What should the fontanel in newborns be like and when should it close? When should a newborn child's fontanelle close and close, and why does it not heal? What will the measurements tell you?

Many people know that a baby has a soft place on his head called the fontanel. Fewer people are aware of the existence of lateral and posterior fontanelles. And certainly not everyone is sure why they are needed and what they really are.

In infants, the skull is not solid; it is made up of many individual bones. They are connected by a kind of membrane; when the baby passes through the birth canal, this helps to flatten the head a little, otherwise natural childbirth would be impossible. In total, newborns have six fontanelles:

• front;
• rear;
• pair of mastoid laterals;
• a pair of wedge-shaped laterals.

After the baby is born, the connective tissue gradually turns into bone. In pediatrics, certain standards have been established regarding the timing of fontanel closure:

1. The posterior fontanel closes the fastest - in a maximum of 2 months; it can close by the first month of the baby’s life.
2. Then the wedge-shaped ones close, this takes about six months.
3. The following are mastoid, their closure lasts from six months to one and a half years.
4. The anterior fontanelle can be soft until the baby is two years old.

It is the anterior fontanelle that raises the most questions among mothers. At birth, its size is from 2 to 3.5 centimeters. Many people are afraid to even just touch this soft area on the top of the head, although the mother can kiss the baby’s fontanel or comb her hair without any fear. There are a lot of rumors associated with this area, so mothers begin to worry when it seems to them that the size of the fontanel is too large or that it is not closing quickly enough. We would like to clarify all unclear points and thereby reassure young mothers.

Why is the fontanelle big?

In most cases, the mother simply thinks that the fontanel is larger than it should be, but normally it can reach a size of 3.5 centimeters. Sometimes a simple measurement dispels all doubts and confirms that the size does not exceed the norm. There are certain factors that influence the size of this area:

№	Causes of a large fontanel	Description of the reason
1	Hereditary predisposition	If one of the baby’s grandmothers confirms that the parent was also born with a large fontanelle, then this is not at all dangerous for the baby and is simply a family trait
2	Problems during pregnancy	If the mother was deficient in vitamins, ate irregularly and did not take care of her diet, then this may be one of the reasons for the increased size. A pregnant woman should carefully take care of her menu, take special vitamin complexes and walk more often
3	Baby menu	A baby who is breastfed usually does not have such problems, but bottle-fed babies sometimes have a large fontanel.

To understand what dynamics of fontanelle tightening are normal, check out the table:

Age	Dynamics
1 month	During this period, no visible changes in size are observed.
2 months	Sometimes at this age the fontanel enlarges slightly. This is a variant of the norm
4 months	Around this time, the first downward changes begin
6 months	The pulsation of the fontanelle remains noticeable, so it is difficult to accurately measure changes
8 months	The area becomes rounded, pulsation decreases
1 year	Some fontanelles close by this time, others may remain partially open until the age of 2 years.

Note that no connection has been recorded between the size of the fontanel at birth and its subsequent changes. Some pediatricians note that this process goes faster in boys than in girls.

If at 8 months the fontanel is still too large and has changed little since the birth of the child, then tell your pediatrician so that he can give you advice.

What can a large fontanelle talk about?

In rare cases, a large fontanel size can still signal serious problems:

№	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, which causes bone formation to be impaired. 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 a single 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. This child will need medical care 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 wide head, and a significantly protruding forehead. In modern medicine the disease is considered incurable
5	Hydrocephalus	With this disease, excess 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	Cleidocranial dysplasia	Passed on by inheritance. 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 child’s mental development in any way
8	Glass/crystal man syndrome	With this pathology, human bones lack 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 baby'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:

№	Factors	Description
1	Stress	Frequent stress and 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	Mother's age	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.

Try to watch your diet, don’t worry about troubles at work, and protect yourself from worries. And of course, do not poison your child. Some mothers refer to their friends who drank/smoked, and “everything is fine with the child.” Each child is individual; in addition, it is impossible to predict the effect of these substances on the baby’s health in the future.

In the vast majority of cases, a large fontanel is not a pathology, but rather a developmental feature.

If you're still worried, just handle it with care:

1. There is no need to put pressure on this delicate area. If it is sunken or, conversely, slightly swollen, then contact your pediatrician for advice. There is no need to examine it yourself.
2. Do not comb your baby's hair too often so as not to disturb the fontanel area. An ungrown fontanelle can easily be damaged by the teeth of a brush or comb.
3. Make sure that there are no scratches, abrasions or wounds in this area.
4. Don't let your baby sleep on one side or only on his back, turn him over. This also contributes to the formation of the correct shape of the skull.
5. If you see crusts or peeling in this area, lubricate them with cosmetic baby oil or cream, then carefully comb them out.
6. Try to reduce the impact on the fontanel: carry the baby in your arms, put on a hat.
7. Protect your baby from stress and excessive crying; if you continue to breastfeed, eat more cottage cheese and dairy products.

The main thing is not to panic, especially before the age of six months. At this age, it is still impossible to track the dynamics of the overgrowth of the fontanelle; the doctor should recommend that you add vitamin D to the child’s diet (2 drops per day) and continue to monitor the general condition of the baby.

Let's sum it up

Dangerous and incurable conditions associated with increased size of this area are extremely rare. Moreover, they are usually diagnosed immediately after birth. If this did not happen in your case, then the environment and the modern rhythm of life are most likely to blame, which exhausts the expectant mother and affects her general condition.

Video - fontanel. Doctor Komarovsky

What should the fontanel look like in a newborn baby? When should the fontanel close? What does a fontanelle that is too big or too small mean? What to do if the fontanel closes too early or too late? Fontanas are empty spaces between the bones of the skull covered with a strong membrane. A newborn baby has six fontanelles. Four of them close in the first days of a child’s life, the fifth in the second month of life, and the sixth, the largest (anterior), closes in the period from 3 to 24 or more months. Very often, fontanelles and the rate at which they close cause great concern among parents. In this article we will discuss the main aspects of the development of springs: their number, shape, size depending on the age of the child, speed and limits of closure, as well as what needs to be done in case of closure of the fontanel too early or too late, its retraction or bulging. 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 babies born at term, only the first two fontanelles are noticeable - the remaining four either close very quickly after birth or are so small that they are very difficult to notice. Growth of the skull and the role of the fontanelles in the life of a child In the minds of most people, the fontanelles are the only possible space for the growth of the skull, and the closure of the fontanel is associated with the end of skull growth. Actually this is not true. The bones of the skull, as mentioned above, grow in the center and along the edges. The fontanelles (mainly anterior and posterior) occupy only a small length of the border between adjacent bones and therefore are not of great importance in the growth of the skull. The main role in the growth of the skull bones is played by the sutures, which, unlike the fontanelles, remain open for up to 20 years. The development of the skull bones is strictly dependent on the rate of brain development. The most rapid growth of the brain, and, consequently, the bones of the skull is observed during the first two years of a child’s life. The main role of the fontanelles is to provide elasticity to the baby's skull during childbirth and during the first years of life. Indeed, thanks to the fontanels, the bones of the skull of a newborn child remain very mobile, and the size of the child’s skull easily adjusts to the size of the mother’s small pelvis during childbirth. The head of a newly born baby is somewhat flattened on both sides and elongated in the anteroposterior direction. This ideal head shape for childbirth is formed during the birth process itself thanks to the fontanelles. Also, thanks to the elasticity of the fontanels, the shape of the baby’s head takes on a normal appearance a few days after birth.
In the first two years of life, a child falls and hits his head more than in the rest of his life. Thanks to the open large fontanel, upon impact, the possibility of elastic deformation of the skull remains, which absorbs all the kinetic energy of the impact and protects the child from serious injuries. What should fontanelles look like normally? Typically, at birth and during subsequent examinations, the condition of two fontanelles is assessed: the posterior (small) and the anterior (large). The size of the fontanel is estimated using a special formula:

