Open Fontanelle at Age Two: What Parents Should Know

The anterior fontanelle has not closed by the age of two?

It is common for some children to have an open anterior fontanelle at the age of two.
The anterior fontanelle typically closes between 9 to 18 months, but in some cases, it may remain open until the child is 24 months or older.
If the fontanelle is still open at this age, it is important to monitor the child's development and overall health.
Factors that may contribute to a delayed closure of the anterior fontanelle include genetic factors, nutritional deficiencies (such as vitamin D deficiency leading to rickets), and certain medical conditions such as hypothyroidism or syndromic conditions.
If there are concerns regarding the size of the fontanelle or the child's development, further evaluation may be warranted.
This could include blood tests to check for nutritional deficiencies or hormonal levels, as well as imaging studies like an ultrasound or MRI of the brain to rule out any underlying structural issues.
For pediatric neurologists in New Taipei or Taipei, it is advisable to consult local medical directories or seek recommendations from your pediatrician for specialists who can provide a thorough evaluation and guidance.
Thank you for your inquiry.

Ms. Wang, 30~39 year old female. Ask Date: 2022/12/06

Dr. Xiao Kaiwen reply Pediatrics

Aside from the head circumference not being excessively large (>97%), it is important to monitor whether the head circumference growth curve has remained stable without significant deviations.
If both conditions are met and neurological development is normal, it may simply be a normal variation without any clinical significance.
It is recommended that if the fontanelles have not completely closed, a pediatric neurologist can perform a simple cranial ultrasound examination and provide consultation.
Cranial ultrasound is a basic training procedure for pediatric neurologists at medical centers, so there are no specific recommendations for particular physicians.
If the examination results are normal, continued observation can be conducted until closure occurs.

Reply Date: 2022/12/06

More Info

Understanding the open fontanelle in a two-year-old child is an important concern for many parents. The fontanelles, or soft spots on a baby's skull, are areas where the skull bones have not yet fused together. The anterior fontanelle, located at the top of the head, typically closes between 12 to 18 months of age, but it can remain open until the child is as old as 24 months or even slightly longer in some cases.
In your daughter's case, at two years old, having an open fontanelle that measures about the size of a thumbnail is not uncommon. While the majority of children will have their fontanelles closed by this age, there are variations in development, and some children may take a bit longer. The size of the fontanelle and the timing of its closure can be influenced by several factors, including genetics, nutritional status, and overall health.

The fact that your daughter's head circumference is in the 85-95 percentile indicates that she has a larger head size compared to her peers, which can be a normal variant. However, it is essential to monitor her growth and development closely. The height percentile of 5-15% suggests that she is shorter than many of her peers, but this alone does not indicate a problem, especially if she is developing normally in other areas.

If the fontanelle remains open beyond the age of two or if there are concerns about her growth or development, it may be advisable to consult a pediatric neurologist or a pediatrician who specializes in developmental issues. They may perform a physical examination and, if necessary, imaging studies such as an ultrasound or MRI to assess the brain and skull structure. These tests can help rule out any underlying conditions that might be affecting her growth or the closure of the fontanelle.

Common factors that can contribute to a delayed closure of the fontanelle include:
1. Genetic Factors: Family history of delayed fontanelle closure can play a role.

2. Nutritional Deficiencies: Conditions such as rickets, which is caused by a deficiency of vitamin D, calcium, or phosphate, can affect bone development.

3. Hydrocephalus: An accumulation of cerebrospinal fluid in the brain can lead to increased head size and delayed closure of the fontanelles.

4. Metabolic Disorders: Certain metabolic conditions can also impact bone growth and development.

In terms of recommendations for pediatric neurologists in New Taipei or Taipei, I suggest looking for specialists affiliated with reputable hospitals or medical centers. Some well-known institutions include Taipei Medical University Hospital, National Taiwan University Hospital, and Chang Gung Memorial Hospital. These facilities often have pediatric neurology departments with experienced professionals who can provide comprehensive evaluations and care.

In conclusion, while an open fontanelle at the age of two can be within the range of normal development, it is crucial to monitor your daughter's growth and development closely. If you have any concerns, do not hesitate to seek a professional evaluation to ensure that she is developing appropriately and to address any potential issues early on. Regular check-ups with her pediatrician will also help track her progress and provide peace of mind.

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