The main thing about fontanelles in a newborn and the neonatologist’s answers to frequently asked questions from parents

Causes

A bulging fontanel has many possible causes that vary in severity.

Hydrocephalus

A bulging fontanel often indicates that the child has hydrocephalus. Hydrocephalus is caused by the accumulation of fluid in the ventricles of the brain, which are the spaces containing cerebrospinal fluid. Fluid pressure dilates the ventricles, potentially putting pressure on brain tissue and causing the fontanelle to swell. There are many possible causes of hydrocephalus. If the bulge is present at birth, it is called congenital hydrocephalus

.
If the condition develops after birth, it is called acquired hydrocephalus
.

Congenital hydrocephalus

Some risk factors for developing hydrocephalus and a prominent fontanel at birth include:

• Infections
  : Some infections, such as rubella, can be passed from mother to baby, potentially causing swelling of the brain.
• Brain hemorrhage
  : This problem is more common in premature babies and those who are injured or deprived of oxygen during childbirth.
• Congenital abnormalities
  : Abnormalities that affect the development of the brain, skull, spinal cord, or other parts of the nervous system may increase the risk of congenital hydrocephalus.

Acquired hydrocephalus

Some babies suddenly experience a bulging fontanel after birth. Possible reasons for this include:

1. Infections
   : An infection of the brain or spinal cord, such as bacterial meningitis, may be accompanied by a bulging fontanel.
2. Injuries
   : Injuries to the brain and spinal cord, including blows to the head, can cause swelling of the brain.
3. Tumors of the brain or spinal cord
   can cause hydrocephalus.
4. Stroke
   : Very rare in infants, but still possible.

Other reasons

The cause of a bulging fontanel is not always hydrocephalus. Some other potential causes include:

1. Benign intracranial hypertension :
   caused by a violation of the dynamics of the cerebrospinal fluid. Sometimes it is a consequence of infection. Although the condition usually goes away on its own, it is an emergency.
2. Crying
   : Sometimes crying creates temporary pressure in the brain. In these cases, the bulge usually goes away on its own. However, babies may cry a lot when they have serious illnesses, so don't assume that crying is the direct cause of a bulging fontanel.
3. Vomiting
   : Similar to crying, vomiting can increase pressure in the skull. Vomiting can also occur with life-threatening illnesses, so vomiting with bulging fontanel is still an emergency.
4. Vaccinations
   : Children sometimes develop a benign and temporary bulging fontanel after vaccinations. The exact reason for this is unknown, but researchers believe it is related to the fever that the vaccines can cause as a side effect.
5. Medications and nutrition
   : Some nutritional problems, such as vitamin deficiencies, can cause a bulging fontanel. Some medications also cause the fontanelle to bulge.

• Body position
  : If the child is lying down, the fontanelle may appear bulging. If the fontanel does not bulge in a vertical position, then most likely there is no problem.

Why does a child need fontanelles on his head?

From a physiological point of view, the fontanelles play a very important role - first of all, they help the baby pass through the birth canal. If you look closely at the head of a newborn, you will notice that it seems to be slightly flattened on the sides. This is explained by the fact that the anterior and posterior fontanelles allowed the bones to overlap each other. Literally after 4–5 days, the baby’s head takes on a normal shape.

The fontanel also participates in the process of thermoregulation of the body, which is extremely important in infancy. When the child's body temperature rises above 38 ° C, the membrane of the large fontanel helps remove excess heat from the meninges.

What can happen if it is not treated?

A bulging fontanelle often signals a serious illness. This may mean there is fluid in or around the brain. This fluid can damage brain tissue, causing severe damage. The cause may be a serious infection or other injury that can be fatal. It must be scary to see a bulging fontanel, and parents are worried about painful treatment. However, the sooner the child receives treatment, the better the prospects. Even in cases of serious infection, timely treatment can improve the child's condition. Delay may cause permanent health problems.