(longitudinal diameter of the fontanel + transverse diameter of the fontanel)/2 In most newborn children, the size of the posterior fontanel does not exceed 0.5-0.7 cm. The posterior fontanel usually closes in the second month of the child’s life. The large one (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 fontanelle, which often frighten inexperienced parents. 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 0.6 and 3.6 cm (the average size is 2.1 cm, see the formula above). - 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. Typically, in boys, the large fontanelle closes somewhat faster than in girls. -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
-As mentioned above, 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. With the exception of the metopic suture (the suture in the middle of the forehead), which closes at about two years of age, all other sutures remain open for the next 18-20 years, allowing the skull to grow to the size of an adult. - The speed of fontanelle closure depends on the intake of calcium and vitamin D into the child’s body.
- Calcium and vitamin D can affect the speed of fontanel closure only if they are deficient (in this case, the fontanel closes more slowly).
Very often, parents and local doctors observing their children are concerned about the “quick closure” of the fontanel, and therefore they cancel the prevention of rickets with vitamin D and transfer the child to a low-calcium diet. If we consider that the normal time frame for closure of a fontanel varies from 3 to 24 or more months, then in most cases there can be no talk of any “quick” closure of the fontanel. In this case, the real threat to the child’s health is not the closure of the fontanel, but the cessation of the prophylactic use of vitamin D. Appearance of a large fontanel in a healthy child Externally, a large fontanel in a healthy child looks like a 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. What changes in the size or appearance of the fontanel indicate disease? Usually, when examining a child, the size of the large fontanel is determined, their relationship with the age and general development of the child, as well as the external characteristics of the fontanel. What does a too large fontanel or slow (late closure) fontanel mean? Too large a fontanel or its slow (late closure) may be a sign of the following diseases: The fontanelle is too large or slow (late closure) Cause Other signs of illness What should be done? Rickets Rickets is one of the most common causes of slow closure of the fontanel. Most often, rickets develops in premature babies who do not receive preventive treatment with vitamin D and who are exposed to the sun too rarely. In a child with rickets, the edges of the large fontanel are flexible, the back of the head is flattened, and characteristic bone thickenings form on both sides of the sternum. Read more about the symptoms of rickets in the section Rickets. If you suspect rickets, the child should be shown to a pediatrician. If the diagnosis is confirmed, treatment with vitamin D preparations should be started as soon as possible. Congenital hypothyroidism Congenital hypothyroidism is a fairly rare disease in which there is a decrease in thyroid function. Because thyroid hormones are critical to skeletal growth, one of the earliest signs of congenital hypothyroidism may be slow closure of the fontanel. Other symptoms of congenital hypothyroidism may include chronic constipation, lethargy, drowsiness of the child, poor appetite, and swelling. Read more about congenital hypothyroidism and its treatment in the Hypothyroidism section. If congenital hypothyroidism is suspected, the child should be shown to a pediatrician and undergo examinations to determine the concentration of thyroid hormones (T4) and hypothalamus (TSH) in the blood. If the diagnosis is confirmed, the child is prescribed thyroid hormone replacement treatment. Achondrodysplasia This is a rare congenital bone disease, which is characterized by impaired skeletal growth, significant shortening of the limbs and, as a result, dwarfism. In newborns with achondrodysplasia, as a rule, in addition to a slowly closing or large fontanel, short arms and legs, a wide head, and a strongly protruding forehead are noted. Currently, there are no effective treatments for achondrodysplasia. Down syndrome Down syndrome is one of the most common chromosomal diseases in which various abnormalities in the mental and physical development of the child are observed. Typically, the diagnosis of Down syndrome is established immediately after the birth of a child based on a number of characteristic signs, except for a large fontanel: one transverse lining on the palm, a characteristic facial expression, a short neck, etc. If Down syndrome is suspected, the child should be shown to a pediatrician. The diagnosis of Down syndrome is confirmed by karyotyping (determining the number and structure of human chromosomes). Children with Down syndrome require special care and treatment. Other causes In more rare cases, slow closure of the fontanel or its large size can be caused by some other congenital skeletal diseases. The diagnosis of these diseases can only be made after a detailed examination of the child in specialized pediatric centers. The fontanel is too small or the fontanel closes too quickly. Early closure of the fontanel is said only when the large fontanel closes before three months, but even in this case it is not at all necessary that the child is sick. When assessing the condition of the fontanel, it is important to take into account not only its size relative to the child’s age, but also the overall circumference of the child’s head. If a fontanel is found to be too small or closes before 3 months, but with a normal head circumference, the child should be considered healthy.
Most often, the following diseases are the cause of early closure of the fontanel: Early closure of the fontanel Cause Other signs of illness What should be done? Craniosynostosis is a rare disease of the skeletal system, which is characterized by early closure of the cranial sutures, small skull circumference, increased intracranial pressure, hearing impairment, strabismus and impaired growth of other parts of the skeleton. Craniosynostosis can be congenital or occur against the background of rickets, increased function of the thyroid or parathyroid glands. Diagnosis of craniosynostosis is carried out in specialized pediatric clinics. Treatment of craniosynostosis is predominantly surgical. Anomalies of brain development Very rarely, the cause of too early development of the spring is an abnormality of brain development. Diagnosis of this disease is carried out by specialists in the field of neuropediatricians. Treatment depends on the type and severity of the abnormality. What does a protruding (swollen) or sunken fontanelle mean? The fontanel of a healthy child should be only slightly higher or lower than the level of the surrounding skull bones and pulsate noticeably.
A change in the appearance of the fontanel (sunken or, on the contrary, protruding) fontanel may indicate a number of diseases. What does a sunken fontanel mean? Most often, retraction of the fontanel is observed due to dehydration of the child against the background of fever, diarrhea, and repeated vomiting. If a sunken fontanel is discovered, the child should drink plenty of fluids and contact a doctor to treat the illness that caused the dehydration. What does a protruding fontanel mean? Most often, a protruding fontanel is observed against the background of diseases that are accompanied by increased intracranial pressure: meningitis, encephalitis, tumors, intracranial bleeding, increased intracranial pressure for another reason.
If a bulging fontanelle is combined with one or more of the following symptoms, you should call a doctor as soon as possible: High fever Bulging of the fontanelle occurred after a head injury or a child’s fall. Vomit Your child is sleepy or overly irritable Strabismus Convulsions or epileptic seizures Loss of consciousness Bulging fontanel for a long time without other symptoms Proper care of the fontanel The child's fontanelle does not require any special care or protection. The fontanel area can be safely washed while bathing the child, and then blotted (do not rub) with a towel. Copied from here

