohematoma. If a risk is identified, doctors should take actions to decrease the chances of a potential injury and monitor your baby for a hematoma after delivery.

If the doctor does not follow protocol and your child does not receive prompt medical intervention, it may be considered medical negligence. Misusing tools during delivery or failure to address fetal distress immediately can constitute as medical malpractice.

In cases of medical practice, compensation may be available to you and your family.

Nurse Beth Carter

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Newborn Cephalohematoma Risk Factors

Not all of the causes listed above are guaranteed to give your child a hematoma. However, there are risk factors that can increase the risk of developing newborn cephalohematoma. The most common reported risk factor for an infant hematoma is using vacuum extractors or forceps during childbirth.

Newborn hematoma risk factors include:

  • Carrying multiple children
  • Difficult or prolonged labor
  • Fetus in a breech or posterior position
  • Fetus is larger than average
  • Mother is unable to push the child through the birth canal
  • Premature birth
  • Use of assisted-delivery devices such as forceps or vacuum extractor

Possible Complications From a Newborn Cephalohematoma

Anemia

Anemia is a condition caused by a deficiency of red blood cells. Since newborn cephalohematoma causes pooling of blood, anemia can result from the blood loss.

Cephalohematoma Calcification

If newborn cephalohematoma does not go away after about one month, the hematoma may become calcified. Calcification is when bone deposits form and harden around the pool of blood. While it is uncommon, cephalohematoma calcification can cause serious deformity to the skull.

Fracturing of the Skull

A more common complication of newborn cephalohematoma is fractures to the skull. Although fractures occur in almost 25% of cases, they are usually not very serious and often heal without significant medical intervention.

Infection

One of the more dangerous complications of newborn cephalohematoma is infection.

Infection can begin in the pooled blood and lead to a serious systemic infection such as sepsis or meningitis. These types of serious infections have a high death rate in infants, so getting diagnosed promptly is critical.

Jaundice

Jaundice is caused when there is an excess of bilirubin, which is a chemical waste created by recycled blood cells. Bilirubin is normally disposed through the liver and urination. Babies with jaundice usually have a yellowish color in their skin and eyes.

Untreated jaundice can cause kernicterus, which is a serious condition that can cause brain damage and even lead to death.

Newborn Cephalohematoma Symptoms

  • Feeding difficulties
  • High pitched cry
  • Increased head circumference
  • Pain in the skull area
  • Seizures
  • Soft spots (bulging fontanelles) on the head
  • Swelling
  • Tiredness
  • Vomiting

Your child may develop signs and symptoms of an infant hematoma right after the injury occurred, or it may take days or weeks for symptoms to appear. The time between the injury and the appearance of symptoms is referred to as the lucid interval.

Additionally, bruising and hematomas are commonly mistaken for one another. The collection of blood in a hematoma can create a dark spot on your baby’s skin, similar to a bruise. While bruises typically appear a few hours after a child sustains a minor injury, cephalohematomas occur exclusively after head trauma.

Diagnosing Newborn Cephalohematoma

If your child is exhibiting symptoms of newborn cephalohematoma, your doctor will monitor your child’s head size to see if it is expanding more rapidly than it should.

Your doctor will also check your child’s hematocrit level — the number of red blood cells compared to the rest of their blood’s volume — to see if it is lower than it should be.

Next, your doctor will likely order imaging scans. They will often choose to conduct a computed tomography (CT) scan, and they may also recommend an X-ray or magnetic resonance imaging (MRI). These imaging tests will help the doctor pinpoint the source of the bleeding and the size of the hematoma.

Newborn Cephalohematoma Treatment

If you suspect your child has a newborn hematoma, seek immediate medical attention. Your child may need surgery to drain blood, remove a large clot, or tie off a bleeding vein. In cases where surgery is not needed, treatment involves a lot of resting.

Treatments for possible complications caused by a hematoma include:

  • Anemia: Blood transfusion, phototherapy, or antibiotics
  • Calcification: Surgery
  • Skull fracture: Careful monitoring to ensure it heals properly
  • Infection: Antibiotics
  • Jaundice: Monitoring and light therapy

With treatment, a hematoma does not generally cause major problems to the newborn. Speak with your doctor to learn their specific instructions for recovering from newborn cephalohematoma.

Newborn Cephalohematoma Prognosis

With prompt and proper treatment, children diagnosed with newborn cephalohematoma are likely to live a life without any physical or developmental challenges and live as long as an individual without the condition would live.

Many of the complications related to newborn cephalohematomas can be avoided or reduced if the injury is caught and treated early. For this reason, if your doctor or nurse fails to address the signs of an infant hematoma quickly enough, it can be considered medical negligence.

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Do you suspect your child’s birth injury was caused by medical malpractice?

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Financial Compensation for Newborn Cephalohematoma

If your child suffered a preventable birth injury, you and your family may be entitled to financial compensation. Although pursuing legal action will not undo any harm caused to your child, the compensation a birth injury lawyer may be able to get you can help you pay for your child’s ongoing treatment and provide a sense of justice for the act of medical negligence.

If you would like to connect with a law firm experienced in birth injury cases, contact the Birth Injury Justice Center today to get a free case review.

Birth Injury Support Team

The Birth Injury Justice Center was founded in 2003 by a team of legal professionals to educate and empower victims and families affected by birth injuries. Our team is devoted to providing you with the best resources and legal information for all types of birth injuries.

View 4 Sources
  1. Holland, K. (2017, June 5). Cephalohematoma (CH): What Is It and What Does It Mean for Your Baby? (1192477595 891386605 S. H., Ed.). Retrieved from https://www.healthline.com/health/cephalohematoma
  2. National Center for Biotechnology Information, U.S. National Library of Medicine. (Sept-Oct 2002). “Acute subdural hematoma in infancy.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12480224.
  3. National Center for Biotechnology Information, U.S. National Library of Medicine. (December 9, 2019). “Cephalohematoma.” Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470192/.
  4. National Institutes of Health, U.S. National Library of Medicine. (December 9, 2019). “Caput succedaneum.” Retrieved from https://medlineplus.gov/ency/article/001587.htm/.
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