How long does a cephalohematoma (head hematoma) in a newborn take to resolve?

Management of Cephalohematoma in Newborns

A cephalohematoma in a newborn typically resolves spontaneously within 2-4 weeks, though larger ones may take up to 3 months to completely disappear. 1

What is a Cephalohematoma?

A cephalohematoma is a collection of blood between the skull bone and its periosteum (covering), commonly occurring as a result of birth trauma. Unlike other types of head bleeding, cephalohematomas:

• Are limited to the area of one cranial bone (cannot cross suture lines)
• Do not cause direct pressure on the brain
• Usually appear within the first few days after birth
• Present as a soft, fluctuant swelling on the baby's head

Natural Resolution Timeline

The resolution timeline depends on several factors:

• Size of the hematoma: Small cephalohematomas typically resolve within 2-4 weeks, while larger ones may take up to 3 months 2
• Location: Parietal bone cephalohematomas (most common) tend to resolve faster than those in other locations
• Absence of complications: Uncomplicated cephalohematomas resolve more predictably

Monitoring and Complications

Regular monitoring is essential during the resolution period to watch for potential complications:

• Calcification: Can begin after 2-3 weeks if not resolving properly 1
• Infection: Rare but serious complication that can lead to abscess formation 3
• Persistent deformity: Large cephalohematomas may leave behind cosmetic deformities if they calcify 1

Management Options

1. Observation (First-line approach):

   • Most cephalohematomas require only observation
   • Weekly monitoring of size and consistency
   • No manipulation or massage of the area

2. Intervention (For specific cases):

   • For large cephalohematomas with high projection (>9mm), needle aspiration between day 15-30 may be considered to prevent calcification and cosmetic deformities 1
   • This should only be performed by specialists after proper evaluation including coagulation studies and ultrasound assessment

3. Surgical management:

   • Reserved for rare cases with complications
   • Not indicated for typical uncomplicated cephalohematomas

When to Seek Medical Attention

Parents should seek immediate medical attention if:

• The swelling increases in size after the first week
• The area becomes red, warm, or tender
• The baby develops fever or increased irritability
• There is spontaneous drainage from the site 3
• The baby shows signs of increased lethargy or abnormal posturing (rare but serious) 4

Parental Reassurance

It's important to reassure parents that:

• Cephalohematomas do not affect brain development
• They are not painful to the baby
• Most resolve completely without intervention
• Regular follow-up with the pediatrician is sufficient for monitoring

In conclusion, while cephalohematomas may appear concerning to parents, they typically resolve spontaneously within 2-4 weeks for smaller ones and up to 3 months for larger ones. Observation is the mainstay of management, with intervention reserved only for specific cases with complications or high risk of cosmetic deformity.