All parents have noticed a non-ossified pulsating area on the head of their newborn baby - the fontanel. Many even try not to touch this place for fear of harming the child. But the doctor must feel the fontanel during a routine examination. After all, it serves as one of the indicators of the child’s health and development.

With age, the fontanel becomes ossified. When the fontanel overgrows in newborns depends on many factors - these are the individual characteristics of the baby, and disorders of the development and health of the baby. Therefore, the condition of the fontanel requires special attention.

The fontanel is a soft, non-ossified area of ​​the skull, consisting of a dense membrane, connecting certain bones of the baby’s skull. These areas allow the skull to transform to facilitate the birth process. In addition, thanks to the fontanelles, the cranial vault adapts to the rapidly growing brain of a newborn.

After birth, the baby has six fontanelles:

• • Fontana connecting the two parietal bones and the occipital bone of the skull

Called posterior or occipital. It is very small, only 0.6 mm;

• • The anterior one, which connects the 2 frontal and 2 parietal bones

At birth, its size is about 30 mm;

• There are two types of lateral fontanelles: wedge-shaped and mastoid

The wedge-shaped ones are located closer to the temples, the mastoid ones - to the back of the head;

The largest fontanel, the anterior one, is considered the main one. It stays open the longest. Another fontanel that can be felt is the posterior one, although it is much smaller than the large one. However, it heals 1-2 months after birth. The remaining fontanelles have very small cracks, are almost invisible and within a few months they overgrow and ossify, forming cranial sutures.

Since at the time of birth the baby’s head is quite large, its passage through the birth canal can be difficult. Thanks to the fontanelles, the baby's head is deformed, which not only facilitates passage, but also protects the contents of the skull.

In addition, fontanelles have other functions:

1. 1. The fontanel plays a significant role in the thermoregulation of the baby

Newborns are quite poor at maintaining the required body temperature due to the immaturity of thermoregulation mechanisms. The fontanelle helps heat transfer during overheating, protecting the child’s brain and the body as a whole.

1. 1. The elasticity of the fontanelle tissue helps protect the child from injury from falls.

It is a kind of shock absorber between the bones of the skull. It is in infancy and early age that a child has the worst control of his body, so nature protected the little person’s head from frequent falls and blows in this way.

1. 1. Some diseases in a child are determined by the condition of the fontanelle.

So if the fontanel is swollen, this may be a sign of intracranial pressure.

1. An ultrasound examination of the brain can be done through an open fontanelle.(neurosonography)

Once the soft area has healed, this will no longer be possible, because the skull serves as an acoustic barrier.

Where is

There is a large fontanel in the upper part of the head, almost on the top of the head. It connects the two frontal and two parietal parts of the skull. The site has a diamond shape. The size of the fontanel may vary. As the head grows, it decreases. So from the initial dimensions of about 3*3 cm, it gradually decreases to 5 mm and becomes overgrown.

When it overgrows

The large fontanel should be overgrown closer to 12-18 months. However, this depends on how much calcium is in the baby’s body. If there is enough of it, then the fontanel can last up to a year. Small deviations in the timing of overgrowth from the norm are not critical. In the absence of other signs of pathology, they cannot indicate disorders in the body.

