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    Fontanelles - sunken

    Sunken fontanelles; Soft spot - sunken

    Sunken fontanelles are an obvious curving in of the "soft spot" in an infant's head.

    Considerations

    The skull is made up of many bones. There are seven bones in the skull itself and 14 bones in the face area. They join together to form a solid, bony cavity that protects and supports the brain. The areas where the bones join together are called the sutures.

    The bones are not joined together firmly at birth. This allows the head to change shape to help it pass through the birth canal. The sutures gradually gain minerals and harden, firmly joining the skull bones together. This process is called ossification.

    In an infant, the space where two sutures join forms a membrane-covered "soft spot" called a fontanelle (fontanel). The fontanelles allow the brain and skull to grow during an infant's first year.

    There are normally several fontanelles on a newborn's skull, mainly at the top, back, and sides of the head. Like the sutures, fontanelles harden over time and become closed, solid, bony areas.

    • The fontanelle in the back of the head (posterior fontanelle) usually closes by the time an infant is 1 or 2 months old.
    • The fontanelle at the top of the head (anterior fontanelle) usually closes within 7 - 19 months.

    The fontanelles should feel firm and should curve inward slightly to the touch. A noticeably sunken fontanelle is a sign that the infant does not have enough fluid in his or her body.

    Causes

    • Dehydration (not enough fluid in the body)
    • Malnutrition

    When to Contact a Medical Professional

    A sunken fontanelle can be a medical emergency. A health care provider should check it right away.

    What to Expect at Your Office Visit

    The health care provider will perform a physical examination and ask questions about the child's symptoms and medical history, such as:

    • When did you first notice that the fontanelle looked sunken?
    • How severe is it? How would you describe it?
    • Which "soft spots" are affected?
    • What other symptoms are present?
    • Has the baby been ill, especially with vomiting, diarrhea, or excessive sweating?
    • Is the skin turgor poor?
    • Is the baby thirsty?
    • Is the baby alert?
    • Are the baby's eyes dry?
    • Is the baby's mouth moist?

    Tests may include:

    • Blood chemistries
    • CBC
    • Urinalysis
    • Tests to check the baby's nutritional status

    You might be referred to a place that can provide intravenous (IV) fluids if the sunken fontanelle is caused by dehydration.

    References

    Carlo W. Physical Examination of the Infant. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 88.2.

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    • Skull of a newborn

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    • Sunken fontanelles (supe...

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      • Skull of a newborn

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      • Sunken fontanelles (supe...

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      Self Care

        Review Date: 2/21/2013

        Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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