Small size of a large fontanel (should I give vitamin D?)

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.

If the deadline for the fontanelle to heal has passed

They are so small that they are difficult to notice or feel. But the rest - the front and back, located in the center of the skull, can be easily felt even by simply stroking the baby’s head.

Gradually, the connective tissue begins to ossify, and the fontanelles close. The anterior, largest fontanel survives the longest. Its average size in a newborn is approximately 3x3 cm.

It finally disappears around the age of 18 months.

The question of at what age does a child’s fontanelle close up is difficult to answer unambiguously. The timing of closure of the parietal fontanel varies from person to person. In general, significant fusion of the skull bones occurs within about a year.

Time limits

Indicators of normal fontanelle size by child’s age

The situation is considered normal when the fontanel in a newborn heals between 1 and 1.5 years. It is believed that the timing and speed of fontanel closure are determined by a genetic predisposition, which no medicine can change. Within a period of up to 3 months, a small area should heal, and the paired lateral ones should already be closed.

Important! In premature babies, the fontanel may heal later - by 2-2.5 years. All developmental delays are eliminated by 3 years, subject to all doctor’s recommendations for care

Early closing

The timing of overgrowth, in addition to heredity, is influenced by the following factors:

• the general growth rate of the child - if the child quickly gains height and weight, then the crown of the head will grow faster;
• method of feeding a baby - in breastfed children, the period of overgrowth is ahead of artificial ones.

Closing of the crown at the age of less than 3 months indicates a violation in the child’s body of the percentage of vitamin D and an increased calcium content. Most often this is caused by a violation of the regimen of taking vitamin and mineral complexes during pregnancy.

Breastfeeding promotes timely overgrowth of fontanelles

Since the timing of overgrowth is largely determined by genetic inheritance, it is possible that late closure is a characteristic feature of the family on the father's or mother's side. However, the question of when exactly the crown of a newborn becomes overgrown, and why it takes so long, is very worrying for parents.

You can understand that the film windows between the vaults of the skull have begun to harden and have completely tightened by touch or with the help of hardware examination (ultrasound, NSG). Pediatricians and parents often use the palpation method. If pulsation is not felt on the crown of the child, hard tissue (bone) has formed, then the window is overgrown.

The window closed for a year or less. The reason for the too small diameter of the fontanelles in a newborn and premature closure may be:

• Congenital microcephaly. The diameter of the head and brain are reduced in size. The remaining parts of the body in this case correspond to the norms.
• Metabolic disorders.
• Pathologies of the central nervous system.
• Craniosynostosis. Threatens the child with intellectual development disorders. The cranial sutures close too quickly, preventing the brain from growing.
• excess calcium. Mothers need to reduce the amount of dairy products in their diet during breastfeeding and when introducing complementary foods to the child.
• individual characteristics of the development of the cranium. If other indicators are normal, parents do not need to worry.

A crown size that is too large according to yearly standards may indicate the following diseases:

• Rickets. Develops due to a lack of vitamin D. The risk group includes premature babies. With timely treatment, the problem of vitamin D and calcium deficiency is solved without consequences for the child.
• Hypothyroidism. The congenital form is diagnosed in the maternity hospital through a blood test for hormones. If the thyroid gland does not function properly, the child will lag behind in mental and physical development.
• Down syndrome. Genomic pathology resulting from mutations.
• Bone development syndrome – chondrodysplasia. Patients are retarded in physical growth and are diagnosed with dwarfism.

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 67%, 345 votes
  345 votes 67%

  345 votes - 67% of all votes

• Constantly 13%, 68 votes

  68 votes 13%

  68 votes - 13% of all votes

• Sometimes when 11% cries, 57 votes

  57 votes 11%

  57 votes - 11% of all votes

• Rarely 8%, 43 votes

  43 votes 8%

  43 votes - 8% of all votes

  Read also:  Miramistin: instructions for use for the throat in children under 1 year of age

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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

Diagnostics

MRI for infants is performed under anesthesia.
If the fontanelle is swollen or other dangerous symptoms are observed, it is necessary to show the child to a pediatrician or call an ambulance. To make it easier for the doctor to make an initial diagnosis, parents need to tell in detail when the problem appeared and describe the baby’s behavior and well-being. It is important to describe in detail the condition of the soft crown - how it pulsates, bulges constantly or under certain circumstances.

After the examination, you may need to consult with specialized specialists - a neurologist, endocrinologist, osteopath, infectious disease specialist.

Diagnostic methods for bulging large fontanel:

• measuring the head, checking reactions and muscle tone;
• neurosonoscopy - ultrasound of the brain is not performed on children over 6 months of age;
• CT or MRI of the head, encephalogram;
• urine test to determine calcium levels;
• clinical and biochemical blood test;
• if a neuroinfection is suspected, a spinal puncture is performed and an analysis is performed to determine the sensitivity of pathogens to antibiotics.

