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An infant skull fracture occurs when a physical force cracks a baby’s vulnerable skull, often during labor and delivery. Doctors do not know how common this type of birth injury is because it is not always easy to diagnose or recognize. Minor fractures that heal readily and cause few symptoms or complications may be much more common than has been reported.
The Newborn Skull
The newborn skull is made up of several plates:
- Two frontal bones
- One occipital bone
- Two parietal bones
These are knitted together by sutures, fibrous tissue that allows the plates of the skull to move and the overall skull to be more flexible as a newborn’s head is emerging from the birth canal.
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The sutures also allow the skull to grow and expand as the brain develops. They fuse together as a child ages.
The newborn skull is flexible, allowing it to come through the birth canal more easily than if it were hardened and fused bone.
On the other hand, a newborn’s softer, more flexible skull leaves the brain more exposed and vulnerable. If a fracture does occur, it can cause more damage and injury.
Causes of Fractures
Most causes of fractures in newborns involve the use of instruments during delivery. Instruments are more likely to be used during difficult labor, so skull fractures are more common when labor is difficult, goes on for a long time, or includes complications. This could include an unusually large baby or breech birth.
Instruments used by the person delivering the baby may include forceps and vacuum extractors. The doctor may use these instruments if delivery is difficult and the baby and mother need extra assistance. The instruments can easily cause the skull to fracture if the doctor uses too much force.
A doctor can be liable if this causes a skull fracture with complications because of excessive force with instruments or because they should have ordered a Cesarean section after recognizing the delivery would be difficult.
Skull fractures have been known to occur spontaneously during delivery—that is, without the use of instruments—but this is rare. It has not been reported very often in the medical literature, and when it explains why the fracture occurred is not usually well understood.
Spontaneous skull fractures may occur simply because the baby’s head is under tremendous pressure. As it comes out of the womb, it is squeezed through past the pelvis, which can press on the head to a large degree, and then it has to pass through the birth canal. Most infants emerge undamaged, but this pressure can, in some cases, lead to fractures.
Linear Skull Fractures
There are several types of skull fractures possible in an infant after childbirth. A linear fracture is a simple break that does not cause the bone to move. One plate will not move past the other or lift up or down. These are not usually too serious, but there may be underlying bleeding.
Depressed Skull Fractures
A depressed skull fracture has the potential to be much more serious. A depressed fracture occurs when the skull sinks inwards. This is more serious than a linear fracture because it is more likely to cause bleeding and to put pressure on the brain.
Studies have found that these can be caused by instruments pressing on the head during delivery but that they sometimes also develop spontaneously. Those caused by instruments are more likely to cause damage to the brain.
Diastatic Skull Fractures
Another type of fracture is diastatic, which means it occurs along a suture. This is fairly common among newborns as compared to children and adults with skull fractures. Because these occur along the sutures, which are supposed to expand as the brain grows, this type of fracture can cause damage as the baby gets older and the fracture expands with the size of the brain.
Minor fractures often go undetected in a newborn. In most cases, these are just small, linear fractures, which heal with time and cause no lasting damage.
More severe fractures, on the other hand, may cause symptoms. For instance, a depressed fracture may cause a misshapen appearance to the baby’s head, or it may appear as a lump.
A fracture may also cause damage associated with seizures, listlessness, bleeding, or bruising.
A doctor may order imaging scans to assess whether a newborn has suffered a brain fracture. These may include X-rays, CT scans, or MRIs. The images can help a doctor see breaks in the bone, bleeding, pressure on the brain, or swelling of the brain.
A doctor may also perform simpler examinations before ordering an image, such as a comprehensive neurological exam.
Treatment for an infant skull fracture depends on the type of fracture, the severity, and any complications it is causing. In most instances, the only treatment is to simply observe and to continue to test the child and image the head.
Linear fractures are likely to heal independently, as are diastatic, although these must be monitored carefully.
A depressed fracture may also simply be monitored, but it may also need to be treated surgically. Fluid or blood, for instance, pooling in the brain can cause lasting damage and may require surgery to remove it. A baby may need surgery to reduce pressure or swelling.
Prognosis and Complications
Most skull fractures that occur during childbirth are not serious and heal quickly. Rarely skull fractures can be more severe and cause lasting complications.
Skull fractures can also put pressure on the brain or cause bleeding in the brain, potentially serious complications. Bleeding, also known as a hemorrhage, can cause brain damage.
A depressed skull fracture can cause pressure on the brain resulting in bleeding. Even when these potentially damaging complications occur, the prognosis is good for most infants, and they will recover.
Overall the prognosis for a child born with a fractured skull is good. Most will not require treatment, and most will have no long-term complications. However, for those few who do have complications, these can include brain damage, paralysis, neurological problems, developmental delays, and cognitive impairments.
If your child was born with a fracture and you believe malpractice or negligence played a role, you can make a case with the assistance of a lawyer and seek compensation and justice for your baby.
- Traumatic brain injury in infants and toddlers, 0–3 years old. (2011, August 15). PubMed Central (PMC).
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168813/
- Head Injury in Children. (n.d.). Johns Hopkins Medicine, based in Baltimore, Maryland.
Retrieved from: http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/head_injury_in_children_90,P02604/
- Pediatric Skull Fractures - StatPearls - NCBI Bookshelf. (2019, May 2). National Center for Biotechnology Information.
Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK482218/
- Harvard Health Publishing. (2019, September 24). Head Injury In Children. Harvard Health.
Retrieved from: https://www.health.harvard.edu/a_to_z/head-injury-in-children-a-to-z
- Pediatric skull fractures: the need for surgical intervention, characteristics, complications, and outcomes in: Journal of Neurosurgery: Pediatrics Volume 14 Issue 2. (2018, October 30). Home.
Retrieved from: https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/14/2/article-p205.xml