Infant Skull Fracture

What Is Infant Skull Fracture?

Unlike adults, infants have soft, flexible skulls meant to allow them to pass through the birth canal more easily. However, this flexibility can also leave infants at higher risk for skull fractures.

A newborn’s skull is made up of five major bone plates held together by tough, fibrous membranes called sutures. The places where these sutures intersect are called fontanelles or, simply, soft spots. These gaps and sutures are what allow the bone plates to shift and flex during birth, but they are also areas of extreme vulnerability.

Head injuries occur most commonly in children under two and can have a wide variety of causes. In newborns, instrumental delivery is one of the most common causes of skull fractures leading to traumatic brain damage.

Types of Skull Fractures

There are many different types of skull fractures, each with its own particular dangers and characteristics. However, some are more commonly seen in newborns suffering from traumatic birth injuries than others.

Common types of infant skull fractures include:

• Depressed: Sometimes called ping-pong fractures because the indent resembles that of a ping-pong ball impression on the infant’s head. This type of fracture creates a depression or indentation in the skull that can put pressure on the brain, which generally heals on its own within 6 months. Therefore, physicians will wait 6 months before surgical interventions.
• Diastatic: Diastatic fractures occur along the sutures between the bone plates. This type of fracture is common in infants because the bones have not yet fused, leaving these areas particularly vulnerable. This type of fracture has a high risk of becoming a growing skull fracture — a serious condition where the brain swells out of the skull through the fracture — and must be closely monitored.
• Linear: The most common type of skull fracture. Linear skull fractures in infants are characterized by a straight crack in the bone that does not move the bone itself. Patients require observation but don’t usually require surgery. There is some risk of developing growing skull fractures or hematomas.

Causes of Infant Skull Fracture

When present at birth, infant skull fracture generally has its roots in trauma associated with the delivery. This trauma can have a variety of causes, both natural and unnatural.

Skull fractures in infants may be caused by:

• Aggressive delivery techniques: Excessive force during delivery can put too much pressure on the infant’s fragile skull
• Difficult or long labor: Prolonged labor exposes the baby’s head to continuous pressure, potentially weakening the skull bones
• Forceps complications: Incorrect or forceful use of forceps (large tong-like device) can apply uneven pressure on the baby’s head
• Prolonged instrumental birth: Extended use of birth-assisting tools increases pressure duration on the head, weakening the skull
• Using instruments too early: Early use of instruments can lead to their improper application, putting undue stress on the baby’s head
• Vacuum extraction complications: Improper use of a vacuum extractor can create intense pressure spots on the baby’s head

Due to the high risk of complications, instrumental births — where the doctor uses tools to maneuver the baby out of the birth canal — are becoming less common. Instances in which these medical tools are misused can have devastating consequences.

Symptoms of Infant Skull Fracture

Failure to carefully handle the delicate structures of the infant skull can lead to serious injuries from which children may never fully recover. Because infant skull fractures can vary so widely in location, severity, and type, the symptoms are also highly variable.

Common symptoms include:

• Bleeding
• Brain damage
• Bruising
• Listlessness/lack of energy
• Loss of consciousness
• Lump on the skull
• Misshapen appearance of the skull
• Pallor
• Seizures
• Vomiting

While small, linear fractures may heal without major intervention, it is always important to monitor all fractures as they heal. Complications from infant skull fractures can rapidly become serious and even lead to death if left untreated.

How Is Infant Skull Fracture Diagnosed?

Babies showing symptoms of skull fracture should be given a complete neurological exam, assessing their symptoms and looking for visible signs of damage. If there is cause for concern, doctors will usually order imaging tests to look for evidence of fractures, bleeding, and swelling.

Imaging tests used to diagnose infant skull fractures include:

• CT scans
• MRI
• Ultrasound
• X-rays

CT scans and X-rays are the most common methods used to diagnose skull fractures in infants, but there are drawbacks to both procedures. Exposure to radiation at such a young age can have serious consequences later in life. Additionally, the sedatives needed to make a child that young hold still while images are taken can also have serious side effects.

MRI and ultrasound imaging both eliminate the threat of radiation, but neither is commonly used. MRIs, while effective, may not always be feasible in emergencies due to the longer time they take to perform. On the other hand, while widely available, ultrasound technology has not been as closely studied and may not be as effective as other methods.

Is Infant Skull Fracture Treatable?

An infant skull fracture is treatable, but the methods vary widely depending on the type and severity of the fracture. Smaller, less serious fractures where there is no injury to the brain may only need monitoring and will heal with time and without much medical intervention.

More serious fractures or fractures of a type likely to lead to brain injury may require surgery. Surgery may be used to help repair the skull, drain fluid and reduce swelling. In cases where surgery is necessary, more than half of patients need intervention to both repair the skull and manage the results of a traumatic brain injury.

Even with treatment, some children may suffer permanent brain damage and need additional medical care and assistance for the rest of their lives.

Can Infant Skull Fracture Be Prevented?

Some cases of infant skull fracture occur during the course of normal labor and are not considered preventable. These fractures are usually mild and often heal without medical intervention.

In cases where instruments — such as forceps or vacuum extractors — were used during labor, the presence of skull fractures can be a sign that these tools were misused or applied with excessive force. The use of these instruments during labor is increasingly controversial due to the documented risk they pose to babies.

When dangerous implements are mishandled, they can cause permanent harm. Doctors who do so may be in breach of their duty to provide quality care to their patients and may be liable for medical negligence.

Infant Skull Fracture and Medical Negligence

When health care professionals make mistakes in the delivery room, the results can be serious. Children and families may end up suffering from lifelong physical and financial consequences all stemming from a few moments of excessive or misapplied force.

If your child has a skull fracture and you suspect it is the result of mistakes made during an instrumental birth, you may be able to access compensation. Get a free case review now to get started.