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Fontanelles - excessively large
Alternative namesSoft spot - large
The skull of the newborn is made up of boney plates (7 in the skull itself and 14 in the facial area). They join together to form a solid, bony cavity protecting the brain and supporting the structures of the head. The areas where the bones join together are called sutures.
The bones are not joined together firmly at birth (this allows the head to pass through the birth canal). The sutures gradually accumulate minerals and harden by a process called "ossification", firmly joining the skull bones together.
In an infant, the spaces where sutures come together, but are not completely joined is called the "soft spot". It is covered by a membrane, and the medical term for such spaces is "fontanelle" (fontanel or fonticulus). The fontanelles allow for growth of the skull during an infant's first year.
There are typically two fontanelles that are normally evident on a newborn's skull, primarily at the top in the midline just forward of center, and in the back in the midline. Like the sutures, fontanelles gradually ossify and become closed, solid bony areas. The posterior fontanelle (in the back of the head) usually closes by the time an infant is 1 or 2 months old. The anterior fontanelle at the top of the head usually closes sometime between 9 months and 2 years old.
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.
Delayed closure (larger-than-normal fontanelles ) is caused by:
More common causes:
Call your health care provider if
The medical history will be obtained and a physical examination performed.
Medical history questions documenting the symptom in detail may include:
Note: This finding is usually discovered by the health care provider, and the parents may not have been aware of its presence.
The physical examination may include repeated assessment of the size of the fontanelles and the head circumference over several months. This can help determine abnormalities of the fontanelle and head growth. Transillumination of the skull using a bright light may be done to help determine the presence of hydrocephalus, "water on the brain", a relatively common cause of an enlarged fontanelle. Transillumination can also help discern separated sutures.
Diagnostic tests that may be performed are:
AFTER SEEING YOUR HEALTH CARE PROVIDER
Update Date: 5/20/2002Elizabeth Hait, M.D., Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT