Early Closure of Fontanelles in Infants: Key Concerns

Q: Early Closure of Fontanelles in Infants: Key Concerns

Hello, Shan Shan's mother： The soft spot on the top of the baby's head that feels like there are no bones is called a fontanelle. <br>There are two fontanelles that can be felt along the midline of the skull, which provide flexibility and space between the bones of the skull in n

Premature closure of the fontanelle?

Hello Doctor: My baby turned 4 months old on August 4th.
Isn't it true that newborns typically have open fontanelles at birth? However, it seems that my baby's anterior fontanelle was closed at birth, or perhaps I just didn't notice.
I can only feel that the posterior fontanelle has a diamond shape, and the top of the head doesn't feel soft...
1.
When I touch her head from the nose tip upwards, there is a raised, pointed strip (is this the sagittal suture? I forgot...) Has it already closed? 2.
Is early closure of the fontanelle a sign of disease? 3.
Is this condition clinically observed? 4.
Do doctors typically perform this examination on newborns at birth? 5.
Last month, when we went for the pentavalent vaccination, the head circumference was measured and should be within the normal range; otherwise, the doctor would have informed us, right? Please answer my questions, thank you!

Shan, 30~39 year old female. Ask Date: 2005/07/19

Dr. Cai Zhengxian reply Pediatrics

Hello, Shan Shan's mother: The soft spot on the top of the baby's head that feels like there are no bones is called a fontanelle.
There are two fontanelles that can be felt along the midline of the skull, which provide flexibility and space between the bones of the skull in newborns.
The anterior fontanelle is diamond-shaped and located slightly above the forehead, between the two parietal bones and the frontal bone; it is generally larger and varies individually, measuring about 3 to 4 centimeters in length and 2 to 3 centimeters in width.
The posterior fontanelle is smaller, triangular in shape, and located at the junction of the parietal and occipital bones; it can be felt along the midline from the anterior fontanelle towards the back.
Typically, the anterior fontanelle closes between 12 to 18 months of age, although some babies may close it as early as 9 to 12 months.
The posterior fontanelle usually closes earlier, around 2 months after birth.

The presence of fontanelles is a remarkable aspect of nature; when a healthy baby must leave the mother's womb to enter the world, whether through vaginal delivery or cesarean section, they must first pass through a narrow opening or the pressure of the pelvic cavity.
Therefore, a newborn's skull cannot be rigid and fixed like that of an adult; instead, it must have overlapping spaces and flexibility between the bones to facilitate a smooth delivery.
Based on your description, the child's fontanelle does not appear to be closing prematurely; it seems that the bones are slightly overlapping, which may cause the sutures to disappear and make the anterior fontanelle less palpable, so there is no need for excessive concern.
What we are more concerned about is the development of the cranial cavity, specifically the brain development.
It is a good sign that your baby's head circumference is developing normally, so please continue to maintain regular follow-ups.
Tainan City Hospital cares about you!

Reply Date: 2005/07/19

More Info

Understanding the early closure of fontanelles in infants is a topic that raises several important concerns for parents. Fontanelles, commonly referred to as "soft spots," are the spaces between the bones of an infant's skull that allow for growth and flexibility during birth. Typically, infants are born with two main fontanelles: the anterior (front) fontanelle and the posterior (back) fontanelle. The anterior fontanelle usually closes between 12 to 18 months of age, while the posterior fontanelle generally closes within the first few months after birth.

In your case, you mentioned that your baby’s anterior fontanelle appeared to be closed at birth, which is unusual. Here are some key points to consider regarding your concerns:
1. Assessment of Fontanelle Closure: The presence of a raised area on the top of your baby's head could indicate that the sutures (the fibrous joints between the skull bones) are fusing. If you feel a ridge or a pointed area, it may be the sagittal suture, which runs from front to back along the top of the skull. If the fontanelle is indeed closed early, it is essential to monitor the baby's head shape and growth closely.

2. Early Closure of Fontanelles: Early closure of fontanelles, known as craniosynostosis, can be a sign of underlying conditions. It can lead to abnormal head shapes and potentially increased intracranial pressure if not addressed. However, not all cases of early closure are problematic, and some may be benign variations. It's crucial to consult with a pediatrician or a pediatric neurologist for a thorough evaluation.

3. Clinical Observations: Clinically, early closure of fontanelles is not very common, but it does occur. Pediatricians routinely check fontanelles during well-child visits. If there are concerns about the shape of the head or growth patterns, further imaging studies, such as a cranial ultrasound or CT scan, may be recommended to assess the skull's structure.

4. Routine Checks by Pediatricians: During routine check-ups, pediatricians assess the fontanelles as part of the physical examination. They will typically measure the head circumference and compare it to growth charts to ensure that the baby is developing normally. If there are any abnormalities, the pediatrician will discuss them with you and may refer you to a specialist if necessary.

5. Head Circumference Measurements: You mentioned that your baby's head circumference was measured during a recent vaccination visit and was within the normal range. This is a positive sign, as it indicates that the head is growing appropriately. If there were any significant concerns regarding the fontanelles or head shape, the pediatrician would likely have addressed them during that visit.

In conclusion, while early closure of fontanelles can be a concern, it is essential to have a thorough evaluation by a healthcare professional. If you have any doubts or notice any changes in your baby's head shape or growth, do not hesitate to reach out to your pediatrician for further assessment. They can provide reassurance and guidance on the best course of action for your child's health and development. Regular monitoring and open communication with your healthcare provider are key to ensuring your baby's well-being.

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