Is Late Closure of Fontanelle in Toddlers a Cause for Concern?

The fontanelle has not yet closed at one year and eight months?

A boy who is one year and eight months old still has a palpable anterior fontanelle.
The literature states that the anterior fontanelle typically closes between one year and one and a half years of age.
Is it concerning that it is closing late? Should he be taken for any examinations?

Q Mami, 30~39 year old female. Ask Date: 2015/09/11

Dr. Xiao Kaiwen reply Pediatrics

The anterior fontanelle typically closes around 18 months of age on average, although it is normal for some to close later.
It is important to monitor the child's development for any abnormalities.
It is recommended to visit a major hospital's pediatric neurology department for a non-invasive brain ultrasound to check for hydrocephalus or other brain issues.

Reply Date: 2015/09/11

More Info

Late closure of the fontanelle in toddlers can indeed be a cause for concern, but it is essential to understand the context and the individual child's development. The fontanelles are the soft spots on a baby's skull where the 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. However, variations exist, and some children may take longer for this closure to occur.

In your case, with a 20-month-old boy still having a palpable anterior fontanelle, it is important to consider several factors before determining if this is a cause for concern. First, the overall growth and development of the child should be assessed. Are there any developmental delays in motor skills, speech, or social interactions? Is the child meeting other milestones appropriate for their age? If the child is developing normally in these areas, the late closure of the fontanelle may not be a significant issue.

However, late closure of the fontanelle can sometimes be associated with underlying medical conditions. For instance, conditions such as hypothyroidism, rickets, or certain genetic syndromes can lead to delayed closure. If there are any accompanying symptoms, such as poor growth, developmental delays, or signs of increased intracranial pressure (like persistent vomiting, irritability, or changes in consciousness), it would be prudent to seek medical evaluation.

In terms of what checks or evaluations might be necessary, a pediatrician would typically perform a thorough physical examination, including measuring the child's head circumference to assess for any abnormalities in growth patterns. If there are concerns, they may recommend further investigations, such as blood tests to check for metabolic or hormonal issues, or imaging studies like an ultrasound or MRI to evaluate the brain's structure.

In summary, while a late closure of the fontanelle can be a cause for concern, it is not always indicative of a problem, especially if the child is developing normally. It is advisable to consult with a pediatrician who can evaluate the child comprehensively and determine if any further investigation is necessary. Regular check-ups and monitoring of developmental milestones are crucial during this period to ensure the child's health and well-being.

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