Technique for measuring the size of a large fontanel

Types of fontanelles

In total, six types of fontanelles are observed.

• lateral. There are two pairs of them. Wedge-shaped fontanelles are located in the temple area, are very small, and most often close in the first month of the baby’s life. The mastoid are located behind the ear and, like the wedge-shaped, most often disappear by the end of the first month, and sometimes even in the womb;
• small unpaired occipital fontanel. It is a small triangle with a diameter of up to 5 mm, its ossification occurs mainly in the first three months;
• large unpaired frontal fontanel. It is its volumes that the doctor measures in the clinic during examination every month. It resembles a diamond in shape, and its volume is on average 3 × 3 cm. Normally, the period of its closure is between the ages of three months and two years.

Why do you need to measure the fontanelle?

At 1 month, newborns are prescribed neurosonography - ultrasound of the brain - as part of a preventive examination. Ultrasound examination allows you to find out the exact size of the soft crown and the state of development of the baby’s brain.

Regular determination of the size of a large fontanel allows one to exclude or timely recognize serious diseases - infectious pathologies, tumors, hemorrhages, increased intracranial pressure.

Normally, the soft crown closes completely between the ages of 3-4 months and 1.5 years.

Why is it needed?

The fontanelle has many functions. At the time of birth, when the baby passes through the birth canal, it allows the bones of the skull to come together, thereby protecting them from deformation and the brain from injury.

It is an indicator of various diseases. And it helps with failures of the baby’s not yet perfect thermoregulation. When he has a high temperature, it naturally cools the brain and its membranes.

Also, the fontanel is an excellent shock absorber for the head. When the baby still has poor control of his body and often falls, he protects her from serious injury.

While the fontanel is not overgrown, the state of the brain and circulatory system can be assessed by doing neurosonography. Once complete ossification occurs, this procedure will no longer be possible.

General recommendations

As a rule, the doctor at the appointment pays attention to the following details:

• is the fontanel open or closed and whether this corresponds to the age of the child (is the closure too early or too prolonged);
• the number of open fontanels at birth and the number of open ones at the time of examination;
• the rate of change in the size and shape of a given area compared to the previous inspection;
• How do its edges feel to the touch: elastic (normal) or excessively soft (possible development of rickets);
• whether it sticks out or, conversely, sinks.

If any suspicions arise during a medical examination, the following examinations and consultation may be prescribed:

• neurologist;
• endocrinologist;
• genetics.

You should take a urine test for the Sulkovich test to determine how well the newborn’s body absorbs calcium and do an ultrasound of the brain.

Many parents also often wonder: is it possible to somehow harm the baby by touching the fontanelle or pressing on it? No, the connective tissue and skin are strong enough to prevent this from happening. So you can comb, wash and independently inspect this area on your baby’s head without any fear.

When to worry

There are several anomalies associated with the size and shape of the fontanel, according to which the doctor can suggest a particular disease. But as Dr. Komarovsky says, deviations in volume are only an additional sign, and if the child is cheerful and develops in accordance with his age, then everything is fine. A single symptom without the presence of other signs does not mean anything. The main types of deviations are:

1. Sunken fontanel. This is the first sign of malnutrition or dehydration; in the first months of life it is very dangerous, so it is better to consult a doctor immediately. But for some children this is a normal physiological state.
2. A bulging and tight fontanel in infants indicates ICP (intracranial pressure), and may also be a sign of encephalitis, dropsy or meningitis. At the same time, when crying and for some time after, this is considered the norm.
3. A small fontanel at birth and early closure at the age of three months is one of the signs of microcephaly (a significant reduction in the brain and skull, coupled with mental deficiency), which develops due to intrauterine infection. However, rapid closure does not mean that the brain or skull has stopped growing; there are sutures between the bones of the skull, they remain open until about 20 years.
4. A large fontanel at birth is considered one of the signs of dropsy, and also occurs due to premature birth or impaired ossification.
5. Late closure of the fontanel may simply be an individual feature or be a sign of diseases such as rickets, hypothyroidism, dropsy, etc.

In no case should you self-medicate; an accurate diagnosis and necessary medications should only be prescribed by a doctor, based on the baby’s age, a detailed examination and tests performed.

Causes

The elastic membrane may descend below the level of the bone edges for various reasons.

Dehydration

Recession of the fontanelle is most often a sign of a lack of fluid in the body. This occurs when the mother does not give water between feedings and wraps the baby up tightly. Insufficient intake of breast milk or artificial formula is also dangerous.

The cause of dehydration may be too dry air or high temperature in the baby's room. Therefore, you need to dress your baby according to the weather, avoid prolonged exposure to the open sun, and in hot weather give him water to drink in small portions.

In addition, this condition develops against the background of various pathologies.

Infectious diseases

Diseases caused by viruses, bacteria or fungi are usually accompanied by fever. Heat exchange is disrupted, the child develops shortness of breath, which leads to increased loss of moisture. Many infections occur with vomiting and loose stools due to intoxication. Due to increased fluid loss in infants, the fontanelle sinks. This is typical for food poisoning, dysentery, salmonellosis, and influenza.

