To determine whether soft tissue swelling, as identified by computed tomography, invariably accompanies acute calvarial fracture, the computed tomography scans of 35 children aged 3 months to 8 years with acute skull fractures were evaluated. Bone window settings revealed at least 4 mm of soft tissue swelling in all instances. We conclude that a skull fracture without overlying soft tissue swelling demonstrable by computed tomography is probably inconsistent with an acute injury.