Neonatal birth injuries (caput, cephalohaematoma, clavicle fracture) !

Bumps, bleeds and fractures caused by the forces of delivery. Most, like scalp swelling or a broken collarbone, heal on their own.

Updated 2026-11-01

Structures involved

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Why it happens

What it is

Injuries to the newborn caused by mechanical forces during labor and delivery. The most common are caput succedaneum, cephalohematoma, subgaleal hemorrhage and clavicle fracture; brachial plexus palsy is covered on its own page.

Who gets it

Minor scalp injuries are very common after vaginal birth; clavicle fracture is the most common fracture of birth. Serious injuries have become less frequent with better obstetric care in Colombia, but remain linked to difficult and instrumental deliveries.

Causes

Pressure of the head against the cervix during labor (caput)
Shearing of vessels between skull and periosteum (cephalohematoma)
Rupture of emissary veins under the galea, often after vacuum delivery (subgaleal hemorrhage)
Compression of the shoulder during delivery, especially shoulder dystocia (clavicle fracture)

Risk factors

Fetal macrosomia and maternal diabetes
Shoulder dystocia
Vacuum or forceps delivery
Prolonged or very rapid labor
Abnormal presentation, such as breech
First birth and small maternal pelvis

Pathophysiology

Caput is serous edema above the periosteum, so it crosses suture lines. A cephalohematoma is blood under the periosteum, so it is limited by the sutures, usually over a parietal bone. A subgaleal hemorrhage lies in the loose space under the galea aponeurosis, which can hold a large part of a newborn's blood volume. The clavicle, the first bone to ossify, breaks at its middle third when the shoulder is compressed.

Classification

Caput succedaneum: soft, pitting scalp edema crossing sutures, present at birth
Cephalohematoma: firm swelling that does not cross sutures, appearing hours after birth
Subgaleal hemorrhage: fluctuant swelling across the whole scalp that can expand quickly
Clavicle fracture: mid-shaft, often with crepitus

Symptoms and signs

Scalp swelling present at birth that crosses the midline (caput)
Well-defined swelling over one parietal bone that appears after some hours (cephalohematoma)
Crepitus, swelling or a palpable bump over the clavicle
Reduced arm movement or asymmetric Moro reflex on the affected side
Crying when the arm is moved

Diagnosis

Clinical: Mainly clinical: the type of scalp swelling is distinguished by whether it crosses sutures and when it appears; the clavicle is palpated and the Moro reflex and arm movement are checked.
Tests: Hematocrit and bilirubin in large scalp bleeds; coagulation tests in subgaleal hemorrhage.
Imaging: X-ray confirms a clavicle fracture; cranial ultrasound, CT or MRI if skull fracture or intracranial bleeding is suspected.

Differential diagnosis

Brachial plexus (Erb) palsy
Humeral fracture or shoulder dislocation
Skull fracture
Intracranial hemorrhage
Encephalocele

Goal of treatment

Detect the rare dangerous injuries early, keep the baby comfortable and let benign injuries heal on their own.

Treatment

Conservative: Caput and cephalohematoma need no treatment; they resolve over days (caput) or weeks to months (cephalohematoma). Aspiration is avoided because of infection risk.
Follow-up: Bilirubin monitoring after a large cephalohematoma; frequent head circumference, vital signs and hematocrit checks in subgaleal hemorrhage.
Conservative: Clavicle fracture: gentle handling, pain relief, and sometimes pinning the sleeve to the shirt for comfort; it heals in about 1–2 weeks with a callus.
Acute: Subgaleal hemorrhage with shock needs volume resuscitation, blood products and correction of coagulopathy in a neonatal intensive care unit.
Rehabilitation: Parent education on handling and positioning; physiotherapy if a nerve injury accompanies the fracture.

Complications

Hyperbilirubinemia from reabsorbed blood
Hypovolemic shock and death from subgaleal hemorrhage
Infection or calcification of a cephalohematoma
Associated linear skull fracture
Associated brachial plexus injury with clavicle fracture

Prognosis

Caput, cephalohematoma and clavicle fracture have an excellent prognosis with complete healing. Subgaleal hemorrhage can be fatal if not recognized and treated quickly.

Prevention

Prenatal detection of macrosomia and planning of the mode of delivery
Trained management of shoulder dystocia
Careful indication and technique for vacuum and forceps

Test yourself

Think of the answer, then tap the question to see it.

Which neonatal scalp swelling crosses suture lines and is present at birth?

Caput succedaneum, a serous edema above the periosteum.

Why does a cephalohematoma not cross suture lines?

Because the blood is under the periosteum, which is attached at the sutures.

Which scalp bleed can cause hypovolemic shock in a newborn?

Subgaleal hemorrhage, often after vacuum delivery.

What is the most common fracture during birth?

Clavicle fracture, usually mid-shaft, associated with shoulder dystocia and macrosomia.

What metabolic problem can follow a large cephalohematoma?

Hyperbilirubinemia (jaundice) as the blood is broken down.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Caput succedaneum (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025); Newborn head molding (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025); Fractured clavicle in the newborn (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025).

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Representative model, for educational purposes only.

Parietal bones highlighted on the Durgical 3D model