Digestive disorder

Prolapse of the fontanel is often caused by digestive disorders. Nutrients are not absorbed in the stomach and intestines. This is observed when complementary foods are untimely or incorrectly introduced to a small person, or through too frequent or infrequent feeding.

This condition is accompanied by regurgitation, sometimes turning into vomiting, and the appearance of unstable stools, often in the form of diarrhea. The baby is worried about pain in the tummy, breathes frequently, cries, sweats, which leads to dehydration.

Genetic predisposition

Heredity is important, causing the unique structure of the skull. It lies in the timing of the closure of bone sutures, the size and strength of the fontanelles.

Neurological diseases

In young children, lesions of the nervous system of various origins are often accompanied by headaches and severe vomiting, caused by increased intracranial pressure. This is characteristic of many neuroinfections - meningitis, influenza.

Perinatal pathology can also lead to dehydration. Cerebral palsy, complicated by neurotoxicosis and convulsive syndrome, in the absence of adequate treatment causes increased fluid loss.

Other reasons

A baby born later than expected often has a sunken fontanel. In post-term pregnancy, this is a normal option.

The fontanel may collapse during intense crying caused by pain or fear. This is due to pressure differences inside the skull.

Concerns should be caused by the membrane sinking in the baby in a calm state. It is important to establish whether the fontanelle falls below the contact bone edges permanently or only periodically.

Basic myths

Young, frightened mothers, having often talked with friends or read all kinds of information on forums, begin to adhere to many myths, namely:

• You should not touch the fontanel with a towel or a comb, because when you do this, you can injure the baby. In fact, under the fontanelle there is fibrous tissue that perfectly protects the baby, and hygiene procedures can be safely performed;
• a large fontanel that does not heal for a long time is the first sign of rickets. In fact, this disease has other signs, namely sweating, drowsiness, curvature of the legs and, as an addition, bald patches and a large fontanel. By the way, immediately after childbirth it may increase slightly. And this is a completely normal phenomenon, since after the baby passes through the birth canal, the head shrinks a little and then returns to its previous state;
• You should not take calcium and vitamin D if the fontanelle is quickly overgrown, even when rickets has been detected. This is also an incorrect statement, in this case they should be accepted. But it is important to remember that you should not self-medicate, and give any medicines and vitamins to your baby only as prescribed by a doctor;
• All children of the same age should have the same fontanel. Each child has an individual predisposition, at birth the norm is from 2.2 cm to 3.5 cm, while the rate of ossification is different for each and depends on genetic characteristics.

Most often, a young mother’s worries are in vain; if any concerns arise, it is better to consult with your pediatrician, who, if necessary, will refer you to a neurologist, rather than needlessly spoil your nerves.

A newborn baby is largely protected by nature itself, and the same applies to the brain. Some parents are afraid of soft spots on the head, whereas they are part of the safety. This clever invention helped the baby to be born and in the future it will protect during shocks and intensive growth.

Features of the process of overgrowing fontanelles

There is no strict norm for closing the windows on the head. Timing may depend on many factors:

• Maternal nutrition during pregnancy. An excess of calcium provokes overgrowth in the prenatal period and the rapid appearance of ossification. With a lack of microelements, the process is delayed.
• Baby food. The formula or breast milk of a newborn must contain enough calcium, magnesium, and vitamin D. Otherwise, metabolic processes are reduced.
• Lack of sunlight. Children born in winter or living in northern latitudes need increased levels of vitamin D and additional walks in the fresh air for normal calcium metabolism.
• Congenital pathologies. With some diseases of the gastrointestinal tract and endocrine system, the baby’s body may not absorb vitamins and minerals from food.

The first to close are paired fontanels in the amount of 4 units: often in the first 2 weeks after birth. The connective tissue hardens and begins to fill the seams and bones on the crown of the child. In premature babies or after cesarean section, the process can be carried out within 3-4 weeks, due to the need for rapid brain development and weight gain.

Norms for closing fontanelles

According to the anatomy of fontanelles in newborns, the longest process of overgrowth occurs in the diamond-shaped large window. It can be compacted within 1-2 years. Its parameters range from 1.5 to 5 cm when measured between the edges of the plates. Measurements should be taken monthly at each scheduled pediatrician appointment.

Average timing and size of a healthy child, according to medical tables:

• From birth to 3 months – from 2.7 to 2.5 cm.
• From 3 to 6 months – up to 1.7−1.9 cm.
• From six months to 9 months – up to 1.5 cm in length.
• At 12 months – no more than 1.2 cm.

In boys, the ossification process is more intense and can end by 8-10 months. In girls, closure is considered normal at 1.5 years. But deviations from these figures are not a cause for alarm: the doctor takes into account the general developmental features, the diameter of the head, its circumference, height and weight of the small patient.

To determine complete closure, at home or in the clinic, the pediatrician uses the palpation method: carefully palpating the area on the front of the head. He should feel homogeneous dense bone tissue, the absence of pulsation of the veins.

Fontanas in babies - what are they for?

The fontanelles are the points where the plates of the skull meet, and strong connective tissue runs between them. The baby has six fontanelles in total, only two of them are noticeable - the large one above the frontal part and the small one running along the back side. The size is large, each baby is different, the norm is considered to be from two to four and a half centimeters. Fontana are primarily necessary for safe passage through the narrow birth canal. The head of a newborn is much larger than the mother's pelvis, and during childbirth, due to incomplete bone fusion, it is deformed as necessary.