Doctors should determine the cause of a bulging fontanelle as quickly as possible. Doctors may ask questions about the child's development, daily routine, and medical history, including whether the child has been sick recently. In addition, the doctor will take the child's temperature and perform a blood test. Your doctor may also order a brain scan. In many hospitals, doctors perform a lumbar puncture, called a spinal tap. A lumbar puncture involves inserting a needle into the area around the spine to remove a sample of cerebrospinal fluid.

Although this procedure is generally safe and the most accurate way to determine whether an infection is causing a bulging fontanel, it can be stressful. If a lumbar puncture shows that there is no infection and the doctor cannot determine the cause, he may recommend hospitalization of the child for observation. Treatment will depend on the cause. If your child has bacterial meningitis, he or she will need antibiotics. Some forms of congenital hydrocephalus require ongoing support and care, such as physical and occupational therapy. Children with head or spinal cord injuries also require ongoing care.

What to pay attention to

In addition to a bulging fontanel, the following factors indicate problems in the baby’s well-being:

• temperature increase;
• nausea, vomiting, stool disorders;
• changes in physiological terms: drowsiness, lethargy or, conversely, excessive excitability, irritability, crying for no apparent reason;
• strabismus.

An increase in intracranial pressure associated with a malfunction of the body's systems may be accompanied by convulsions, epileptic seizures, and loss of consciousness. If parents notice this condition at night, there is no need to wait until the morning. These signs indicate that the baby requires urgent medical attention.

How often does your child's fontanel swell?

• First time 66%, 290 votes
  290 votes 66%

  290 votes - 66% of all votes

• Constantly 14%, 61 votes

  61 votes 14%

  61 votes - 14% of all votes

• Sometimes when she cries 12%, 52 votes

  52 votes 12%

  52 votes - 12% of all votes

  Read also:  How to treat cough with laryngotracheitis in children
• Rarely 8%, 37 votes

  37 votes 8%

  37 votes - 8% of all votes

Total votes: 440

29.11.2018

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Prevention

It is not always possible to prevent bulging of the fontanel. Some strategies parents can use to reduce risk include:

• wash your hands regularly and try to keep your distance from people who are sick
• Get regular checkups during pregnancy to reduce the risk of infections, premature birth, and some congenital abnormalities
• protect the child from head injury, never leave the child unattended on the bed or sofa

What is a fontanel?

A newborn's skull consists of bones that are connected to each other by sutures. The bone tissue on the baby’s head is thin, pliable, and rich in blood vessels. Some areas on the head do not ossify and are membranous tissue. They are located at the junction of several bones and are called fontanelles.

How many fontanelles does a newborn have? Many will be surprised to learn that a child is born with six fontanelles.

The concept of the norm for overgrowing fontanel

The development of the human body is a very individual process. However, there are certain boundaries, beyond which is a deviation from the norm.

Parents are concerned about both late and early overgrowth of the fontanelle zone. In order not to worry unnecessarily, doctors advise measuring the size of the fontanel and comparing them with the indicators in the following table:

The table shows average dimensional values. Minor deviations in one direction or another do not play a significant role. The same applies to age indicators. Early closure of the fontanelle in a child is not always a pathology - it all depends on the age at which it begins and how quickly the process proceeds.

The speed at which the fontanel membrane of the skull closes depends on the following factors:

• Heredity - parents should ask their grandparents how this process went for them. If the mother/father's fontanel also closed quickly, it is quite possible that the baby inherited this feature from one of them.
• Non-standard skull structure - if the circumference of the baby’s head and the proportions of his body are close to normal, there is no reason to worry.
• Metabolic processes in the child’s body – in particular, phosphorus-calcium metabolism. The diet of a nursing mother during breastfeeding or the infant's diet during artificial feeding should contain a complete set of all microelements and vitamins necessary for normal development.