The timing of fontanel overgrowth can be influenced by the following factors:

• • Prematurity of the child

Such children usually lag behind their peers in development. Therefore, the fontanel may heal more slowly. Usually by 3 years the lag goes away.

• • If a child grows quickly with adequate nutrition, then the fontanelle may close faster

If the diet is rich in carbohydrates or proteins, growth may slow down.

• Method of feeding a baby

In breastfed children, the fontanelle heals faster, since breast milk is most fully absorbed by the body.

However A deviation from the norm can also be caused by hereditary diseases or a lack of calcium and vitamin D3.

Norms and deviations. When to worry

In how many months the fontanel will heal depends on the individual characteristics of the body and related factors.

If it overgrows before 3 months, then this is not normal. If the child is older, then it is necessary to regularly show the baby to a pediatrician who will monitor his condition. In a newborn, the fontanel seems to be pulsating. In some countries it is called a fountain. If such pulsation does not go away with age, then you should consult a doctor.

Often, a deviation from the normal state of the fontanel can be evidence of disease. In this case, it is necessary to pay attention to other accompanying symptoms.

• • A bulging fontanel indicates a possible increase in intracranial pressure

What may be a sign of diseases such as hydrocephalus (water on the brain), meningitis, encephalitis. If the swelling of the fontanelle is accompanied by convulsions and high fever, then the child requires urgent medical attention;

• • A sunken fontanel may be a sign of malnutrition and dehydration.

If a sunken fontanel is accompanied by fever, diarrhea, and vomiting, which indicates the presence of infection and dehydration, then it is necessary to urgently call an ambulance and hospitalize the child;

• • The size of the fontanel exceeding the norm may be one of the signs of Down syndrome;
  • A fontanel that does not heal for a long time may indicate rickets

Rickets occurs due to a lack of calcium and vitamin D in the body. However, to diagnose this disease, it is imperative to look not only at the fontanel, but at other characteristic symptoms;

• A slowly growing fontanel may be a sign of an endocrine system disorder;
• If the fontanel on the contrary is overgrown too quickly, it may indicate the development of the disease microcephaly or craniosynostosis (craniostenosis).

Therefore, in case of any deviations from the norm, it is better to consult a doctor. It will help determine if there are other signs of the disease or if this condition is normal for this child.

Care for fontanelles

Often parents are afraid to even touch the fontanel site. But there is no need to worry. Connective tissue is strong enough to withstand touch and various hygiene procedures. Of course, some caution must be observed, but the child can safely wash his hair, comb his hair, and perform other care procedures.

There is no special care for the fontanel. There is no need to constantly feel or measure it. If there are violations, they will immediately become noticeable.

In addition, during a regular examination, the doctor always feels the fontanel and notices deviations.

Myths about fontanelles

Often, out of ignorance, parents worry unnecessarily about fontanelles. There are such myths:

1. If the fontanel is quite large and does not heal well, then the child has rickets.

However, this is not necessary. In addition to the rate of overgrowth of the fontanel, rickets also has other signs: sleep disturbance, severe sweating, tearfulness, muscle sagging, and others. Therefore, the diagnosis must be made by a doctor. The duration of overgrowth of the fontanel depends on other factors.

1. Do not touch the fontanel, you can damage the brain

This is wrong. The brain is protected by a strong membrane of connective tissue. She is able to withstand both touch and baby care activities.

1. If the fontanel overgrows quickly, then you should not take calcium and vitamin D3 even with rickets

Parents should know that rickets is a very serious disease. You cannot self-medicate. If the doctor has prescribed a drug, then it is necessary to take it. For all other questions, it is better to seek additional advice;

1. In all children of the same age, the size of the fontanel should be the same

This is wrong. There are certain standards, but each child has his own characteristics of growth and development. Therefore, the size of the fontanel and the rate of overgrowth may differ in children of the same age.

1. If the fontanel closes prematurely, the brain will stop enlarging and the child will be mentally retarded

This is wrong. Brain development is not associated with the timing of fontanel closure. The skull is not a monolithic structure. The bones of the skull are connected by elastic sutures that lengthen as they grow. The skull grows until the age of 20.

Thus, deviations from the norm in the size of the fontanel can be both an individual feature and a symptom of the disease. Therefore, you should be careful about this area.

If the child is healthy and cheerful, nothing bothers him, then, most likely, deviations from the norm are his individual feature. If in doubt, be sure to consult your doctor so as not to waste time.

New parents know that newborn babies have a special place on their heads that requires careful care - this is the fontanel. What is it? What is its function? What size is considered normal - large or small? When does the fontanel overgrow? Is there a danger of injuring him and disrupting his brain function? How to properly care for it?