First-time moms are usually a little shocked to notice a pointed or angled head, but the concern is unfounded as it takes a few days or weeks to become perfectly round. Even after birth, preserved plasticity continues to have a beneficial effect, for example, in the event of an impact, it allows one to avoid a concussion, and with intensive development, which is observed in the first three years of life, the brain easily increases in size.

The opinion that the fontanel area should not be touched is a little exaggerated. You can safely bathe your baby, kiss and hug without putting too much pressure on the connective tissue. In fact, damage by parents is extremely rare, since it requires targeted rather than random efforts. Of course, gentle touches are a guarantee of safety. The observed pulsation of the fontanelles is normal, since there are blood vessels underneath them.

What are fontanelles made of and where are they located?

The word “fontanel,” as a rule, means a soft area of ​​a newborn’s head, resembling a diamond shape, which is located right in the middle of the crown of the baby. It is he who is the object of close attention from parents and pediatricians. However, few people know that at birth a child has not one, but as many as 6 fontanelles, but 5 of them usually close within the first month of life.

In addition to the largest and most famous, diamond-shaped, on the top of the head there is also:

• posterior small fontanelle , triangular in shape, small in size (about 0.5 cm) and located on the back of the head of a newborn;
• wedge-shaped (paired) , located in the temporal region;
• mastoid (paired) , located behind the ear.

These are non-ossified areas of the skull and they consist of fairly soft connective tissue. Thus, the newborn’s brain in this area is protected only by the above-mentioned connective tissue, a small layer of fat and skin.

What time does the fontanelle heal in babies?

In the first two months after birth, the fontanelles are slightly enlarged as the skull begins to grow. The period until the skull bones are completely closed varies depending on the size. A small fontanel on the back of a child’s head becomes overgrown with bone tissue in about two to three months, and the four lateral ones are connected to each other by the first birthday.

The large one, the front one, closes around two years. It may happen that the fontanelles grow together too early, this is called ossification or craniosynostosis, which occurs as a concomitant symptom of various diseases.

If ossification of the skull begins in the womb, compensatory growth occurs leading to an asymmetrical shape of the skull. In such cases, surgery is performed to make room for the growing brain. When the fontanel closes too slowly, this is usually due to a deficiency of some substances, for example, a lack of vitamin D, which is also characterized by rickets. Don't worry if you are under the impression that fusion is not happening. Regular examination by a pediatrician will help dispel all doubts.

What can a large fontanelle talk about?

In rare cases, a large fontanel can still signal serious problems:
No. Causes of a large fontanel Description 1 Rickets This is a disease that is characterized by the fact that the child does not receive enough calcium, because of this, bone formation occurs with disturbances. It often happens in those babies who do not receive enough vitamin D and rarely get exposure to the sun, sometimes this is the result of prematurity. In addition to a persistent fontanel, one of the symptoms is thickening of the bones on the sides of the sternum. In this case, you need to show the child to the doctor; most likely, he will be prescribed vitamin D 2 Down syndrome It is clear that this syndrome is diagnosed immediately after the baby is born by its characteristic appearance and the only transverse fold on the palm; an additional study of the number of chromosomes is prescribed. This disease causes deviations in physical development, as well as mental development. Such a child will need the help of medical professionals throughout his life. 3 Hypothyroidism With this disease, a person’s basic functions of the thyroid gland are reduced. Additional symptoms: lethargy, apathy, drowsiness, frequent constipation, refusal to eat. Since the thyroid gland influences the formation of the skeleton, it also indirectly affects the tightening of the fontanel. To accurately determine the diagnosis, you need to donate blood to determine the concentration of hormones. If the disease is confirmed, the doctor prescribes hormone replacement therapy. 4 Chondrodysplasia The disease is extremely rare; its other name is dwarfism. Babies with this disease have slightly shorter arms and legs than other children, a broad head, and a significantly protruding forehead. In modern medicine, the disease is recognized as incurable 5 Hydrocephalus With this disease, an excess amount of cerebrospinal fluid accumulates in the brain. The disease has several stages, depending on the complexity, doctors make predictions. Today there is an operation that can help a child, and if the disease is detected immediately after birth and the operation was performed on time, then the consequences for the child will be minimal 6 Apert syndrome This is a pathology of cranial development, the most striking symptom: abnormalities of the hands, for example, fusion of the fingers. This is a rare disease that occurs in one in 180,000 babies. Treated by surgery 7 Clavocranial dysplasia Is inherited. With this syndrome, there are disturbances in the development of the cranial bones, the collarbones are either underdeveloped or completely absent. Occurs in 1 case per million children born. Does not affect the mental development of the child in any way 8 “Glass-crystal man” syndrome With this pathology, the human bones do not have enough collagen, they become too fragile and break from minor impacts. There are 4 types of the disease, differing in severity of manifestations

As you may have noticed, most of these diseases are rare, or even exotic. The most common cause of a large fontanel is prematurity of the baby.

Premature birth

A baby born at less than 37 weeks is considered premature. In Russia, babies starting at 22 weeks are currently considered viable. However, cases of 20-week-old babies being saved have been recorded.

