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Fontanelles - enlarged

Soft spot - large; Newborn care - enlarged fontanelle; Neonatal care - enlarged fontanelle

 

Enlarged fontanelles are larger than expected soft spots for the age of a baby.

The skull of an infant or young child is made up of bony plates that allow for growth of the skull. The borders at which these plates intersect are called sutures or suture lines. The spaces where these connect, but are not completely joined, are called soft spots or fontanelles (fontanel or fonticulus).

Considerations

 

Fontanelles allow for growth of the skull during an infant's first year. Slow or incomplete closure of the skull bones is most often the cause of a wide fontanelle.

 

Causes

 

Larger than normal fontanelles are most commonly caused by:

  • Down syndrome
  • Hydrocephalus
  • Intrauterine growth retardation (IUGR)
  • Premature birth

Rarer causes:

  • Achondroplasia
  • Apert syndrome
  • Cleidocranial dysostosis
  • Congenital rubella
  • Neonatal hypothyroidism
  • Osteogenesis imperfecta
  • Rickets

 

When to Contact a Medical Professional

 

If you think that the fontanelles on your baby's head are larger than they should be, talk to your health care provider. Most of the time, this sign will have been seen during the baby's first medical exam.

 

What to Expect at Your Office Visit

 

An enlarged large fontanelle is almost always found by the health care provider during a physical exam.

  • The provider will examine the child and measure the child's head around the largest area.
  • The doctor may also turn off the lights and shine a bright light over the child's head.
  • Your baby's soft spot will be regularly checked at each well-child visit.

Blood tests and imaging tests of the head may be done.

 

 

References

Haddad J, Keesecker S. Congenital malformations. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 638.

Robinson S, Cohen AR. Disorders of the head shape and size. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 64.

 
  • Skull of a newborn

    Skull of a newborn - illustration

    The "sutures" or anatomical lines where the bony plates of the skull join together can be easily felt in the newborn infant. The diamond shaped space on the top of the skull and the smaller space further to the back are often referred to as the "soft spot" in young infants.

    Skull of a newborn

    illustration

  • Fontanelles

    Fontanelles - illustration

    Fontanelles are the "soft spots" on an infant's head where the bony plates that make up the skull have not yet come together. It is normal for infants to have these "soft spots", which can be seen and felt on the top and back of the head. Fontanelles that are abnormally large may indicate a medical condition.

    Fontanelles

    illustration

  • Large fontanelles (lateral view)

    Large fontanelles (lateral view) - illustration

    A wide fontanelle occurs when the fontanelle is larger in size than expected for the age of the baby. Slow or incomplete ossification of the skull bones is most often the cause of a wide fontanelle.

    Large fontanelles (lateral view)

    illustration

  • Large fontanelles

    Large fontanelles - illustration

    The bones of the skull are not joined together firmly at birth. The sutures gradually accumulate minerals and harden (this process is called ossification), firmly joining the skull bones together. In an infant, the spaces where sutures intersect but don't completely touch is called the "soft spot", a membrane covered area also called a fontanelle (fontanel or fonticulus). The fontanelles allow for growth of the skull during an infant's first year. When the spaces of the fontanelles are larger than normal underlying causes such as hydrocephalus may be suspected.

    Large fontanelles

    illustration

    • Skull of a newborn

      Skull of a newborn - illustration

      The "sutures" or anatomical lines where the bony plates of the skull join together can be easily felt in the newborn infant. The diamond shaped space on the top of the skull and the smaller space further to the back are often referred to as the "soft spot" in young infants.

      Skull of a newborn

      illustration

    • Fontanelles

      Fontanelles - illustration

      Fontanelles are the "soft spots" on an infant's head where the bony plates that make up the skull have not yet come together. It is normal for infants to have these "soft spots", which can be seen and felt on the top and back of the head. Fontanelles that are abnormally large may indicate a medical condition.

      Fontanelles

      illustration

    • Large fontanelles (lateral view)

      Large fontanelles (lateral view) - illustration

      A wide fontanelle occurs when the fontanelle is larger in size than expected for the age of the baby. Slow or incomplete ossification of the skull bones is most often the cause of a wide fontanelle.

      Large fontanelles (lateral view)

      illustration

    • Large fontanelles

      Large fontanelles - illustration

      The bones of the skull are not joined together firmly at birth. The sutures gradually accumulate minerals and harden (this process is called ossification), firmly joining the skull bones together. In an infant, the spaces where sutures intersect but don't completely touch is called the "soft spot", a membrane covered area also called a fontanelle (fontanel or fonticulus). The fontanelles allow for growth of the skull during an infant's first year. When the spaces of the fontanelles are larger than normal underlying causes such as hydrocephalus may be suspected.

      Large fontanelles

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Fontanelles - enlarged

           

             

            Review Date: 11/19/2015

            Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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