Which statement best differentiates caput succedaneum from cephalohematoma?

• A. Caput succedaneum crosses suture lines; cephalohematoma does not cross sutures
• B. Caput succedaneum is a periosteal blood collection; cephalohematoma is edema across the scalp
• C. Caput succedaneum occurs after cesarean birth; cephalohematoma occurs with instrumental delivery
• D. Caput succedaneum persists for weeks; cephalohematoma resolves within hours

Answer: (A)

Differentiating these neonatal scalp swellings hinges on whether the swelling crosses the skull suture lines. Caput succedaneum is edema of the superficial scalp tissues from the pressure of birth; because it involves the soft tissues, the fluid can spread across the scalp and cross sutures. It’s typically present at birth and resolves within a day or two without treatment. Cephalohematoma, on the other hand, is a subperiosteal hematoma—blood collecting between a skull bone and its periosteum. The periosteum stays attached to the sutures, so the swelling stays confined and does not cross suture lines. It may become apparent at birth or shortly after and often takes weeks to resolve. This crossing-versus-not-crossing of sutures is the key distinction.