Based on the examination results, the doctor selects safe and effective treatment methods. Treatment of pathological conditions is carried out in a hospital.

When the fontanelle overgrows. Norm

fontanel normally heals within an average period of six months to one and a half years . If this happens earlier or later, then you should consult a doctor and find out the cause, since often such a symptom indicates certain problems in the functioning of the baby’s body.

• Early fusion indicates a disorder of calcium-phosphorus metabolism, in which hypercalcemia is possible, which will affect bone density and their ability to elasticity. In the future, without treatment, a child can break a limb even from a small blow to the hand.
• Slow healing , which has not ended by the age of two, indicates a lack of the main building material in the body - the same vitamin D and calcium, which can cause rickets to develop.

Swollen or bulging fontanelle

Again, if after your baby’s whims the fontanel becomes normal, this means that nothing terrible is happening. However, if you have the following symptoms, call an ambulance immediately:

• Temperature;
• Lethargy;
• Excessive sleepiness;
• Convex fontanel.

Get ready to answer the main question: when did you first notice a bulging fontanelle, and is it always like that? The rest will be examined by the doctor himself, who will prescribe an examination and the necessary treatment.

The causes of swelling of the fontanel can be:

• encephalitis;
• hydrocephalus;
• increased intracranial pressure;
• meningitis.

Diagnoses are complex and ambiguous - only a doctor can make them!

IMPORTANT! See a doctor promptly!

Sunken fontanel

The main thing in any incomprehensible situation, especially with your little one, is not to panic! You notice a sunken fontanel - you don’t need to immediately run to the doctor, observe how sunken it is, what the child’s temperature is in the room, whether his stool is normal, whether he eats well.

• If all the parameters go against not only the norms, but also common sense, contact your pediatrician. Without examining it, it is difficult to determine the true cause.
• If all indicators are normal, stop panicking and watch the fontanel for a couple of days.

In any case, during your appointment with your pediatrician, contact him with this question. He will dispel your groundless fears, and you, in turn, will stop worrying about the next question.

What should a newborn's fontanel look like?

A small dimple on the crown of the child - the fontanelle - performs an important task during the birth of the baby

And after birth, she is given a serious role, and with this, special attention from mothers and doctors

Fontanas are areas at the junctions of the cranial bones, covered instead of bone tissue with soft elastic membranes. Thanks to them, the baby's head is plastic and during childbirth can adapt to the curves of the mother's pelvis. The volume and size of the baby’s head decreases at the time of birth, which helps protect both the baby’s brain and the mother’s organs from damage.

There are six fontanelles in total, but in full-term babies at the time of birth, as a rule, only one remains open, in the area of ​​the crown - the so-called large fontanel. Normally, its size ranges from 0.5 to 3 cm, and its shape resembles a diamond. After birth, it helps the baby adapt to a changing external environment: maintain body temperature, regulate fluctuations in intracranial pressure.

We have been involuntarily trying to get around this large fontanel all year, when we stroke the child’s head, take off his cap, and comb it. Just under the skin, thin and shiny, there is a strong but elastic membrane, which will later be replaced by bone, and beneath it a fairly large vein pulsates. It is she who swells, transmitting vibrations of the arteries and heart when the baby cries, screams or takes a deep breath.

The large fontanel overgrows gradually and finally closes between 6 and 18 months. When exactly this happens depends primarily on the characteristics of the baby’s body. Although too slow or, conversely, rapid overgrowth of the fontanel can be a sign of illness, not by itself, but together with other symptoms. So, most often the “dent” heals too slowly due to rickets. It also happens that the fontanel disappears already in the first six months of the baby’s life - the reason for this is a violation of the metabolism of calcium and phosphorus in the body.

The “hollow” does not require special care. You can touch the fontanel with your hand or with a comb - although, of course, you shouldn’t put too much pressure on it, as well as on any other part of the child’s body.

By the appearance of the fontanel, you can assess the condition of the baby. Normally, it should neither swell nor sink; touching the fontanel with your fingers, you can easily feel the pulsation.

You should consult a doctor if the fontanel becomes hard to the touch, no pulsation can be felt inside it, it swells or sinks, and the baby is worried or, conversely, looks lethargic (normally, the fontanel can swell when the baby cries, but then quickly returns to its original form). When the fontanel is pulled inward, this may indicate severe dehydration of the child: he should be seen by a doctor immediately.

Each baby has its own rate of overgrowth of a large fontanel - this is normal if the head circumference increases smoothly and on time. This phenomenon can be explained as follows: if, due to some kind of stress received during childbirth, the child’s brain “lives better” in the conditions of a “spacious” skull, it will retain a large fontanel and open sutures for a long time, and if mobility harms the brain, wise the body will overgrow it in 3 months.