Newborn baby. It is a soft area on the parietal part of the head between the parts of the skull. This area does not have bone tissue, but is covered by a strong membrane. The fontanelle in infants makes it possible to contract during childbirth as the baby passes through the birth canal.
What are the types of fontanelles in newborns?
Newborn babies have six fontanelles. The largest is the front one, the second largest is the back one. There are two more mastoid and two sphenoid. After childbirth, two main fontanelles usually remain open: the frontal (large) and occipital (small).
Sizes of children's fontanelles
The large fontanelle resembles a diamond shape. It is considered normal if its size is within 1-3 centimeters. Most often, such a fontanel in children is 1.7-2.5 centimeters. And at three months of age it decreases to 1-1.5 centimeters.
For correct definition the size of the frontal fontanel should be added to its longitudinal and transverse diameters and the resulting sum divided by 2. The small fontanel resembles the shape of a triangle. Its dimensions usually do not exceed 0.7 centimeters. Although most often a child is born with a closed small fontanel. But do not worry if the size and shape of the child’s fontanelle differs from the standard. Each child is individual. A pediatrician should be consulted to determine whether this is a concern.
Timing of fontanel closure
The four lateral fontanels in full-term babies close before birth, in premature babies - in the first few days after birth. The occipital closes completely at 2-3 months. But there are no exact dates for the closure of the largest fontanel. This is a very individual process. It can be overgrown by 12 months, or maybe at 1.5 and 2 years. Behind last years, thanks to the acceleration of children, the frontal fontanel disappears by 10 months.
What is the reason for the early closure of the frontal fontanel?
Closing of the fontanel before the third month of the baby’s life is considered early. This is usually due to the expectant mother’s passion for taking multivitamins, which results in small and fairly dense fontanelles in the child. Therefore, you should follow the norm in taking vitamins according to your pregnancy.
Why is it dangerous?
Early closure of the fontanel has a significant effect on full development brain, preventing it normal growth. The danger is that early overgrown
fontanel can cause serious illness in infants. Very rarely (but there is still a possibility) a baby may have one of two diseases: craniosynostosis. These diseases are accompanied by a number of other symptoms. If a child’s fontanel closes early, but the circumference of his head is normal, this means that the child is healthy.
What is the reason for late closure of the fontanel?
Late closure of the frontal fontanel is associated with low levels of vitamin D3 in the baby’s body. And this leads to changes in bone tissue.
Why is it dangerous?
In itself, late closure of the fontanel does not indicate danger. It is important to study and associated symptoms, as this can also be a dangerous signal.
The most common cause of late closure is rickets. This may also be a signal of Down syndrome, achondrodysplasia and other serious diseases. Even if a fontanel that does not close for a long time in infants does not cause concern, you should consult a specialist.
What else can a fontanel “tell” about?
There are several more “signals” that should not be ignored:
the fontanel in infants sinks - there is not enough fluid in the body;
for a long time it is “convex” -;
increased size - impaired ossification or prematurity.
The fontanel is a non-ossified section of the cranial vault, consisting of the remains of the membranous skeleton and connecting the bones of the skull of a newborn baby. Fontana allow deformation of the cranial vault, which is necessary during childbirth, as well as for accelerated growth of the brain.
The fontanel is necessary to perform many functions. Let's consider the main ones:
- Relief birth process . The fontanelles allow the bones of the skull to move, reducing the size of the baby's head during childbirth.
- Thermoregulation. The fontanel membrane allows the brain to cool down when the temperature rises naturally.
- Depreciation. If the head hits the surface, the impact is softened, thereby protecting the brain from concussions and the skull from deformations.
Since the fontanel facilitates easier access to the brain, this allows diagnosing its work on early stage identify various pathologies.
How many fontanelles in a child?
In babies just born, they distinguish 6 fontanelles:
- Basic, big, it's the front one.
- Rear or small.
- Pair of mastoid.
- A pair of wedge-shaped ones.
All fontanelles, with the exception of the large one, usually have no big sizes and immediately after birth they tighten and become invisible.
Where are the large and small springs?
- Great fontanel located in the area of the junction of the bones of the crown with the frontal bone (on the top of the head, middle of the crown).
- In the area of convergence of the bones of the back of the head and the crown of the bones, palpate small fontanel.
The size of the fontanel in children - norms in the table by month of life
Inspection of the large fontanelle is carried out monthly for up to a year. The specialist checks the size of this area to determine the baby’s health condition.
