What Is a Cephalohematoma?
Simply put, a cephalohematoma is an accumulation of blood under the scalp. During the birth process, small blood vessels crossing the thin layer of tissue just above the skull bones are torn, allowing blood to gather on top of the skull bone and under this tissue layer. Because the cephalohematoma is a collection of blood on top of the skull, there is no pressure on or bleeding into or around the baby’s brain since the brain sits under the skull bones. Cephalohematomas do not affect your baby’s brain. The bleeding is gradual and usually takes several hours or days after birth for the cephalohematoma to form. Because the mass forms on top of the skull, there is no concern about bleeding into or around your baby’s brain. They are also more common in larger babies, babies of first time parents, and babies who are malpositioned in the birth canal, such as head down, but back-facing (also known as “sunny-side up” babies).
Symptoms of Cephalohematomas
The most prominent symptom of a cephalohematoma is a soft bump or bulge on your baby’s head. Generally, the bump is skin colored and not bruised or reddened. Cephalohematoma can vary in size—some will be obvious to most onlookers, and some will be less so (though usually a baby’s observant and concerned parent will notice it!). You may notice that the center of the bump begins to dissipate before the outer edges do. Some parents say in this stage in resolution, the bump has a “crater-like” look to it. This is normal as well, and is another sign that your baby’s cephalohematoma is in the process of resolving. Besides the obvious bulge, sometimes cephalohematomas have complications, as they can cause newborn jaundice. In rarer cases, they may cause anemia or infection.
Causes
Newborn cephalohematomas usually occur during the birth process. However, it may take several hours or days for them to present themselves after birth. Any sort of intense pressure on your newborn’s scalp during the birthing process can cause the blood vessels in their periosteum (the thin layer of tissue just above the skull bones) to burst, causing a cephalohematoma. The most common causes of birth related cephalohematomas include:
Forceps delivery Lengthy second stage of labor Long labors Macrosomia (babies born with unusually large heads, which can make vaginal birth more difficult) Malpositioning in the birth canal (breech birth, “sunny-side up” birth) Multiple gestation birth (twins, or more) Vacuum assisted delivery Weak uterine contractions, which prolong labor
Diagnosis
Usually your baby’s cephalohematoma will be diagnosed by discharge at your hospital, but sometimes your baby’s pediatrician will diagnose it at a later date. However, cephalohematoma will not generally prolong your hospital stay. You will likely be discharged with instructions to keep watch over your baby’s cephalohematoma and discuss it with your pediatrician. Usually, a physical inspection is all that’s used to diagnose a cephalohematoma. However, in rare cases, if your doctor suspects something else is the cause of the bump, they may want to perform other diagnostic evaluations—especially if other symptoms are present beside the bulge. Neurological, respiratory, or cardiovascular symptoms may warrant further testing. These tests include X-rays, CT scans, and ultrasound.
Risks and Complications
Most of the time, cephalohematomas are just an appearance issue. Most parents don’t like how they look, but they pose no danger to babies, and typically resolve on their own. They do not hurt your baby. They do not cause physical pain to the baby, nor do they harm the baby’s brain or any other part of their body. And, they don’t affect your baby’s brain development, because they occur outside of your baby’s protective skull. They also do not pose any long-term physical or developmental dangers. However, in rare cases, a cephalohematoma may increase your baby’s risk of developing newborn jaundice.
Newborn Jaundice
If the bleeding in your baby’s cephalohematoma is significant, your baby may develop jaundice as a result of the breakdown of red blood cells that happen after the cephalohematoma develops. Newborns are particularly prone to jaundice because their livers are not yet efficient at breaking down bilirubin. If your baby has a cephalohematoma, your doctor will likely ask you to monitor your baby for signs of jaundice. Here is what to look for in your baby:
Feeding difficulty High-pitched crying Lethargy (hard to rouse) Yellowish color to the skin Yellowish color to the white of the eyes
You should bring your baby into the doctor if you notice any signs of jaundice. Your doctor will likely check your baby’s bilirubin levels. If your baby has jaundice, they will probably need prompt treatment. Most jaundice treatment is non-invasive and involves blue light phototherapy. Jaundice needs to be addressed as soon as signs emerge; if untreated, it can cause brain damage.
Treatment
Unless there are additional complications such as jaundice, most doctors will take a hands-off approach to cephalohematoma. However, it is necessary to monitor the condition. Draining cephalohematomas is not recommended because the blood has already clotted. Plus, aspiration has an increased risk of infection and abscess formation. The best way to treat a cephalohematoma is to leave it alone and allow the body time to reabsorb the collected fluid.
Do Cephalohematomas Disappear?
In almost all cases, cephalohematomas resolve on their own. It can take 2 weeks to 3 months for the resolution to be complete. Again, it is not considered safe to drain or otherwise remove cephalohematomas, but time and a little patience go a long way.
What Is the Long-Term Outlook?
Cephalohematomas may look concerning and you may naturally feel worried about what it means for your baby to develop one. But cephalohematomas are “skin deep” issues, and do not impact your baby’s body as a whole, nor do they affect your baby’s brain. Jaundice, if it does occur, is time-limited and only a concern in the newborn period. There are no known long-term complications of being born with a cephalohematoma, and within a few weeks or months, your baby’s cephalohematoma will be gone.
A Word From Verywell
Because of the dramatic appearance of some larger cephalohematomas, it’s reasonable that parents might feel quite concerned. After all, it’s our instincts as parents to worry over every little bump, bruise, or abnormality our baby develops. Even after you’ve been given every reassurance that your baby’s cephalohematoma is nothing to be concerned about, you may still feel a nagging sense of worry about it. Of course, even though cephalohematomas are largely innocuous, they can cause jaundice, so you should monitor your baby for any signs of jaundice including yellowing skin, lethargy, and poor feeding. Don’t hesitate to call your doctor if you encounter any of these—or any other concerning symptoms. Always trust your parental instincts when it comes to your baby, and report any issues you observe to your doctor. Most cephalohematomas resolve in a matter of weeks, so however stressful this may be to your right now, before you know it, that funny little bump on your baby’s head will be a distant memory.
