The fontanel in a newborn: when it closes, what it should be like, why it pulsates, does not close. Why does a child’s fontanel not heal? What to look for when a child's fontanel closes

14.10.202327.05.2017

Young parents ask the doctor many questions about their babies. Especially often questions arise about why children need fontanelles on their heads, what size they should be and when they should close. Motherhood asked pediatrician Alena Paretskaya to answer the most frequently asked questions about fontanelles.

What are fontanelles?

Fontana are special connective tissue membranes in the head area, which are formed at the joints of the skull bones. Unlike the head of an adult, which is a single bone in the area of the brain part of the skull, in newborns the bones are separated from each other, they are connected to each other by movable sutures, at the junctions of which fontanelles are formed.

In the area of these fontanelles, the child’s brain is covered only by the meninges themselves, as well as membranes of connective tissue and skin on top. Usually, at the time of birth, a child has two fontanelles - an anterior or large fontanel in the crown area, shaped like a diamond, and a posterior or small fontanel, triangular in shape, on the back of the head, which closes in the first month, and sometimes even in the womb.

In premature babies, these fontanelles may be large at birth, and there may also be lateral fontanelles in the temple area. They, along with the small fontanel, should close quickly after birth, but the large fontanel will close much later, at certain ages. The area of the anterior fontanel is formed by the joints of the parietal and frontal bones, the posterior area is formed by the bones of the parietal and occipital bones.

What functions do fontanelles perform in children?

The initial and main function of the fontanelles is their assistance in the process of giving birth to the baby. When the baby is ready to be born and labor begins, in the process of dilation of the cervix, the head is configured - the baby passes through the birth canal of the mother with the head forward. At the same time, the bones of the skull, due to the sutures and fontanelles, slightly overlap each other, which gives the head somewhat smaller dimensions and volumes, allowing it to pass smoothly and without injury through the birth canal. When a child is born, his head may not be completely straight, slightly elongated forward and upward, and egg-shaped. If there were no fontanelles and sutures, then there would be a higher likelihood of injury to both the fetal head and the mother’s birth canal.

After the birth of a child, the area of the fontanelles allows the child’s head to grow in volume, while the sutures gradually grow together. The fontanel also functions as a natural shock absorber, because children can sometimes hit their heads, and due to the fontanel, the impacts are softened, and the fluid inside the head can move more freely. In addition, due to the active work of the brain and increased metabolism in it, the brain can become quite hot. And since thermoregulation in infants is imperfect, the fontanelle acts as a kind of “window” for the outflow of excess heat.

Thanks to the presence of the fontanelle, modern doctors have the opportunity to examine the child’s brain using ultrasound through it, since ultrasound rays do not penetrate bone tissue, but they penetrate quite easily through the connective tissue membrane. This study of the brain through the fontanel is called neurosonography (NSG or ultrasound of the brain).

What determines the size of the fontanelle at birth?

First of all, the size of the fontanel depends on the level of calcium and phosphorus metabolism in the baby’s body. And this level is largely determined by how the pregnant woman ate while carrying the baby. If she took multivitamins in large quantities, and her diet included a lot of dairy products and calcium-containing substances, the baby’s fontanelles will be small at birth, the bones will be quite dense, the sutures and fontanelles will quickly close. Therefore, you should strictly follow your doctor’s recommendations when taking multivitamin and mineral complexes, and do not overuse products with calcium, as this affects both the fetus and the aging of the placenta. Immediately after birth, it is difficult to judge the size of the fontanelle, since the bones of the skull have not yet taken their correct places, but after a couple of weeks everything will be more clear.

With excess calcium and early ossification of the skull bones before birth, the bones and sutures become stubborn, and then it will be more difficult for the head to pass through the birth canal. This can lead to the formation of cephalohematomas (hemorrhages under the periosteum), intracerebral hemorrhages and injuries.

Naturally, the size of the fontanel also depends on the due date. If the child is full-term, the size of his fontanel will be smaller than that of premature and immature children. With prematurity, the bones of the skull have not yet completely ossified, and there may be large gaps between them in the area of the sutures, and accordingly, the size of the fontanelles will also be larger. The dynamics of fontanelle closure in such children will be different.

What size should a fontanel be? If it is more or less than the norm, what does it mean and what to do?

The size of the fontanel in children depends on age and metabolic characteristics, the presence or absence of any neurological or metabolic diseases (rickets, hydrocephalus, malnutrition, etc.). If we talk about healthy and normally developing babies, the size of their fontanel has a certain dynamics of closure according to age periods.

