Neonatal scalp hematoma is clinically more common and easily noticed and given less attention to its treatment and prognosis. Most obstetricians recommend conservative treatment, thus depriving some children with subperiosteal osteogenesis of scalp hematoma of the best treatment period. Subperiosteal hematoma of the skull can be seen in newborns delivered spontaneously, but is more often the result of ruptured subperiosteal vessels caused by negative pressure suction of the fetal head or forceps assisted delivery. Subperiosteal hematomas are slow to resorb. The cranial periosteal cells are very active in the neonatal period and often form proliferative ossified tissue. Once the subperiosteal hematoma ossification is formed, it is difficult to be absorbed, which affects both the appearance and the development of the cranial bone, resulting in the absorption of the original normal cranial bone in the area. Therefore, if a subperiosteal hematoma of the skull is not significantly absorbed within 15 days after birth, puncture and blood sampling can be considered; if the hematoma has ossified and hardened, surgical treatment should be considered. Scalp hematomas are very common in newborns and infants and are relatively simple to diagnose, but there are different opinions on treatment. Most scalp hematomas are self-resorbing. In general, subcutaneous hematomas <5 cm in diameter have a greater chance of being located under the scalp and are usually treated conservatively or with hematoma puncture. For hematomas >8 cm in diameter and the mass is located on one side of the head, attention should be paid to its development. If there is no significant change in the size of the scalp hematoma after 3 weeks of life, especially if the circumference of the hematoma is gradually sclerotic, great attention should be paid and early surgical treatment should be performed. Most of the scalp hematomas absorb themselves within 1 to 3 weeks, and the chance of self-absorption becomes less and less after 1 month. In our 46 cases, all the hematoma mechanized hard masses gradually formed after 3 to 4 weeks. For scalp hematoma, if it is observed up to 3 weeks and there is still no absorption and ossification is not obvious, puncture can be considered after strict sterilization, but after 4 weeks, when the subperiosteal hematoma gradually starts to ossify, surgery is generally considered. Some people believe that scalp hematoma has the possibility of resorption and neonates are not advocated for treatment. In fact, after 3 weeks, the subperiosteal hematoma starts to ossify gradually in newborns, and if left untreated, it will seriously affect the appearance as well as the normal development of the skull, which is difficult for the family to accept. We followed five children with unoperated subperiosteal osteogenesis of scalp hematoma, the longest of which was now 8 years old, and the cranial CT scan showed significant convexity of the parietal bone and significant thinning of the skull. Observing the change process of their cranial CT, we considered that the normal cranial bone gradually thinned and resorbed due to the loss of periosteal nutrition, and subperiosteal osteogenesis replaced the normal cranial bone during the conservative process of the children. Subperiosteal osteogenesis of scalp hematoma has good efficacy if surgically removed early. Therefore, children with scalp hematoma should be observed for changes in the scalp hematoma, and if there is no significant resorption and hardening of the mass after 3 weeks, surgery is recommended for definite results. Newborns and small infants have poor surgical tolerance, especially not excessive bleeding, so adequate preoperative and intraoperative preparations should be made to ensure normal blood volume of the child. Generally, 0.5-1 unit of red blood cell suspension should be prepared before surgery. Intraoperative blood leakage from the skull should be minimized. The medical history should also be taken carefully to exclude comorbidities of scalp hematoma, so as to ensure the successful completion of the operation. Any intracranial comorbidities should be treated first until there are no obvious contraindications to surgery. After surgical treatment, all children with cranial subperiosteal osteogenesis regained positive cranial shape and cranial development.