There are many factors that influence the timing of a child's birth. There are reasons that a mother cannot influence:

• the mother has previously undergone surgery on the uterus or abdominal organs;
• multiple pregnancy;
• placenta previa;
• the gender of the baby is male (boys are more often born prematurely);
• serious illnesses.

However, some risk factors are the mother's responsibility:

No. Factors Description 1 Stress Frequent stress, high fatigue at work, especially in the later stages, lead to early delivery. This also includes riding public transport during rush hour for a significant period of time and refusing to part with heels. 2 Nutrition Irregular eating and skipping meals can affect the health of the mother. Some pregnant women believe that they have gained a lot of weight and sharply limit their diet in pursuit of beauty. This negatively affects the condition of both mother and child! 3 Age of the mother Prematurity is experienced by minors and women of elegant age (closer to 40 years), especially if this is their first pregnancy 4 Bad habits If during pregnancy the mother smokes, drinks or uses drugs, then this is a direct path to premature birth

Fontanas in children as an indicator of disease

There are signs indicating health problems, this is another advantage - you have the opportunity to consult a doctor in time to prevent complications. Dangerous signs include a convex, sunken or excessively compacted large fontanel. Slightly sunken is considered normal when the baby is sitting, but if the phenomenon is noticeable when the body is horizontal, you should urgently consult a doctor. One of the reasons is dehydration, which does not seem too dangerous, but from a medical point of view, a serious disorder in children under three years of age.

A convex fontanel in an infant indicates an increase in body temperature, intracranial pressure, hemorrhage, the formation of hydrocephalus or meningitis, so you should immediately visit a pediatrician to clarify the diagnosis and take appropriate measures to speed up recovery. Compacted, not amenable to light pressure, indicates inflammation that requires the attention of medical personnel. If a child hits a fontanel, you should notify the pediatrician and monitor the baby’s condition.

The genius of nature continues to amaze, thanks to such a simple solution, parents have time and a high chance of saving lives. Carefully monitor the condition of the baby in order to preserve the most valuable thing - his health.

When should a fontanel overgrow? This question worries many mothers. After all, its early or late closure may indicate health problems for the baby.

A tense fontanel, a sunken fontanel, soft edges, closed early, does not heal - all these questions very often worry mothers in the first year of a child’s life.

When to worry

A fontanelle that does not close for an excessively long time, together with a number of other signs, may indicate:

• development of rickets (at the same time, there is also a lag in physical development, decreased immunity);

• hypothyroidism – insufficient production of thyroid hormones (accompanied by constant drowsiness, lethargy, as well as deviations in physical and mental development);
• achondroplasia , which is accompanied by underdevelopment of bones, dwarfism, etc.;
• Down syndrome (in this case, it is too large in a newborn and, accordingly, does not close for a long time).

In some cases, too early closure may also indicate a metabolic disorder in the newborn’s body, in particular, an excess of calcium, which occurs, for example, with craniostinosis or microcephaly.

Anomalies of the fontanel

A sunken or protruding fontanel in an infant also indicates abnormal processes in the body:

• Sunken. This indicates critical dehydration of the newborn due to vomiting, diarrhea, etc.
• Protruding. Speaks of an increase in intracranial pressure in a child, which can occur against the background of: encephalitis, meningitis, intracranial hemorrhage, etc. We can talk about danger if the bulging is accompanied by: high fever (which is almost impossible to bring down), nausea and vomiting, lethargy and drowsiness (or, conversely, excessive irritability), convulsions, loss of consciousness.

Sometimes a baby's fontanel may pulsate; this usually occurs when the baby is excited or crying and should not cause concern. However, if pulsation is observed constantly, then this is a reason to visit a neurologist, who will conduct an examination and, most likely, prescribe an ultrasound of the brain.

But you should never sound the alarm ahead of time, because if the child develops normally and feels well, the rate of closure of this part of the skull does not matter at all.

What is a fontanel?

During the period of intrauterine development, the baby’s skull is initially formed from plates of dense tissue - this is a prototype of future bones, which are connected to each other by zigzag sutures. Over time, these plates are replaced by cartilage tissue, and later by bone. Ossification first appears in the center of the flat bones, and then spreads to the sides and to the edges. By the time of birth, this process is almost complete, although the bones are still quite soft and thin. But still, not the entire skull of the baby ossifies, because it still has to undergo the birth process. To make the baby's head easier to pass through the birth canal, some areas of the skull at the junction of several bones still represent connective tissue plates. They are called fontanelles.

In fact, a newborn has six fontanelles. The most famous is the large frontal, or anterior (this is what we know best). It is located on the top of the head, at the place where the frontal and parietal bones connect, has the shape of a rhombus measuring from 2.2 to 3.5 cm. Another one - small (occipital, back) - is located at the junction of the parietal and occipital bones, has the shape triangle about 5 mm in size. In about half of babies it closes before birth, in the rest it closes within a month after birth.

The remaining fontanelles are paired: on the sides of the head (sphenoid) at the convergence of the frontal, parietal, sphenoid and temporal bones and behind the ear - at the junction of the occipital, temporal and parietal bones (mastoid).