On average, at birth the length of the fontanel is approximately 250-320 mm, and due to the alignment of the head after birth, it may increase slightly in the first weeks of life. In healthy full-term children during this period, the size of the fontanelles may increase and then gradually decrease, so it is important to determine their absolute sizes - the length of the fontanel should not exceed 3.2 cm.

The size of the fontanel may be larger than normal due to prematurity, or as a result of problems with ossification of the skull, or be the result of congenital or acquired hydrocephalus.

If at birth there is complete closure of the lateral and posterior fontanel, while the large fontanel is very small in size, microcephaly is suspected. Such conditions require a thorough examination by a neurologist and additional research.

With a rapid and progressive increase in the size of the fontanels with divergence of the sutures of the skull, you should immediately contact a neurologist; this is a sign of increased intracranial pressure and accumulation of fluid in the head. With damage to the nervous system, fontanelles and sutures can close pathologically quickly - this also requires consultation with a doctor.

In children with organic brain lesions, the size of the fontanel decreases against the background of a very small increase in head circumference (or lack thereof), which does not provide room for brain growth. With hydrocephalus the picture will be the opposite.

At what age should a large fontanelle normally close?

In the period from one to three months, the lateral and small fontanelles should close, and the size of the large fontanel should not exceed 240-220 mm.

In the period from three to six months, the size of the large fontanelle decreases to 210-180 mm, while it is also important to look at the increase in head circumference.

In the period from six to nine months, the fontanel also decreases in size to 160-140 mm, and by the age of 9 to 12 months it reaches a size of 100-120 mm.

Typically, the large fontanel closes completely by the age of 12 to 18 months; for some children (premature, with rickets or developmental problems), closure by 20-22 months is acceptable. This largely depends on the individual pace of development.

If the fontanel closes too early, is it bad?

In rare cases, there are options for closing the large fontanel by the age of six months, then consultation with a pediatric neurologist is recommended to exclude craniostenosis and microcephaly. These pathologies interfere with the normal rate of brain growth and development, which will affect mental abilities.

Sometimes the fontanel closes within 7-10 months; with normal development of children, this is not a pathology. If monthly increases in head circumference are not affected, then nothing interferes with the development and growth of the brain and the child develops according to his age.

What to do if the child is one and a half years old, but the fontanel does not heal?

If the fontanel does not close well after a year, it is worth showing the child to a pediatrician and ruling out a violation of skeletal ossification. Usually, with proper treatment, everything goes away quickly.

What determines the time of fontanel closure?

You can often hear that early closure of the fontanel can negatively affect the child’s condition and development, but this is only partly true. If these are individual characteristics, and the size of the head increases according to age, then everything is normal. But if the rapid closure of the fontanel is accompanied by a slowdown in the growth of head circumference, then the closure of the fontanel will affect brain growth by limiting the amount of free space inside the skull.

If the fontanel closes late, will this indicate calcium deficiency?

This is also only partly true. Late closure of the fontanelles may be an individual feature, or it may also be a sign of a deficiency of vitamin D in the body, which helps the absorption of calcium by bone tissue. Vitamin D deficiency leads to the development of rickets, and then, in addition to the fontanelles, there will be a disruption in the formation of all bone tissue with disturbances in the structure of the ribs, bones, teeth, as well as the child’s anxiety, sweating, baldness of the back of the head and poor sleep.

Rickets is typical for children born in conditions of insufficient sun activity (children of northern latitudes, children born in autumn and winter), and to prevent this disease, children are prescribed vitamin D drops. Further prevention is carried out by introducing complementary foods enriched with vitamin D. Frequent exposure to the sun, massages and, in some cases, calcium supplements are also useful.

If the fontanelle is larger than normal, this may be a sign of impaired outflow of brain fluid from the area of the lateral ventricles of the brain (as a result of infections, hemorrhages, or other problems). In addition, a large fontanel size may be the result of metabolic disorders, hypofunction of the thyroid gland, or Down syndrome, or prematurity.

If you have any doubts about the size of the fontanel, you should undergo a full examination by a pediatrician and take blood tests, as well as urine tests for calcium and phosphorus levels. If more serious pathologies are suspected, consultation with a neurologist, orthopedist and other specialists is necessary. It is important to monitor the rate of increase in head circumference and the level of psychomotor development; if changes are detected, treatment will be prescribed.

