Cephalohematomas: One lump or two? .... Or three?

Cephalohematomas are encountered rather frequently in the newborn nursery setting.  These subperiosteal collections of serosanginous fluid are not present at birth but accumulate over the first several hours to few days. They often feel fluctuant or boggy early on, but some are rather tense or firm.

Bilateral Cephalohematomas

bilateral cephalohematomas


The subperiosteal location of the fluid leads to one distinguishing feature of a cephalohematoma -- it cannot cross suture lines. If an infant has more than one bone affected, there will be more than one palable and/or visible lump. This patient has two -- one on each parietal bone. It's less common, but the occipital bone can also be affected. If that occurs in a baby with bilateral parietal involvement, you might actually palpate three separate lumps.