The cause of enlarged fontanelles in a newborn compared to accepted norms may be prematurity or disturbances in the intrauterine ossification process. Sometimes they indicate congenital hydrocephalus. On the other hand, the lateral and occipital fontanels completely covered by bone tissue and the small size of the anterior one immediately after birth may be a symptom of congenital microcephaly.

Types and functions

In full-term babies, the largest are the large and small fontanelles.
A newborn has 6 fontanelles. But in full-term babies, only the anterior and posterior fontanel are noticeable. The lateral ones are open in very premature infants.

The posterior fontanel is triangular and usually closes during the first month of life. The large anterior one is diamond-shaped and is located in the area of ​​the crown. May be flat, slightly convex or sunken, and pulsate noticeably. It is the soft crown that the doctor examines to assess the baby’s developmental status.

Functions:

• movable sutures and fontanelles ensure the plasticity of the baby’s head as it passes through the birth canal;
• do not interfere with brain growth;
• thermoregulation of the brain - when the temperature rises, cooling occurs through the soft crown, which helps to avoid overheating;
• shock absorption and fall absorption.

The crown is reliably protected by a dense membrane. Therefore, it cannot be damaged by combing, bathing, or stroking the head.

Why does a child need a fontanel?

Fontanas and sutures help the head change its configuration in the birth canal and compensate for excess intracranial pressure so that there is no headache. And these are growth zones: if the large fontanelle is closed along with the others at birth, the skull will not grow, and this is fraught with consequences.

Natural functions

Fontanas allow you to avoid injuries during the birth process.
Scientific research has proven that the main purpose of the windows on the baby’s skull is to help the newborn go through the intrapartum period without injuries or consequences. When exiting through the birth canal, the fontanelles and sutures narrow and may slightly overlap each other’s edges, reducing the diameter of the head. It easily passes through the pelvis without creating increased pressure on the brain.

Functional significance of the fontanelle:

• They act as a natural shock absorber between fragile bones on the skull. This reduces the risk of brain damage from shaking or an accidental impact from a fall.
• In premature babies, intracranial pressure often increases in the first months. The fontanelles expand, which reduces the negative impact on the brain, reduces discomfort and headaches. With the next attack, the area under the thin skin swells, indicating the need for treatment.
• The baby's brain increases greatly in size during the first year of life. Mobility of the fontanelles is necessary for rapid expansion of the head and helps avoid injury.
• When your body temperature rises during illness or hot weather. The fontanelle becomes a natural regulator, eliminating overheating in the absence of profuse sweating.
• The process of closing the fontanelle helps doctors determine whether the brain is developing properly. This is important for pathological childbirth and congenital neurological anomalies.

An open fontanelle is the safest and fastest way to examine a newborn. If there is strong entanglement or hypoxia during pregnancy or childbirth, there is a risk of damage to the child’s brain and nervous system. The doctor can monitor the condition of the white matter and the main centers using ultrasound. Ultrasound easily passes through the thin skin, allowing scanning during sleep without pain or sedatives.

When should you sound the alarm?

Parents need to be attentive to the following signs:

Large (large exceeds 3 x 3 cm, small - 1 x 1 cm) and tense fontanelles may indicate hydrocephalus (water on the brain). With this diagnosis, the head, bursting from the inside with fluid, quickly enlarges, the bones diverge, and the fontanelles grow. If the fontanel is constantly swollen, even at rest, there is no visible pulsation in it, and it does not change when screaming, parents need to consult a doctor.

Does the large fontanel tense and bulge only when the baby screams or strains? This is fine.

Protruding or sunken fontanel in a newborn

In a healthy newborn, the fontanelle should be only slightly higher or lower than the surrounding skull bones. It should also pulsate a little. A protruding or sunken fontanel in a baby may indicate the presence of a disease.

Protruding fontanel in a newborn

In a healthy newborn, the fontanelle should be only slightly above or below the surrounding skull bones and should pulsate slightly. It’s okay if, while crying, the baby’s fontanelle swells and forms a lump. But, if the fontanel constantly pulsates and is constantly swollen, then this is a reason to show the newborn to the doctor, as this may be a sign of increased intracranial pressure or other diseases. But if a bulging fontanel is also accompanied by: vomiting, high fever, drowsiness, irritability, strabismus, convulsions and epileptic seizures, loss of consciousness, as well as swelling of the fontanel in a newborn for a long period and swelling of the fontanel after a head injury, then it is necessary to CONSULT A DOCTOR IMMEDIATELY.

Sunken fontanelle in a newborn

Retraction of the fontanel most often occurs due to dehydration of the newborn (reasons: vomiting, diarrhea, fever, etc.). In this case, it is necessary to provide the baby with plenty of fluids and immediately consult a doctor who will diagnose and prescribe treatment for the disease that caused dehydration in the newborn.

When does the fontanel overgrow?

The timing of fontanel overgrowth is a genetically determined factor. But there are certain boundary norms. The large fontanel closes by one year, maximum by two. The shape and size of the child’s skull depend on its timely closure and ossification of the sutures. Interestingly, girls usually have perfectly round heads, while boys have more elongated heads. The small fontanel in babies born on time is already closed. If your baby was born earlier, its closure will occur by 2-3 months.