In normally developing children, the head circumference is larger than the chest until four months, then they are compared, and by six months the chest circumference prevails over the head circumference.

What does a swollen (bulging) or sunken fontanel mean?

Normally, the fontanelle should correspond to the level of the skull bones. When the baby is in an upright position, he may bend slightly inward, and when screaming and crying, he may stick out slightly. When touching the fontanel, a slight pulsation may be felt, invisible to the eye, due to the passage of the cerebral artery next to it.

But if the fontanel protrudes or sinks, this may indicate possible pathologies.

If the fontanel bulges excessively, you need to be wary. If this happens at rest, and there is no visible pulsation in the area of the fontanelle, it remains unchanged when screaming, and is constantly tense, you need to contact a neurologist. This may be a sign of hydrocephalus or increased intracranial pressure.

Retraction of the fontanel usually occurs as a result of severe dehydration of the child due to diarrhea and vomiting. In case of such violations, it is necessary to immediately consult a doctor, and before his arrival, the child must be soldered in order to restore the water balance. If it is impossible to desolder, a drip infusion of liquid will be necessary. Without treatment, this condition is dangerous for the nervous system.

Is it dangerous to accidentally touch the fontanel?

The fontanelle, despite its tenderness and apparent fragility, is a fairly strong formation, and touching it will not damage any brain structures. Therefore, you can safely touch the fontanel, touch it, wash your child’s hair, comb his hair, without fear of consequences.

Is it possible to cut a child’s hair if the fontanel is not completely closed?

The fontanel and hair cutting are not interconnected in any way; cutting it cannot be damaged in any way, so you can carry out any procedures with the baby’s hair. The fontanelle itself does not require any special care.

Photo - photobank Lori

A newborn baby is a very fragile creature. You need to treat him reverently and tenderly. Knowing this, many new mothers and fathers in the first days after the birth of their beloved child are often afraid of harming the baby with their careless actions. And the greatest concern among parents, as a rule, is the fontanel (or crown). After all, it is this soft part of the baby’s head that is somehow very scary to touch. It seems like one awkward movement and that’s it – at the very least, the child is guaranteed a brain injury. In addition, people say that a crown that is too small, or vice versa, a large soft crown, indicates some kind of anomaly in the development of the baby. Is this true or not? What crown size is considered normal? And when does a newborn’s fontanel close up? Doctors have clear and precise answers to these questions.

A little about anatomy

The fontanelle is a soft, non-ossified area of the cranial vault in a newborn child, located at the place where the bones meet. It is a remnant of the membranous formation that covers the brain from above at the initial stage of the formation of the fetal skull.

After the cartilaginous stage, these formations are replaced by bone tissue. Initially, bony points appear, similar to islands, in certain places. Then, gradually merging, these islands create bone plates and become the basis of the bones of the cranial vault.

By the time a child is born, these areas are preserved in the form of spacious spaces - fontanelles, or thin stripes - sutures. Due to their elasticity, they can protrude or sink (pulsate) under the influence of intracranial pressure. This pulsation is similar to the beating of water in a spring. Hence the name - by analogy.

Often parents are concerned about this very pulsation of the crown of their little one. They try not to even touch such a vulnerable spot on the child’s head.

But in reality, the skin covering the fontanel is very strong, and it is quite capable of protecting the baby’s head from touch, and sometimes even from serious injury.

In total, a child may have six fontanelles open at birth. Some of them close soon after the baby is born.

But the baby has more than one fontanel!

Most of us have only heard about the existence of one fontanel in a newborn. Well, maximum - two. But in fact, a newly born baby has six of them.

First and second. Wedge-shaped paired fontanelles. They are located in the front of the skull, namely at the convergence of the parietal, frontal, squamosal and sphenoid bones, and are so small that they are practically invisible. Their closure occurs some time after the birth of the child, and sometimes towards the end of the intrauterine period.
Third or fourth. Mastoid paired fontanelles. They are located behind the wedge-shaped ones, behind the ears. At the junction of the parietal bone, occipital squama and mastoid process of the temporal bone. They, like the first ones, close some time after the birth of the child.
Fifth. Unpaired occipital (posterior) fontanel. It has a triangular shape and small dimensions (about 5 millimeters). It is located at the convergence of the two parietal and occipital bones. Ossifies during the first two months of the baby's life.
Sixth. Unpaired large frontal or anterior fontanel: has a diamond shape. At the time of birth, the baby's size is approximately two and a half to three and a half centimeters. It is located on the top of the head, at the convergence of the parietal and frontal bones. Closes when the child reaches two years of age. It is this fontanel, since it is the largest and overgrows later than others, is known as the soft crown - we will talk about it further.