Table. Normal sizes large fontanel in children under one year old
| Age in months | Dimensions in mm |
| First month | 26-28 |
| Second | 22-25 |
| Third | 23-24 |
| Fourth | 20-21 |
| fifth | 16-18 |
| Sixth | 16-18 |
| Seventh | 16-18 |
| Eighth | 14-16 |
| Ninth | 14-15 |
| Tenth | 12-14 |
| Eleventh | 9-12 |
| Twelfth | 5-8 |
The shape of the large fontanelle is similar to a rhombus, and the small one is similar to a triangle.
Since the fontanel is similar in shape to a diamond, to determine its size it is necessary to clarify the distance between distant points and divide the result by 2. The result obtained may differ slightly from the average data in the table above, since all children are individual. Only a doctor can talk about deviations from the average norm.
When should a child’s fontanelle normally heal?
Overgrowth of fontanelles is a purely individual process, however, there are average time indicators that experts focus on. The small fontanelle heals by 2 months
, but the closure of the big one is happening at a slower pace. A large fontanel heals by 1 year, and complete overgrowth occurs closer to 2 years
.
Why does the fontanel slowly overgrow, is large, and closes early: the reasons for deviations from the norm in the tables
The size of the fontanel is determined by the genetic component, so you should not panic if they differ from the tabulated norms, because all these data are just average indicators. Slow closure and overgrowth can be facilitated by individual indicators of the body, but the presence of deviations and pathologies should not be ruled out.
Reasons for late closure of the fontanel
| Causes | Additional symptoms of the disease | What to do? |
| The fontanel has flexible thinned edges, the back of the head is flattened, and bone thickenings appear on both sides of the sternum. | Consult a pediatrician, if the diagnosis is confirmed, administer D-vitamin therapy, increase sun exposure, and follow the doctor’s recommendations. | |
| Congenital hypothyroidism | An existing lack of thyroid-stimulating hormones may also manifest itself as drowsiness, lethargy, poor appetite, various edemas. | Take your baby to the pediatrician and get tested to determine the amount of hormones thyroid gland, after clarifying the diagnosis, carry out hormone replacement therapy. |
| Achondrodysplasia | Violation of the growth of bone tissue and, accordingly, the skeleton. There is a slow overgrowth of the fontanel, a wide head with a protruding forehead and short limbs. | Pediatrician consultation. |
| Down syndrome | Chromosomal disease with characteristic features: transverse fold on the palm, shortened neck, specific facial expression, etc. | Consultation with a pediatrician, karyotyping (counting the number of chromosomes), special care and treatment prescribed by a specialist. |
Reasons for early overgrowth of fontanel
Why does a child’s fontanel pulsate, bulge, or fall in – all the reasons are in the table Fell Dehydration due to vomiting, diarrhea, or fever.
Be attentive to the health of your baby, especially during the newborn period.
There is a place on the baby's head where a bone is missing - this is the fontanel. It pulsates and the area is very soft. And when the fontanel in children becomes overgrown, you will find out by reading this article.
Anatomical features
Children who are born naturally have elongated head, because the baby was passing through the birth canal. The fontanelle is what connects. After some time, the soft area will harden, and the head will become completely regular form. The elongation will disappear when the fontanel in children closes. Do not be afraid to touch the baby's head, although the fontanel is soft, it is protected by a dense membrane.
Energy of space
People have long believed that it is transmitted to the baby through the fontanel and thanks to this, babies can see what others do not see. And when the soft spot is overgrown, the child grows up and already loses these skills. Whether this is true or not, no one can answer for sure.
When will the fontanel in children close?
Let's start with the fact that there are actually 6 fontanelles. 4 temporal and 1 occipital are overgrown by the time of birth or, more often, during the first month of life. The frontal one, the one that pulsates, lasts longer. This feature allows the brain to develop better. You've probably noticed that doctors always examine the fontanel - from this place you can judge the changes that are happening in the baby.
When does the fontanel tighten in children: timing
During the first year of life, the baby's fontanelle hardens. Sometimes this process lasts longer - up to one and a half years. There's nothing wrong with that. This phenomenon should not frighten young parents. If the process takes more than late date- then you should consult a doctor.
What does it mean if the fontanel does not heal in children?
This phenomenon is most often associated with ongoing diseases. Late closure is a reason to sound the alarm and conduct a detailed examination. Most often, the fontanel does not heal for the following reasons:
- hydrocephalus;
- metabolic disease.
