Caput succedaneum is a form of swelling on a newborn’s scalp, usually diagnosed directly after birth. The condition, often shortened simply to “caput,” is a minor birth injury common after both vaginal and assisted deliveries. Caput is usually a self-limiting medical condition, which means that the head swelling should disappear on its own with little risk of long-term complications.
Diagnosing Caput Succedaneum
After a child’s delivery, the presence or absence of caput succedaneum should be clear based solely on visual inspection.
- swelling (or “edema”) and puffiness on the newborn’s head, often described as a soft lump or bump on the scalp
- bruising and color changes around the swollen area are common, but do not occur in all cases
Doctors don’t need any additional tests to diagnose caput succedaneum. The condition is confirmed simply by looking at the child’s scalp. Caput normally resolves of its own accord within a few days.
What Causes Caput Succedaneum?
In most cases, caput succedaneum is caused by pressure – often the normal pressures exerted by the uterus and vaginal walls during a head-first delivery. The risk for caput increases during long, difficult labors. The condition becomes more likely once the amniotic sac ruptures, since there is no longer a cushion to protect the child’s delicate head from mechanical forces. Oligohydramnios, in which the amniotic sac is filled with insufficient fluid, is another risk factor.
Infants can also develop the condition before childbirth has begun. When a mother’s membranes rupture prematurely, an unborn child’s head loses the protection normally provided by the amniotic sac. This can increase the risk that the mother’s pelvic bones will place pressure on the infant’s head, possibly causing swelling and bruising of the scalp. As a result, obstetricians occasionally diagnose caput succedaneum via ultrasound. The earliest reported case was diagnosed at 31 weeks of pregnancy, according to the US National Library of Medicine.
Vacuum Extraction & Forceps Deliveries
Caput succedaneum is an unavoidable side effect of ventouse, or vacuum-assisted, deliveries. In fact, there’s even a separate word reserved for cases of caput succedaneum that are caused by ventouse delivery: chignon.
In vacuum deliveries, obstetricians apply a suction cup to a child’s scalp and then apply suction, creating an artificial caput succedaneum as the infant’s scalp is sucked into the vacuum. By applying gentle traction, and working in concert with uterine contractions, ventouse can help obstetricians deliver children under difficult circumstances.
Vacuum-assisted deliveries, however, present their own significant risks, both to mothers and infants. Ventouse can even be fatal, as researchers from Yale University noted in a 2009 report for Reviews in Obstetrics & Gynecology. The risk of severe complications, including bleeding in an infant’s brain and permanent nerve damage, are high. As just one example, ventouse has been shown to increase the risk for intracranial hemorrhage more than two-fold over spontaneous vaginal delivery.
With these significant risks in mind, assisted deliveries should only be performed by experienced obstetricians. Doctors have a legal obligation to prevent harm whenever possible. The extreme care required of medical professionals extends, as one would expect, to include assisted deliveries in which forceps are used. Higher risks of caput succedaneum have also been reported in forceps deliveries, although the risk is likely much lower than in ventouse deliveries.
“Molding”: Changes In Infant Head Shape
Once the swelling and bruising known as caput succedaneum subside, some children will present “molding,” a pointed appearance of the head. Molding is perfectly normal and occurs in almost every vaginal delivery. In fact, the idea that an infant’s head can change shape during childbirth is a good thing.
At birth, the skull is actually made up of five separate bones, Stanford Children’s Health reports. These bony plates are soft and flexible. They won’t fuse together until a child reaches the age of two. Before that, each bone is separated by a gap, or “suture,” which allows the skull to expand, growing larger as the child’s brain develops. Parents often notice two soft spots on a baby’s head, one in front and one in back. These “fontanelles” are evidence that the infant’s skull bones haven’t fused together yet.
A baby’s head is large, at least when compared to the other parts of her body. Fitting through the birth canal can be difficult, especially with a relatively large head trying to fit through first. “Molding” is the brilliant evolutionary trick that makes this process possible. During delivery, a baby’s skull bones change shape, even overlapping in some cases. This allows the baby’s head to pass through the birth canal.
Molding is necessary and beneficial, but the sight of an oddly pointed head (usually described as “cone-shaped”) can be surprising, if not distressing, for parents. Thankfully, molding usually evens out over the course of several weeks or months. The fact that a child’s head can change shape even after delivery, however, doesn’t help to alleviate a family’s concerns.
In cases of positional plagiocephaly, pressure applied to the back of a child’s head leads to changes in the alignment of their skull bones, and thus an uneven head shape. These changes usually happen because children tend to lie, or be placed, in the same position every day, most commonly on their backs. Repeated pressure moves the skull bones, which can give the back of an infant’s head a flattened appearance.
Like the molding that occurs during delivery, these changes in head shape usually resolve within a matter of months. In the vast majority of cases, there is no risk of skull or brain damage. Parents can try changing their baby’s positioning to coax the head back to a normal appearance. For tips on gently repositioning an infant, visit the Mayo Clinic. If the child’s head doesn’t even out within four months, other treatments can be attempted, including molded helmets.
Complications Of Caput Succedaneum & Chignon
Caput succedaneum is normally a harmless complication of vaginal delivery. Swelling and bruising should subside within days of birth. An increased risk of jaundice is the only consistently-reported complication caused by caput succedaneum, usually confined to cases in which bruising is present on a child’s scalp. This risk is also presented by chignon, the artificial form of caput succedaneum caused by a vacuum-assisted delivery.
While common in infants, jaundice should be taken very seriously. The condition is caused by an increase in bilirubin, a yellowish substance that can change the color of a child’s skin and eyes. As red blood cells break down in the body, bilirubin is produced as a by-product. This occurs during the normal life cycle of a bruise, as red blood cells trapped beneath the skin lose oxygen and begin to degrade. Thus children born with bruising are at an increased risk of developing jaundice.
In most children, jaundice will resolve within two to three weeks – without treatment. But prolonged cases of untreated jaundice can result in kernicterus, a form of brain damage caused by excessive levels of bilirubin. Children who begin to present the symptoms of jaundice should always receive medical attention. Since children with caput succedaneum are at an increased risk of developing jaundice, doctors should carefully observe an infant’s progress for signs of the condition.
Beyond jaundice, there is a small risk of infection in children with caput succedaneum, which is greatly increased by attempts to drain fluid from a child’s scalp. Cases of permanent scalp baldness have also been reported in people affected by the condition at birth.
Cephalohematoma vs. Caput Succedaneum
Caput succedaneum should not be confused with cephalohematoma, a similar, but usually more serious, health condition in babies.
Unlike caput, cephalohematoma involves the build-up of blood between two surfaces: an infant’s skull bone and a layer of membrane that directly covers this bone. The condition is normally caused by a ruptured blood vessel, a capillary broken either by the pressures of delivery or forces exerted during instrumental birth. Swelling and bruising will look similar to caput succedaneum, but won’t be immediately apparent. Cephalohematoma develops over the course of 24 to 48 hours after birth, as blood gradually seeps into the space between the skull and its membrane.
To diagnose the condition, doctors look for swelling and discoloration that have clearly-defined borders, ending sharply at the edges of a skull bone. Children should be placed under observation, since severe bleeding can increase the risk for jaundice, along with anemia and low blood pressures. These conditions may have serious consequences if treated improperly.