The speed and time of closure of the fontanelles in a healthy child also depends on how much calcium the baby’s body is provided with. If during pregnancy the mother’s menu was balanced, she gave up bad habits, and, if necessary, took multivitamins according to a doctor’s prescription, then the overgrowth of the fontanelles usually occurs normally.

But the overgrowth of the fontanel ahead of schedule can indicate an excess of calcium in the child’s body, and also indicate microcephaly and craniostenosis - a disease in which, due to premature overgrowth of the sutures or their congenital absence, the formation is disrupted and it takes on an irregular shape.

The editors' opinion may not coincide with the opinion of the author of the article.

Use of photos: Clause 4 of Article 21 of the Law of Ukraine “On Copyright and Related Rights” - “Reproduction for the purpose of covering current events by means of photography or cinematography, public communication or communication of works seen or heard during such events, to the extent justified by the informational purpose. »

4 minutes Author: Anastasia Egorova 2106

• Pay attention to the shape and size
• Approximate terms of overgrowth
• Signs of abnormalities
• Features of fontanelle care

The thin and, at first glance, very fragile fontanel in infants is not a ossified space on the head, protected by elastic connective tissue. The main function is to give mobility to the bones of the skull directly during childbirth. The shape of the baby's head easily adapts to the size and structural features of the woman's small pelvis, and then again takes the correct shape. Such a transformation greatly facilitates the process of the child leaving the womb.

In fact, newborns have more than one fontanel. There are six of them. It’s just that the one located on the top of the head is the largest and most noticeable. And it takes much longer to overgrow than others. In the first six months (maximum, a year) of a baby’s life, the bone tissues of his head, while not yet fastened with sutures, remain mobile and affect the shape of the skull. This feature helps to avoid severe injuries from falls and impacts that are typical for a baby in the process of learning about an unfamiliar world.

What size of the fontanel is considered optimal, and in what cases should you sound the alarm? What should care be like? How not to miss the first signs of deviations? When will the cranial bones heal completely? This article will answer all these questions in detail.

Science and clinical practice

There are great “myths” about fontanelles in newborns, which are often spread by doctors themselves. In this article I will try to dispel them, but first, a little about what this fontanel actually is! What are fontanelles and what do they consist of?

The skull of a newborn baby consists of a large number of individual and rapidly growing bones. Flat bones of the skull grow in the center and along the edges. A suture is formed where the two bones of the skull meet. Where three or more skull bones meet, a polygon-shaped gap is formed. Such gaps covered with strong connective tissue are usually called fontanelles.

The basis of the fontanel is extremely strong connective tissue, which gradually ossifies at the edges, which leads to a gradual decrease in the size of the fontanel and its complete closure.

Newborn children have 6 fontanelles: anterior (largest), posterior (second largest), two mastoid and two wedge-shaped. In most children born at term, only the first two fontanelles are noticeable - the remaining four either close very quickly after birth, or are so small that there are very few of them.

The main role of the fontanelles is to provide elasticity to the baby's skull during childbirth and during the first years of life. Thanks to the fontanelles, the bones of the newborn baby’s skull remain very mobile, and the size of the child’s skull easily adjusts to the size of the mother’s small pelvis during childbirth.

What should fontanelles look like normally?

The large anterior fontanelle is usually clearly visible and always arouses great interest. There are a large number of misconceptions associated with the “normal size” and “timing of closure” of a large fontanel, which often frighten inexperienced parents, and often frighten the doctors themselves or worried relatives and friends (whose children had something “wrong”).

Here are some of them:

— At birth, the size of the large fontanelle is the same in all children.

- In fact, the normal size of a large fontanel varies greatly. The normal limits for a large fontanelle in newborns are considered to be 0.5 cm to 4 cm.

- After birth, the size of the fontanel should only decrease, and an increase in the fontanel is a sign of illness.

-In fact, due to the rapid development of the brain, the size of the large fontanel increases somewhat during the first months of a child’s life.

—There is a certain period when the large fontanel should close

-In fact, the timing of the closure of the large fontanel is as individual as other parameters of the child’s development (beginning of walking, teething, beginning of coherent speech). Observations of healthy children have shown that in 1% of cases the large fontanel closes at three months, at one year the large fontanelle closes in approximately 40% of children, and at two years in more than 95% of children.

But I repeat once again, even if the fontanel closes at 3 months or at 3 years, and there is no clinic of any kind and according to brain examination data (NSG, TUS) everything is normal, then there is no need to worry !

-The smaller the fontanelle at birth, the faster it will close.

-In fact, there is no directly proportional connection between the initial size of the fontanel and the proximity of the moment of its closure.

-Complete closure of the spring will mean a complete stop in the growth of the skull and leads to an increase in intracranial pressure

— The bones of the skull grow mainly due to the increase in their central part and the expansion of the edges in the area of ​​sutures.

—The speed of fontanelle closure depends on the intake of calcium and vitamin D into the child’s body.

- In fact, the rate of overgrowth of fontanelles does not depend on this in any way, because This process is laid down at the genetic level, therefore, doctors’ recommendations that when the fontanel is rapidly overgrowing, foods containing calcium should be removed from the diet, or, on the contrary, they should be increased when the fontanel is not overgrowing, have no basis whatsoever. It is impossible to influence the rate of fontanelle closure in healthy children.