The doctor will probably prescribe vitamin D. Even if you are often in the sun, you should still follow the doctor's prescription. It would also be useful to introduce dairy products, eggs and fish into the child’s diet - they will saturate the body with calcium.
What to do, early?
Early closure of the fontanelle does not always indicate the presence of a disease. Often this is simply because the “open space” is small. In other cases, the reason may be:
- early hardening of cartilage;
- hypervitaminosis;
- increased intracranial pressure.
Why does a child's fontanelle pulsate?
Most parents get scared when they discover a pulsating spot on their child's head. But all fears are in vain, since this phenomenon is absolutely normal. The pulsation corresponds to the beating of the heart, since with each beat blood flows to the brain. The vessels begin to pulsate, and this is transmitted to the surroundings of the brain). If the fontanel does not pulsate, you should immediately consult a doctor. This may indicate pressure changes.
A baby from birth to one year is the object of close attention of parents and relatives. Young parents tend to worry and worry even without any particular reason, let alone situations when the baby’s development does not fit into the norm, according to others. Very often, the determination of such a norm is made not by pediatric specialists, but by neighboring grandmothers, familiar mothers, etc.
In this article we will talk about infant fontanelles. We'll tell you what they are, what they are, how long does it take for the fontanel to heal, what does early closure of the fontanel mean, what to do if the fontanel doesn't heal well, etc.
What is a fontanelle?
Fontanas are soft, non-ossified areas of a newborn’s skull that are not covered by the cranial bones. They are formed due to the fact that the bones of the baby’s skull continue to develop, and at the time of birth they are not fastened together as tightly as in an adult. The mobility of the cranial bones makes it possible for the child to pass through the birth canal. In the first year of life, the child’s skull continues to actively form, and the fontanelles gradually close (initially there are several of them). Parents often think that the slightest touch can damage the integrity of the fontanel. Actually this is not true. The soft parts of the baby’s skull are covered not only with skin, but are also protected by an additional layer of liquid underneath and a durable inner film. Of course, it is still worth observing safety precautions and basic caution when contacting the fontanel, but you should not be afraid to touch it. Often, because of their fear, parents want the fontanelles to close as quickly as possible and worry that they persist, in their opinion, for too long. Meanwhile, one should be afraid, first of all, of early closure of the fontanelles, because if a child’s fontanelle quickly overgrows, this indicates disturbances in the development of the brain and central nervous system, especially when not only the fontanel closes, but also the head circumference decreases..
The fontanels on the sides of the newborn's head close first. This happens in the first month after birth.
The small fontanel located in the back of the head also decreases. At the same time, the large fontanelle, parietal, may increase in size - there is nothing wrong with that. But be careful - the simultaneous enlargement of all fontanelles and the divergence of the sutures of the cranial bones indicates an increase in the internal pressure of the skull.
If you notice a pulsating fontanel, don't worry. This indicates that the baby’s blood circulation is fine. But a sunken fontanel is already a cause for concern - a sign of dehydration.
What time should the fontanel close?
As already mentioned, the lateral fontanels close first (in the first month of life in premature babies, and in children born at term, the lateral fontanelles very often close at birth or in the first days of life, so many parents do not even know about their existence). Non-closing lateral fontanelles in full-term infants may indicate the development of cerebral hydrocele. Do not hesitate and consult a doctor for diagnosis and, if necessary, 
treatment assignments. After this, the small fontanel (at the back of the head) gradually decreases in size and disappears - by the age of three months, it usually completely disappears. The closure of the large fontanel occurs later – usually up to a year. In some cases, its closure extends to 15 months or even a year and a half. Until this time, it gradually decreases in size until it closes completely.
Remember, if you have any doubts about the timing of the overgrowth of fontanelles (it doesn’t matter whether it seems to you that your baby is ahead of schedule or, on the contrary, behind them), consult a doctor immediately.
At birth, the child has elastic and at the same time strong cranial bones, which are connected by the large and small fontanel, as well as sutures; they also act as natural shock absorbers. Based on their condition, it is possible to determine the presence of ICP or the nature of the course of labor. When passing through the birth canal, the newborn's skull is significantly deformed due to the overlapping of bones on top of each other. This reduces the risk of injury for both the baby and the mother. It can be a little intimidating for new parents. irregular shape head, but don’t worry, because after a while it will take on its usual shape.
Why do you need a fontanel?
A large fontanel in a child ensures unhindered development of the brain. And his most active growth occurs, as is known, in the first year of life, precisely at the time when the skull has a space closed by a membrane.