If the size of the parietal fontanel at birth is larger than normal, this may be a symptom of congenital hydrocephalus (accumulation of cerebrospinal fluid in the ventricular system of the brain). Reason: disrupted intrauterine ossification process or prematurity.

This is what the fontanelle (or soft crown) looks like in a newborn

The small size of the anterior fontanel, with the others completely closed, can serve as a symptom of congenital microcephaly (reduction in the size of the brain and skull). Cause: intrauterine infection.

As you can see, it’s not for nothing that people pay so much attention to the size of the soft crown. For an experienced doctor, the size of the fontanelle can become very informative diagnostic material.

Functions

At the time of birth, the largest part of the baby's body is its head (circumference). Therefore, when the baby passes through the birth canal, the head bears the heaviest load. And as a result of physiological compression, it becomes deformed. But it is thanks to the fontanelles that the baby’s head has elasticity and firmness. Therefore, compression and deformation do not harm either the skull or its contents.
The fontanel is involved in the process of thermoregulation of the body. Since the thermoregulation mechanism of a newborn is still far from perfect, it tends to overheat more than the body of an adult. As temperatures rise, the fontanel promotes heat transfer, thereby regulating the temperature of the brain, meninges and the child’s entire body as a whole.
The crown is endowed with the property of pulsating, for example, when intracranial pressure increases. That is why it often serves as an indicator of possible diseases.
The fontanel also acts as a natural shock absorber and thereby protects the child’s brain from injury from impacts and falls.

When should the soft crown heal?

At birth, each baby’s fontanel size is individual and ranges from 60 mm to 3.6 cm (an average of two centimeters).

During the first months after the baby is born, his brain grows very quickly, so even the possibility of an increase in the size of the large fontanelle cannot be ruled out.

Closure of the anterior fontanelle also depends on the developmental characteristics of each individual child, and its timing is quite arbitrary.

In 1% of children, the large fontanel closes at three months.
For 40% - in one year.
At 2 years old, the large fontanel is closed in 95% of children.

In boys, the soft crown heals faster than in girls. But there is simply no exact norm that suits every child. And don't worry that a parietal fontanel that closes early will limit brain growth. In fact, the newborn's brain grows due to the sutures located between the bones of the skull. And the seams close only at the age of eighteen or twenty.

If the fontanel is large, this is considered to be a sign of rickets. However, this symptom is not directly related to this disease. Rickets is characterized by softening of the edges of the fontanelles. But the large size of the crown does not appear among the signs of rickets.

Too late closure of the soft crown in a child may indicate the development of diseases such as rickets, hydrocephalus, or a decrease in thyroid function.

Usually in such cases, doctors prescribe neurosonography, that is, ultrasound of the meninges. Such an examination allows us to identify dangerous diseases.

It is important to remember that an early closed fontanel does not indicate the absence of rickets, does not serve as a basis for canceling the prescribed diet for babies with low calcium levels, and is not a reason to stop prophylaxis with vitamin D.

Normal condition and possible deviations

In a full-term healthy baby, you can see the anterior fontanel by a slightly noticeable bulge on the skull. It’s easy to feel with your finger, since the crown, compared to other parts of the baby’s head, is really soft. That’s why it’s called the soft crown.

If the fontanelle protrudes strongly and tenses when the baby cries or screams, there is no need to be afraid. This is normal. But if it is too convex at rest, then this usually happens in diseases accompanied by increased intracranial pressure.

You should immediately consult a doctor if, in addition to this symptom, your child suddenly develops vomiting, fever, convulsions, drowsiness and other painful conditions.

The sinking of the fontanelle is a clear sign that the baby’s body is dehydrated. This can happen, for example, with vomiting, diarrhea, or high fever. After all, dehydration occurs quite quickly in newborns, and it is life-threatening.

If you notice a sinking fontanel in combination with symptoms such as a small amount of urine and dry mucous membranes, you should immediately call an ambulance.

In the first weeks of a baby’s life, the reason that the fontanel looks somewhat sunken may be that the baby was born later than the due date. If you do not notice any accompanying symptoms, the little one has normal sleep and appetite, he is gaining weight well and his bowel movements are regular, then there is no need to panic, after a certain time everything will return to normal.

