An infant’s skull is not hard and fused like an adult’s. It is soft and made up of sections of bone which meet at “suture lines.” These soft pieces of the skull will harden and join together as the child ages.
In some cases, however, the infant may have a buildup of bloody fluid in its scalp overlying the part of the skull that is born first. This is called caput succedaneum or caput for short.
In addition to swelling of the scalp, a bruise may be noticeable either on the scalp itself or on the baby’s face depending on which part was born first.
Caput succedaneum is most commonly caused by pressure placed on the infant’s head as it passes through the cervical opening and into the vaginal canal. This pressure is caused by vaginal wall and uterine pressure and tension.
Another condition called cephalohematoma can also occur. This is different from caput succedaneum because the fluid that builds up is often deeper in the scalp and mostly composed of blood from broken blood vessels.
Cephalohematoma is caused by pressure from the mother’s pelvic bones on the baby’s skull during delivery and by the use of delivery instruments, such as forceps.
Both conditions do not always occur due to specific risk factors but can happen for no apparent reason during birth. In fact, these conditions can, in rare cases, be present while a baby is still inside the womb.
Both caput succedaneum and cephalohematoma have been identified in ultrasound during late pregnancy. These two conditions may develop when membranes rupture prematurely, denying the infant the necessary cushioning it requires while still in the womb.
Cephalohematomas have also been observed when there are low amounts of amniotic fluid present. This condition is called oligohydramnios.
Certain risk factors that increase the risk for developing caput succedaneum include:
- having a prolonged or difficult labor
- premature rupture of membranes
- low levels of amniotic fluid in the uterus
- delivering a baby for the first time
- Braxton-Hicks contractions
- certain fetal positions, such as being head down
- a delivery that requires instruments, such as forceps or a vacuum
However, when the caput is caused by a vacuum-assisted delivery, it is referred to as a chignon and is not a true caput succedaneum.
Cephalohematoma is a condition that is more commonly seen in women who are:
- having a male baby
- delivering their first baby
- delivering a large baby, which may be too big for the pelvic opening
- having a delivery that requires instruments, such as forceps or a vacuum
- if the infant had a scalp electrode during labor
- experiencing a prolonged labor
The condition is also more likely to appear in children whose heads are not in an ideal position for delivery.
When an infant is born with caput succedaneum, parents may notice scalp swelling or an appearance of puffiness right after birth. This is most likely to appear at the top center of the head and where the bones meet.
Scalp bruising is another possible symptom of caput. In some cases, facial bruising may also be present.
Infants born with a cephalohematoma may develop a scalp bump (not bruise) within days of birth. At times the area may be sensitive to touch, which is more common if there is a skull fracture.
During a vaginal delivery, pressure can cause an overlapping in the soft, bony pieces of the skull at the suture line. This can give a cone-like pointed shape to the baby’s head. This is commonly called molding.
Most often, caput succedaneum resolves on its own without complication. At times, however, complications can occur such as:
- Alopecia: Due to the pressure placed on the scalp, some of the surrounding tissues may die, and hair loss can occur. In most cases, the hair regrows normally, though in some cases this hair loss can be permanent.
- Jaundice: Bruising may be present in some cases. This can lead to a buildup of bilirubin in the blood from the breakdown of red blood cells. This causes infants to have a yellow appearance in their skin and the whites of their eyes.
If severe or untreated, jaundice can lead to many further complications. These complications include:
- brain damage
- hearing loss
- athetoid cerebral palsy, a movement disorder
- abnormal tooth enamel development
- permanent upward eye gaze
In some cases, cephalohematomas can cause complications, such as:
- skull fracture
- hardening of the bump
- jaundice (more common than with caput succedaneum)
Caput succedaneum is often identified on physical examination without the need for additional testing. If there is a more concerning issue, doctors may recommend further tests to evaluate for a more serious problem.
In some cases of cephalohematoma, a skull fracture may be present. As a result, an X-ray may be carried out to evaluate the bones of the skull.
Caput succedaneum typically resolves without the need for intervention within a couple of days following delivery.
When there are no additional injuries or risks factors, a case of cephalohematoma typically resolves without the need for intervention within 2 to 6 weeks following delivery.
There are cases in which a cephalohematoma causes other more concerning problems, such as infection, which may require medications and surgical procedures. Sometimes, a cephalohematoma may persist and harden, causing a firm bump, which most often resolves over time.
Another possible treatment is cranial-molding helmet therapy. This method involves an infant wearing a specially shaped helmet for 18 to 20 hours a day until their head is molded to the desired shape. It is very rare to need this therapy for a persistent cephalohematoma, however.