Appearance of a large fontanel in a healthy child

Externally, a large fontanel in a healthy child looks like a pulsating or non-pulsating diamond-shaped, slightly sunken or slightly convex area of ​​the scalp. Most inexperienced parents are afraid to touch the fontanel and watch with bated breath as the doctor boldly probes it with his fingers. In fact, a large fontanel is much stronger than it seems and its careful probing cannot cause any harm to the child.

The baby's fontanel does not require any special care or protection. The fontanel area can be safely washed while bathing the child.

I would like to emphasize that a slightly sunken fontanel is the norm (especially if the child is calm or sleeping), just as the norm is a slightly sunken fontanel and this can be observed when the child is crying or straining.
I really hope that I have answered some of your questions, and if there is anything else that I missed, ask, I will be happy to answer.

Pay attention to the shape and size

Firstly, all infants cannot have absolutely identical head proportions and fontanel sizes. Each child is unique, so a difference of a couple of millimeters is not a reason to panic. But pediatricians offer average figures that you need to focus on when studying the size of the fontanelle of a newborn child.

A special formula has been developed for calculating and assessing proportions:

1. Add together the longitudinal and transverse diameters of the soft section.
2. Divide this amount by 2.
3. Evaluate the result and compare it with the norm.

The optimal shape and size is a diamond 25x25mm (+/- a few mm).

Secondly, due to the active development of the brain in the first three months, the fontanel may stretch slightly, and this is not considered a pathology. Later the size will return to normal. For example, in a one-month-old baby, the diameter of this area can vary between 22-28 mm.

A normal fontanel has a slightly convex or sunken appearance. But an overly sunken or strongly protruding area is a serious reason for immediately contacting a pediatrician. You will find out a little later what deviations are manifested by the atypical development of the fontanel. In the meantime, about the approximate timing of tightening the non-ossified part of the baby’s head.

Age characteristics

What size of a large fontanel in a newborn corresponds to the norm, and what size serves as a signal for consultation with a specialist? You need to be able to correctly determine this indicator. It is calculated as follows: add the longitudinal and transverse length of the pulsating area of ​​the baby’s head, divide by 2. The norm is up to 3 cm, but it depends on two factors. Firstly, it depends on the size of the child himself. Secondly, from his age.

• at 1 month it is too early to judge whether the fontanel is large or not;
• at 2 months it may even increase, and this will be the norm, which should not frighten parents;
• at 4 months it should begin to gradually grow over, and here is the time to measure it and compare it with the normal indicator;
• at 5 months, if the dimensions do not change, you need to take measures and consult a doctor on this issue;
• at 6 months it is usually still visible how the fontanel pulsates, so it is possible to monitor the process of its overgrowth;
• at 8 months it is normal - acceleration of this process, pulsation becomes barely noticeable (if there are no deviations); at the same time, the shape of the large fontanelle in a newborn gradually changes and turns from diamond-shaped to ovoid, acquiring more rounded outlines, gradually narrowing;
• per year, many even the largest fontanelles overgrow, but this can happen even at 1.5 years without any consequences for the health of the baby. Everything here is very individual.

Parents need to know when the large fontanel closes in order to notice deviations from the norm in time and prevent complications that may arise.

Approximate terms of overgrowth

The large fontanel in a newborn completely ossifies, on average, after 12 months. A small error of six months is also not critical if, according to all other signs of development, the child is healthy and does not lag behind his age norm.

Do not ignore the features of genetics, which also have a direct impact on the size and timing of fusion of the head bones.

The small fontanel in a newborn ceases to make itself known much faster. The one that is located on the lower part of the back of the head. In children born at exactly 9 months, and not earlier, this tender spot hardens after about one quarter.

Factors influencing closure rates

• The fontanel heals a little more slowly if the baby’s body lacks calcium, which is responsible for the development of bone tissue. Vitamin D deficiency also slows down the ossification process.
• In a premature baby with developmental delays, the cranial bones will heal at a reduced rate.
• With proper care for the newborn (when the diet and daily routine are correctly selected), the fontanel, on the contrary, heals faster.

When does a child's fontanelle become overgrown?

If some time ago doctors considered it normal for the fontanelle to overgrow from six months to one and a half years, today the time frame has shifted somewhat. Now, with other satisfactory indicators, it is considered normal for the non-ossified area to heal by three months.

Factors influencing the rate of closure of cavities between the bones of the skull include:

1. Vitamin D3. With its deficiency, the area in question ossifies more slowly.
2. Diseases. Rickets, Down syndrome, hypothyroidism and other diseases can slow the rate of soft patch closure.
3. The period at which the child was born. In premature babies, all processes occur with some lag from the norms adopted for babies born on time. Don’t worry, in the absence of other pathologies, the baby will catch up by the age of one year.
4. Nutrition. It is believed that in breastfed children, the fontanel closes faster. However, this is very subjective and largely depends on the mother’s diet.
5. Floor. Pediatricians from their own practice conclude that in girls the overgrowth of the area under discussion occurs more slowly.