The fontanel is soft fibrous membrane tissue that connects two or more bones of the skull. Based on its location in the crown area, it is also called the crown.

Newborn babies have 6 fontanelles:

When examining a newborn by pediatricians, a neonatologist, pediatrician and neurologist feel the size of the crown and monitor the rate of overgrowth of the anterior (large) fontanel throughout the year. It is the most visible, and it is by the large crown that pediatricians assess the normal development of the child. The last 5 close almost immediately or are invisible due to their small size.

The large crown should be diamond-shaped, and its normal size is from 0.5 to 4 cm. It is located in the middle of the crown (on the crown). Normally, the fontanel overgrows when the baby is one to one and a half years old. The skin on the soft part of the head pulsates to the rhythm of the baby’s heart. It's quite normal.

Function of the large fontanel:

• Facilitating the passage of the baby through the mother's birth canal. With the help of fontanelles, the skull is elastic and tends to shrink. In the first weeks after birth, the baby's head has a slightly elongated shape.
• A child's brain grows and develops very rapidly. The fontanelles provide normal spatial conditions for this (so that there is room to grow)
• The crown is a kind of thermostat on the baby's head. When the body temperature rises above 38 C, the cooling mode “turns on” on the surface of the fontanelle, thereby cooling the brain tissue.
• The crown is a kind of shock absorber that protects the baby’s brain from injury during falls and impacts.

It is advisable for all children under one year of age to undergo neurosonography - ultrasound of the brain. The procedure is painless and safe, but very informative, so it is recommended for all children, even in the absence of complaints and neurological symptoms.

What should you be wary of?

Up to a year, parents should come to the pediatrician for a routine examination once a month. The process of overgrowth of the fontanel is controlled by a pediatrician. As parents spend more time with their baby, there are certain signs that should alert them. With such symptoms, it is advisable to contact a pediatric neurologist as soon as possible:

1. Slow overgrowth of the crown (poor overgrowth in children born with low body weight)
2. Soft fabric size more than 4 cm
3. Closing too early (between 1 and 8 months of age)
4. Sunkenness

Sometimes, the skin in the soft part of the head sinks (due to hot weather or elevated temperature, exicosis of the body occurs). The child needs to be given boiled water to drink and the crown of his head to recover. If it is tense and sticks out, the baby should be shown to a doctor. Only a neurologist can diagnose whether this is normal or a symptom of pathology.

Periods of crown overgrowth

By systematically measuring the crown, you can determine an increase in its size and delayed tightening, which is a sign of rickets or hydrocephalus of the brain. In the latter case, the crown remains wide open for two years and closes very slowly.

Tension and bulging of the anterior fontanelle is observed when the baby screams loudly. Or with increased intracranial pressure, with diseases such as meningitis, meningoencephalitis and others.

If the crown overgrows too quickly and early, this may indicate a calcium oversaturation in the child’s body. In this case, it is necessary to reduce the amount of calcium and vitamin D.

How to care for a fontanel?

The presence of a fontanel becomes a cause of fear in some parents, who are afraid of injuring the child’s head through it. Normally, the crown can pulsate, be sunken when thirsty, and even swell when the baby is crying. If the baby’s general condition is not disturbed and he behaves as usual, then there is no reason to worry.

There are no special rules for caring for the crown. By repeating normal daily routines, such as bathing your baby, brushing your baby's hair, or stroking the head, the risk of injury is reduced. Of course, you need to make sure that the baby doesn’t fall and hit his head. But this rule applies to children of any age and is not related specifically to the presence of a fontanel.

In order not to miss neurological problems, you need to monitor the baby’s development and see a pediatric neurologist. For children under one year of age, the schedule of visits to this doctor is as follows: 1, 3, 6, 9 and 12 months. These are periods of active development of new skills in children. Consulting a doctor will help you identify problems, if any. And if everything is in order, this will give you confidence that the baby is developing normally and his state of health is Healthy!!!

In this article:

The fontanel in newborns is a section of connective tissue located at the junction of three or more skull bones. These non-ossified fragments facilitate the process of childbirth, as they make possible deformation of the skull, slight displacement of the edges of the cranial bones towards each other as the fetal head passes through the birth canal.

After the baby is born, the connective membranous tissue gradually hardens, the size of the pulsating interosseous space decreases, and the fontanel closes.

