[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Neonatal birth injuries (caput, cephalohaematoma, clavicle fracture)

[Conditions](https://durgical.com/en/conditions/) · [Pediatrics and neonatology](https://durgical.com/en/conditions/)

# 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

Tap one to see what it is and open it in 3D.

- [Parietal bones](https://durgical.com/en/anatomy/parietal-bone/)
- [Clavicle](https://durgical.com/en/anatomy/clavicle/)
- [Galea](https://durgical.com/en/anatomy/epicranial-aponeurosis/)
- [Base of the skull](https://durgical.com/en/anatomy/occipital-bone/)
- [Frontal bone](https://durgical.com/en/anatomy/frontal-bone/)
- [Brachial plexus roots](https://durgical.com/en/anatomy/roots-of-brachial-plexus/)
- [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/)

## Why it happens

- [Mechanical and electrical injury: abrasion, contusion, laceration, wounds](https://durgical.com/en/general-pathology/mechanical-and-electrical-injury-abrasion-contusion-laceration-wounds/)
- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)

## 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](https://durgical.com/en/anatomy/roots-of-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](https://durgical.com/en/anatomy/cervix-of-uterus/) during labor (caput)
- Shearing of vessels between skull and periosteum (cephalohematoma)
- Rupture of emissary veins under the [galea](https://durgical.com/en/anatomy/epicranial-aponeurosis/), 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](https://durgical.com/en/anatomy/region/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](https://durgical.com/en/anatomy/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

## Red flags

- Rapidly growing, boggy scalp swelling extending to the neck or [eyelids](https://durgical.com/en/anatomy/superior-tarsus/), with pallor and tachycardia (subgaleal hemorrhage, a medical emergency)
- Signs of shock or falling hematocrit
- Early or intense jaundice after a large cephalohematoma
- An arm that does not move at all (possible brachial plexus injury)
- Seizures or neurological changes (possible intracranial hemorrhage or skull fracture)

## Diagnosis

**Clinical**
Mainly clinical: the type of scalp swelling is distinguished by whether it crosses sutures and when it appears; the [clavicle](https://durgical.com/en/anatomy/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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## Related conditions

- [Brachial plexus injury](https://durgical.com/en/conditions/brachial-plexus-injury/)
- [Clavicle fracture](https://durgical.com/en/conditions/clavicle-fracture/)
- [Neonatal jaundice](https://durgical.com/en/conditions/neonatal-jaundice/)
- [Basilar skull fracture](https://durgical.com/en/conditions/basilar-skull-fracture/)
- [Perinatal asphyxia and hypoxic-ischaemic encephalopathy](https://durgical.com/en/conditions/perinatal-asphyxia-and-hypoxic-ischaemic-encephalopathy/)
- [Intraventricular haemorrhage of prematurity](https://durgical.com/en/conditions/intraventricular-haemorrhage-of-prematurity/)

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

Sources: [Caput succedaneum](https://medlineplus.gov/ency/article/001587.htm) (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025); [Newborn head molding](https://medlineplus.gov/ency/article/002270.htm) (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025); [Fractured clavicle in the newborn](https://medlineplus.gov/ency/article/001588.htm) (MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine), 2025).

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Source: https://durgical.com/en/conditions/neonatal-birth-injuries/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/neonatal-birth-injuries/