Thanks to the fontanel, it is possible to conduct a brain examination without the use of complex techniques and with the least discomfort for the baby. Neurosonography allows you to identify the consequences of injuries, hemorrhages, various neoplasms, changes in brain structures at a very early stage. Among other functions, it is worth noting the provision of thermoregulation. A child’s large fontanel, in particular the membrane that covers it, cools the body when the body temperature reaches 38 degrees. An additional thermoregulatory mechanism significantly reduces the likelihood of cerebral edema and seizures that can be caused by high temperature. It also acts as a kind of shock absorber during falls, without which the first steps cannot be taken.
Timing of closure of the large fontanel in children
The dimensions are on average 2x2 cm, the fontanel is located on the top of the head and has a diamond shape. With age, the cranial bones fuse and by the age of one year it disappears. But all children have different development, so this process can last up to 18-20 months. This should not be a cause for concern as long as other indicators are normal.
The skull of a newborn is distinguished by the presence of a small fontanelle on the back of the head, which is much smaller in size. In almost all children it is closed immediately after birth; it can be detected in infants born before the due date. In this case, its complete fusion is observed after 4-8 weeks.
The pulsation and size of the fontanelle have special meaning and allow doctors to assess the child's condition. Due to its functional load, late or, conversely, earlier overgrowth in some cases may be a symptom of pathological growth of the cranial bones.
Course of pregnancy
A woman’s nutrition during pregnancy affects the phosphorus-calcium metabolism of the child, which accordingly affects the time of overgrowth of the fontanel. A large fontanel in a child may be dense, small in size and have a tendency to close quickly if future mom I consumed too much dairy products while taking vitamins. This is one of the reasons for the need to strictly adhere to the established norm, selected by the gynecologist depending on the stage of pregnancy. It is also worth noting that an excess of calcium contributes to early
In addition, due to limited space for brain growth, there is an impact on brain development.
Calcium-phosphorus metabolism
A large one should have dimensions within 1-3 cm. Exceeding this parameter may indicate the presence of infectious diseases, injuries received during childbirth, hypoxia during pregnancy and impaired outflow of fluid in the cerebral ventricles. In addition, children born ahead of schedule, as well as those with developmental defects, endocrine disorders and abnormal metabolism, may also have a large fontanel.
When to see a doctor
If a discrepancy occurs, tests are required to determine the level of calcium in the urine and blood and additional medical examination is required. This is caused by the fact that rickets, which is common cause an incorrectly sized fontanel leads to bone deformation, a decrease in overall muscle tone and changes in the functioning of the nervous system. In this case, constipation may occur due to general muscle weakness. The child must be shown to a neurologist if the fontanelle does not correspond to his age, most often the reason for this is that it can be eliminated with special drugs. At the same time, parents should monitor the child’s development and, if any doubts arise, contact a pediatrician. The physician must be aware of any non-compliance with standards and alarming symptoms. For example, frequent crying during sleep and loud screams upon awakening may indicate headache, the cause of which is high intracranial pressure. When a baby cries, the fontanelle becomes tense, and arterial pulsation is felt underneath it.
A depressed surface also requires a medical examination; this indicates dehydration due to frequent vomiting or diarrhea.
What are mothers afraid of?
New parents are often afraid to even accidentally touch the “soft” crown and ask the pediatrician about the need for specific care. The fontanelle of a baby, in particular its membrane, cannot be damaged by combing the hair or stroking the head, since it is much stronger than it seems. However, in some cases, it is undesirable for a child to dive, even with the supervision of qualified specialists, since the brain is exposed to pressure differences.
When monitoring the development of the baby, the pulsation of the fontanelle should not cause concern among parents. Many people are of the opinion that it is possible to speed up its overgrowth by increasing the daily dose of vitamin D and calcium in the diet. But such actions will not have any effect if there is a genetic predisposition.
Conclusion
In conclusion, it is worth noting the main reasons for the non-compliance of the fontanelle with established standards:
- Rickets is the most common. But you should not search for symptoms of this disease only if the crown of the head does not heal for a long time. Main additional symptom is skeletal deformation, in particular changes individual parts body, for example, legs or chest.
- A large fontanel in a child can also be caused by hypothyroidism. But such a disorder of the thyroid gland appears quite rarely before the age of 1.5-2 years.
- Hereditary factor. In this case, the timing of fusion is very vague and can reach up to 2.5 years. We can talk about its presence provided there are no other signs and simultaneous development in accordance with age.