Location of fontanelles

Parents should be able to find the fontanelles of the newborn's skull in order to monitor their condition. To do this, you need to know how many fontanelles a newborn has and what their location is.

There are six connecting membranes:

• unpaired (two) - located along the midline of the cranial vault, called anterior and posterior;
• paired (four) - two on each side, called wedge-shaped and mastoid.

Usually, parents can independently find and measure only unpaired fontanels; paired ones are more difficult to detect, they are smaller in size or almost closed at the time of birth.

Where is the fontanel located in a newborn, which is the main one and whose condition is monitored by a pediatrician? It is located in the midline between the frontal and parietal bones and is called the greater anterior.

The small fontanel in children is called posterior. This is a fontanel located in the midline between the parietal and occipital bones.

It is useful for parents to be familiar with paired sphenoid and mastoid springs. They are located on the lateral surfaces of the skull, two on each side. The sphenoid membranes are located at the junction of the temporal, frontal and parietal bones, where they connect to the intracranial sphenoid bone. They can be felt in the area of ​​the baby's temples. The mastoid “windows” are located at the junction of the process of the same name of the temporal bone with the parietal and occipital bones (or behind the ears of the toddler).

There are also intermittent fontanelles, which are not found in all babies. These include nasofrontal, parietal and cerebellar. The fontanel may be in the suture area between the frontal bones.

Dimensions and shape

What should the anterior fontanelle be like in a newborn? The shape of the fontanelle in a newborn is diamond-shaped. At birth, the dimensions range from 2.5 to 3 cm. Sometimes, in the absence of pathology, the interosseous membrane can be small - 0.5 cm. The value is calculated by dividing the sum of the longitudinal and transverse diameters of the rhombus by two.

During the first month of life, the size of the fontanel in newborns may increase slightly, which is associated with a change in the shape of the skull after childbirth and active growth of the brain. The process of inevitable reduction in size begins at four months of age. The pulsation noticeably decreases from 8 months, the fontanel becomes round in shape.

Normally, the posterior fontanel has a triangular shape. It is significantly smaller in size than the front one and, as a rule, does not exceed 7 mm. The wedge-shaped and mastoid fontanels are small in size, the norm is 0.6-1 cm, and also resembles a triangle in shape.

When it overgrows

When does the fontanelle close up in newborns? Connective tissue is converted into bone tissue starting from the periphery over a period of time. The diameter of the “window” gradually decreases. There are no exact and identical periods of ossification for all children; let’s say a certain time range when the fontanel overgrows. In this case, this most often refers to the anterior fontanel.

The fontanelle finally closes by the end of the first year. These norms can change even with normal infant development. The softness of the connective tissue membranes in this area can remain in a healthy child even at 2 years old.

The posterior fontanel usually closes within the first two months of life.

When does a sphenoid fontanel heal? Basically, these fontanelles close at 2-3 months of life. But if a child has already been born with closed wedge-shaped fontanelles, ossification of these membranes occurs in the first six months of the baby’s life.

How long does it take for the fontanel in infants, called the mastoid, to close? The timing of its ossification approximately coincides with the closure of the sphenoid fontanel. That is, at 2-3 months of life.

Thus, when a baby’s fontanelle should close up is difficult to answer with certainty. In many ways, the healing period depends on genetic characteristics, the mother’s diet during pregnancy and the nature of feeding. The gender of the baby also influences - according to medical statistics, in boys the connecting membrane closes much faster.

But even with early closure, brain growth is ensured by the presence of sutures between the bones of the skull, which do not heal until 15-19 years of age.

Developmental disorders

Parents are usually concerned about changes in the size of the connecting membrane. Pathological abnormalities can be suspected when examining and measuring the fontanelles. To identify pathology, the obtained dimensions are correlated with the normal value corresponding to the age of the baby.

The fontanelle enlarges in a newborn under the following pathological circumstances:

• decreased thyroid function;
• (accumulation of an excess amount of cerebrospinal fluid in the brain), while the fontanel in the infant is enlarged, tense, and closes later;
• genetic pathology (Down syndrome, chondrodysplasia, Apert syndrome, cleidocranial dysplasia, glass man syndrome).

Most often it is observed on the baby’s head during premature birth. The fontanelles close more slowly.

There are also provoking factors that contribute to the formation of a large fontanel:

• hereditary predisposition;
• disturbances in the diet and daily routine of the expectant mother (lack of dairy products and unbalanced nutrition, overwork);
• bad ecology;
• mother and baby stress.