Nevertheless, there is a certain schedule for the course of this process, which serves as a golden mean, a guideline, but not an axiom. A deviation of 2-4 mm from the norm should not bother the mother at all. Many parents believe that a quickly ossified skull will prevent the brain from developing as it should. This is not entirely true, since the increase in the volume of the baby’s head does not occur due to the presence of a fontanel on it, but due to the still elastic seams between the plates of the skull. An interesting feature is that the sutures do not lose their quality until the age of 19, which allows the brain to grow even after the fontanelle closes. Therefore, what is indicative in this matter is not so much the rate of overgrowth of the elastic area, but rather the dynamics of the increase in head volume.

Time frame by month for how the fontanelle should heal

Please note that the figures below are approximate and may vary slightly up or down.

Also note that the size of the area of ​​interest to us is measured not between its vertices, but between the centers of opposite sides

Approximate sizes of the fontanel in children at different ages:

1. in a newborn: from 26 to 28 mm;
2. 1 month: 22-25 mm;
3. 3 months: 20-22 mm;
4. at six months: 16-18 mm;
5. at 9 months: 12-15 mm;
6. per year: 5-8 mm.

Signs of abnormalities

Some serious illnesses and minor ailments manifest themselves through a change in the appearance of the large fontanel. As already written above, the normal state is when the area bulges or falls in very slightly. But if it happens that the depression has become too deep, and the barely noticeable tubercle of connective tissue has turned into something like a lump (and the size has not changed), think about an urgent visit to the pediatrician.

1. When the place where the fontanel is located has formed a significant protrusion, and the child has a fever associated with convulsions, immediately call an ambulance. If the fontanel is swollen without visible symptoms, you need to be checked for encephalitis, meningitis, or even a tumor.
2. An atypically deep depression is a sign of water deficiency in the body. Usually accompanied by diarrhea, fever or vomiting.

When the fontanelle closes suspiciously late, this may signal hypothyroidism, rickets, archondrodysplasia, and even Down syndrome. Only a doctor can confirm or refute the diagnosis.

But craniosynostosis or some pathologies in brain development are ailments accompanied by too early fusion of the skull bones.

It happens that the fontanel pulsates too noticeably. There is nothing anomalous about this. The child was just overexcited. As soon as the baby calms down, the pulse will return to normal.

How to understand that the fontanel has sunk (signs)

Normally, the parietal spring is diamond-shaped, it is reliably protected by a dense membrane, does not stick and does not protrude beyond the bones of the skull. When touched, a pulsation is felt; the number of beats per minute does not differ from the child’s heart rate (the norm for infants is no more than 130 beats).

The table provides information that will help determine if there is a problem with the parietal fontanel.

As Dr. Komarovsky says, a change in the appearance of the fontanel as the only symptom does not indicate pathology. You should not drug your child or force him to drink. In situations requiring treatment, changes in the soft crown are always accompanied by other signs of the presence of the disease:

1. When dehydrated, the baby becomes sleepy, lethargic, the mucous membranes and skin dry out, the baby cries without tears, urination decreases (the norm is 10 wet diapers per day), the urine becomes dark and has a pungent odor.

   Severe dehydration is fatal and the child urgently needs medical attention.

2. Characteristic symptoms of brain diseases: meningitis (high fever, increased heart rate, severe headache, loss of consciousness), hydrocephalus (increased head size and intracranial pressure due to excess fluid), etc.
3. Genetic disorders (hypothyroidism, Down syndrome) are always accompanied by a general developmental delay.
4. The presence of rickets affects the timing of closure of the fontanelle, its symptoms: drowsiness, increased sweating, changes in the shape of the head and skeleton, baldness of the back of the head, slow physical and mental development.

Features of fontanelle care

During the entire time the fontanel is closing, some parents are afraid to touch it, not to mention caring for this fragile area of ​​the baby's head. In fact, connective tissue is strong enough to withstand touch and hygiene. The fontanelle can be washed and wetted. You just need to dry it carefully. Lightly press the towel, not rubbing movements. You can also comb your child’s hair in this place. So caring for the fontanel does not require any special knowledge or skills.

Each baby has individual developmental features that are unique to him. Some people have a larger fontanel, others a little less. For some it closes earlier, while for others it closes a little later. For example, it was noticed that in girls the process of fusion is more intense than in boys. This is normal unless minor deviations from the norm are accompanied by signs of any diseases.

Size standards and closing dates

It is impossible to say exactly what the size of the fontanelle should be in a particular newborn baby, since these are purely individual parameters. The size of the largest of them at birth can vary from 0.5 to 3.5 cm (the distance between the two most distant points).

In the same way, it is difficult to say when exactly the fontanel in a newborn will heal, since it depends on many individual factors:

• the date of birth of the baby (whether he was born full-term or premature);
• the intensity of growth of the newborn (for example, with adequate nutrition and good weight gain, it usually closes earlier);
• method of feeding (with breastfeeding this happens faster than with artificial feeding);
• abundance or lack of vitamin D3 in the baby’s body;
• congenital diseases and pathologies.

Closure, as a rule, occurs between the ages of 6 and 18 months, however, there are cases when the healing of the fontanel, with a completely normal and full development of the baby, occurs much earlier than 6 months, and after one and a half years.