Caput Succedaneum
Caput succedaneum involves oedema (fluid) of the subcutaneous tissue on the scalp. Caput is caused by pressure to a specific area of the scalp during a traumatic, prolonged or instrumental delivery.
The swelling is soft and diffus and may cross the suture lines of the skull. It may cause mild discolouration.
Caput does not require any treatment and will resolve within a few days.
Cephalohaematoma
A cephalohaematoma is also described as a subperiosteal haematoma. It involves blood collecting between the skull and the periosteum (a layer of dense connective tissue lining the bone). It is caused by blood vessel damage during a traumatic, prolonged or instrumental delivery.
The lump created by a cephalohaematoma does not cross the suture lines of the skull. This feature helps distinguish between caput succedaneum and cephalohaematoma. Additionally, the blood can cause discolouration of the skin in the affected area.
Cephalohaematomas generally resolve without treatment within a few months. There is a risk of anaemia and jaundice. Jaundice occurs as the blood within the haematoma breaks down, releasing bilirubin. The newborn should be monitored for signs of anaemia and jaundice and for the resolution of the haematoma.
Facial Paralysis
Delivery can cause damage to the facial nerve (cranial nerve VII). Injury due to compression by forceps or the mother’s pelvis can result in unilateral facial weakness. Function normally returns spontaneously within a few months. Specialist input is required when there is persistent paralysis.
Frey’s Syndrome
Frey’s syndrome, also known as auriculotemporal syndrome, occurs due to damage to the auriculotemporal nerve (a branch of the trigeminal nerve) during forceps delivery.
The auriculotemporal nerve normally provides parasympathetic innervation to the salivary gland. After trauma, the parasympathetic fibres may be rewired to send signals to the sympathetic fibres of the sweat glands and blood vessels. The consequence is that when the child eats, the signals that would normally stimulate the salivary glands to release saliva instead trigger sweating and skin flushing.
Frey’s syndrome typically presents during weaning. After eating certain foods, unilateral facial erythema occurs across the child’s cheek. It may be misdiagnosed as a food allergy. Diagnosis is based on the typical presenting features, typically with a history of forceps delivery.
Erb’s Palsy
An Erb’s palsy results from injury to the C5-C6 nerves in the brachial plexus during birth. It is associated with shoulder dystocia, traumatic or instrumental delivery, or large birth weight.
Damage to the C5/C6 nerves leads to weakness of shoulder abduction and external rotation, arm flexion and finger extension. This leads to the affected arm having a “waiters tip” appearance:
- Internally rotated shoulder
- Extended elbow
- Flexed wrist facing backwards (pronated)
- Lack of movement in the affected arm
The function typically returns spontaneously within a few months. Physiotherapy exercises are used to improve recovery and prevent contractures. Specialist input is required when symptoms persist.
Fractured Clavicle
A fractured clavicle can occur with shoulder dystocia, traumatic or instrumental delivery, and macrosomia (large baby).
Signs of a fractured clavicle include:
- Reduced arm movement
- Shoulder asymmetry (the affected shoulder is lower than the normal shoulder)
- Pain and distress with movement of the arm
A fractured clavicle can be confirmed with ultrasound or x-ray. Management is conservative, occasionally with immobilisation of the affected arm. It usually heals well within 6 weeks. A callus forms during healing and may be felt as a lump over the affected area (this disappears as the bone remodels).
Brachial plexus injury is a potential complication, causing weakness in the affected arm. This may resolve over time.
Last updated May 2025
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