I remember going from Edmonton to Ukraine, to Kiev, not long after Chernobyl, as part of what started as the Chernobyl Children’s Project and had by then been renamed “Osvita”, “education” in Ukrainian. There are many Albertans of Ukrainian background, including paediatricians, and the project was set up as an international program to promote collaboration after the break-up of the Soviet Union.

One of the interactions I had with the neonatal physicians there was at the bedside of a baby with a large cephalhaematoma. They asked me what we would do in Canada, and I said: absolutely nothing. I was informed that their practice was to drain the haematoma as if not there was “a risk of serious infection”. I told them (with a touch of superiority, given my first-world education) that, no, draining it introduced a risk of infection, and it would be better just to not touch it.

I realized afterwards that they had just been quoting what they had been taught, and I was just quoting what I had been taught, but that I didn’t actually really know who was right! (Except, of course, for the fact that I am always right….).

Large cephalhaematomas can take months to completely resolve, and in the meantime, marginal calcification can occur, and deformation of the skull can sometimes follow. A new publication reports the results of needle aspiration of large cephalhaematomas still present after 2 weeks of age without signs of resorption. (Blanc F, et al. Early needle aspiration of large infant cephalohematoma: a safe procedure to avoid esthetic complications. Eur J Pediatr. 2020;179(2):265-9). They note that there were no complications, they did this with local anaesthesia and sucrose, and it might actually, I think, be a reasonable idea.

One of the problems I see, with this common situation, is that almost all of the references given in the article are case reports. I cannot tell from the literature how often a cephalhaematoma might cause problems in the long term, with or without drainage. Of course, a randomized controlled trial would be the way to answer the question of what to do, but I have no idea how you would calculate the sample size. You could just guess a number and say if after a hundred babies in each group didn’t show a difference, then the choice of intervention could be left to the parents. Lacking that (which I think is unlikely to happen) some large case series with and without drainage could at least give us an idea. For such a common problem which probably causes parents to worry, and which also makes babies’ heads look funny, it would be great to have some good data.