It is believed that the fontanel may be smaller than normal if a pregnant woman eats too many foods containing calcium. At the same time, the “windows” close faster.

Microcephaly is characterized by premature closure of all membranous joints during the first months of life. In this case, the baby's anterior fontanel may be small, and the other five may be closed at birth.

Which doctor should I contact if I suspect abnormalities?

Until six months, parents should especially carefully monitor the size of the interosseous membranes. If by eight months the connecting membrane has changed little in size since birth, a consultation with a pediatrician is necessary.

If the size is normal, but the fontanel bulges or, conversely, is below the level of the skull bones, you should urgently contact a supervising pediatric doctor. He will prescribe all the necessary tests and examinations. If necessary, the baby will be consulted by a pediatric neurologist.

Examinations for suspected abnormalities

The pediatrician should monitor the following points during the examination:

• Consistency of the connective tissue plate and edges of the cranial bones, their structure and density.
• The size of the fontanel and the dynamics of changes.
• Contours of interosseous membranes.
• Skull circumference.

The data obtained should be correlated with the baby’s age and the characteristics of its development.

If the fontanel does not heal by 2 years, the following examinations are necessary:

• examination by a pediatrician to exclude rickets (with this disease, pliability of the edges of the skull bones, flattening of the back of the head, sweating, and curvature of the lower extremities are revealed);
• genetic consultation;
• blood test for the content of thyroid hormones to identify its hypofunction.

If a closed fontanel is detected in a newborn or the membranes begin to close during the first months of life, pediatricians talk about early closure of the fontanel. This may be due to congenital craniostenosis, abnormal development of the skull or brain, genetic diseases, or intrauterine infections.

If the “windows” are practically closed, but the size of the skull and psycho-physical development correspond to the age norm, parents have nothing to worry about.

Instrumental methods include ultrasound and magnetic resonance imaging of the brain.

Protruding fontanel

The pulsation of the fontanel in a baby often worries parents. But in a newborn, the fontanel pulsates when crying, tension, or anxiety. You also need to remember that the fontanel pulsates when pressed; this is normal and should not cause alarm.

A bulging fontanel in a baby is always an alarming symptom. In the presence of a convex, pulsating fontanel, experts talk about increased intracranial pressure.

Intracranial hypertension can be caused by the following pathological circumstances:

• infectious process (encephalitis, meningitis);
• brain tumor;
• birth trauma of the skull, complicated by cerebral edema or intracerebral bleeding;
• hydrocephalus.

Why does a child's fontanelle pulsate? The rhythmic vibrations of the membrane correspond to heart contractions, causing movements of the cerebrospinal fluid.

But if the baby’s fontanelle is pulsating, and this is accompanied by a disturbance in the general condition, the appearance of a convulsive syndrome, or loss of consciousness, it is necessary to urgently call an ambulance.

Sunken fontanel

Due to dehydration caused by intestinal infection, neurotoxicosis, or drinking disorders, retraction of the dense plate covering the space between the bones of the baby’s skull may occur. This condition requires plenty of fluids, balanced infusion therapy and other symptomatic treatment measures.

In the absence of dehydration and disturbances in the general condition, retraction of the interosseous membrane may occur in a post-term baby.

How to care for a fontanel

The membranes between the bones do not require special care; their dense tissue reliably protects the baby’s brain and is difficult to damage.

But there are simple rules that must be followed:

• You can’t put too much pressure on the connecting membrane, you need to touch it gently and carefully;
• it is necessary to contact a pediatrician if the fontanel sinks or bulges;
• avoid skin damage in the area of ​​open sutures and fontanelles;
• children need to be turned over regularly so that they do not sleep on one side, as this can aggravate the deformation of the skull;
• Apply baby cream to newborns on flaky skin in the area of ​​the membrane between the bones, then carefully comb out the exfoliated crusts.

You need to pay maximum attention to the child: pick him up more often, put on a hat, try to avoid his excessive crying and anxiety. A nutritious diet enriched with calcium and vitamins is important for a young nursing mother. If necessary, the pediatrician prescribes vitamin D for the baby in an age-appropriate dosage.

The fontanelles protect the developing brain from excessive pressure, providing the opportunity for growth, protect against overheating, and play the role of a shock absorber in case of injury. The dynamics of overgrowth of membranes between bones before the age of one is an important indicator of the baby’s health status. If there are deviations in the rate of their closure, an urgent consultation with the treating pediatrician is necessary, as this may be a signal of serious problems with the child’s health.

Useful video about fontanel in a newborn