Doctors have different views on the premature closure of the fontanel zone. According to Dr. Komarovsky, overgrowing of the fontanel at 3-4 months is normal. You should worry if the fontanel is completely overgrown by 2 months. But even in this case, only a specialist can accurately determine whether its early closure is a pathology or one of the normal variants.

Where are the fontanelles located in a newborn?

The large fontanel in a newborn is the most noticeable of the fontanelles, located on the top of the head between the frontal and parietal bones. It got its name for a reason. Its size is quite large and averages 3 cm. The shape of a large fontanel is diamond-shaped, and upon careful examination you can see the pulsation.

Why does the fontanelle pulsate? The thin connective tissue that forms the fontanelle allows you to see the pulsation of the blood vessels of the brain and the fluctuations of the cerebrospinal fluid. This is an absolutely normal physiological process; there is no need to worry about the pulsation of the fontanel.

A small fontanel in a newborn is located posterior to the large one at the junction of the parietal and occipital bones. This fontanelle looks like a triangle about 5 mm in size. Children are often born with an already closed small fontanel; in others, it closes within one to two months.

Two paired fontanelles can be found in the temporal regions. These are wedge-shaped fontanelles. Another pair of fontanelles, mastoid, is found behind the ear. All of them close soon after the birth of the child and have no diagnostic significance.

How to care for a fontanel

In the vast majority of cases, a large fontanel is not a pathology, but rather a developmental feature.

If you're still worried, just handle it with care:

1. There is no need to put pressure on this delicate area. If it is sunken or, conversely, slightly swollen, then contact your pediatrician for advice. There is no need to examine it yourself.
2. Do not comb your baby's hair too often so as not to disturb the fontanel area. An ungrown fontanelle can easily be damaged by the teeth of a brush or comb.
3. Make sure that there are no scratches, abrasions or wounds in this area.
4. Don't let your baby sleep on one side or only on his back, turn him over. This also contributes to the formation of the correct shape of the skull.
5. If you see crusts or peeling in this area, lubricate them with cosmetic baby oil or cream, then carefully comb them out.
6. Try to reduce the impact on the fontanel: carry the baby in your arms, put on a hat.
7. Protect your baby from stress and excessive crying; if you continue to breastfeed, eat more cottage cheese and dairy products.

The main thing is not to panic, especially before the age of six months. At this age, it is still impossible to track the dynamics of the overgrowth of the fontanelle; the doctor should recommend that you add vitamin D to the child’s diet (2 drops per day) and continue to monitor the general condition of the baby.

Let's sum it up

Dangerous and incurable conditions associated with increased size of this area are extremely rare. Moreover, they are usually diagnosed immediately after birth. If this did not happen in your case, then the environment and the modern rhythm of life are most likely to blame, which exhausts the expectant mother and affects her general condition.

What could be the consequences?

Mothers should understand that if a baby’s small fontanel is not yet overgrown at 3 months, then they should consult a doctor in any case. Sometimes inexperienced parents, citing the normal well-being of the baby, can neglect this rule. But the consequences of such a decision can be very sad.

In some cases, the slow process of ossification of areas of the cranial vault leads to the following consequences:

1. deformations of the skull;
2. hearing and vision impairment;
3. child's retardation in mental and physical development;
4. strabismus and mental disorder.

Sometimes surgical intervention by specialists can get rid of such severe consequences, but not always.

Therefore, if you notice any deviations in the development of your baby, do not hesitate, consult a doctor.

After all, the sooner he prescribes treatment, the sooner your baby will recover, which will allow him to avoid quite severe, and in some cases, irreparable consequences.

What could early closure of the fontanel mean?

In most cases, it does not matter when the baby's fontanelle closes up. This does not affect brain development and intelligence in any way. But there are situations associated with calcium and metabolic disorders, in which the fontanelle closes too quickly.

Other diseases, such as craniosynostosis, abnormalities of brain development, are very rare and have a severe course and characteristic symptoms. If the child feels well and develops according to the calendar, the rate at which the fontanelles close does not matter.