Cephalhematomas are usually uncomplicated and of little clinical importance. When infection occurs, osteomyelitis of the underlying bone may ensue. The progression of clinical and roentgenographic events in our patient represent an instance of infected cephalhematoma associated with neonatal sepsis and complicated by osteomyelitis. Treatment with antibiotics alone did not eradicate the infection. Recovery followed adequate treatment by incision and drainage in addition to appropriate antibiotic therapy for four weeks.