To summarize, I would like to draw your attention to the fact that any disease is determined by a number of symptoms, and not just the size of the fontanel. There is no need to panic if your newborn baby has a larger or smaller crown than your neighbor's baby. Every person from his very birth is individual and unlike anyone else. But it’s also not worth losing your vigilance. If you have any doubts about the size or condition of your child’s soft crown, be sure to discuss them with your local pediatrician during your next scheduled visit to the children’s clinic.

Video “Everything about the fontanel in newborns” - Komarovsky

A tiny baby is the most amazing creature that brings real family happiness to a young couple. But the birth of a child is accompanied not only by joy and unforgettable emotions, but also by increased caution and additional worries. All loving parents have to learn a lot of intricacies of proper care for their baby, monitor his condition and provide comfortable conditions for full growth. In this case, the little treasure will grow healthy and strong, and its body will be able to effectively resist various diseases.

When does a child's fontanel overgrow?

When a baby appears in the family, many mothers and fathers wonder when the fontanel, a tender, pulsating area on the newborn’s head, heals. This is an object of increased concern for parents is an important indicator of child health, so you need to be aware of all the signals it can provide. Many young mothers treat the fontanel with special caution, protecting it like the apple of their eye. This is not strange, because such a formation on the baby’s head requires special treatment and care.

Any deviations in the condition of the fontanel can indicate a developmental pathology or the presence of a serious disease. When a child’s fontanel overgrows, what he can tell his parents about, what size tables mean and other important points will be discussed in the current article.

As mentioned above, the fontanel is a soft space between the bones of the skull, which contains the connecting part. During development, it ossifies. Few people know that in addition to the main fontanelle, there are about 5 smaller ones on the head, but in most cases they heal immediately after childbirth. If anyone thinks that such an object means nothing, he is deeply mistaken. In fact, the role and purpose of the fontanelle is very important. It is known that during childbirth, enormous pressure is applied to the baby's skull, but the presence of this pulsating formation allows the skull to compress, reducing the difficulty of labor.

After the baby is born, the remaining fontanelles serve as reliable shock absorbers to prevent brain damage in case of unexpected falls or impacts. However, they prevent the bony part of the skull from compressing the small, rapidly developing brain, and when exposed to high temperatures act as thermostats, promoting effective cooling of the organ.

Mothers who gave birth to their first child should know where the notorious large fontanel is located. In fact, it is very easy to notice, because... it measures 3 by 3 centimeters and is located in the center of the crown. As for the small posterior fontanel, it should be looked for in the back of the head. True, the small size complicates the process of searching for an element.

What does the fontanelle “say”?

As mentioned above, the poor condition of such a pulsating formation can serve as an unconditional indicator indicating the presence of certain health problems in the baby. Based on the appearance of such a pulsating formation, a lot can be understood:

If the fontanel looks sunken in the first days of the child's life, this may indicate that the pregnancy has been too long. If this condition is noticed in adulthood, you should think about consulting a doctor. In many cases, the problem indicates dehydration;
If the fontanel is swollen and pulsating, this is a sign of increased intracranial pressure. If this appearance is noticed only when the child is crying or naughty, it’s okay. If the situation does not change at rest, it is better to consult a pediatrician;
If the object does not heal for a long time and does not close, the development of rickets or hydrocephalic syndrome cannot be ruled out. Take your baby to the hospital or call a doctor at home as quickly as possible;

Any changes in the external state of such a formation must be recorded and provided to the local pediatrician during the appointment. This is due to the fact that mothers are with their child 24 hours a day and can know what is hidden from the doctor.

When does a child’s fontanelle close up?

When wondering when a fontanel should heal, you should take into account the physiological characteristics of the child and a lot of other individual aspects. There are no strict criteria for when such an object should heal. Nevertheless, a significant part of pediatricians are of the opinion that overgrowth occurs between six and 18 months. Sometimes closure occurs at six months of age or when the baby reaches one year. Less commonly, this happens at the age of three months or two years. Again, the child’s individual differences play a role here.

There is no need to worry about an unhealed fontanel. Each baby is a unique creature with its own physiological properties and characteristics. If your neighbor’s child’s fontanelle is closed, but yours is not, don’t sound the alarm. Most likely, this condition is explained by the individual development of the baby.

The size of a child's fontanel by month. Table

Each examination of the baby at the pediatrician's appointment will be accompanied by a detailed study of the condition of the fontanel, including measuring the size by month. Such activities are necessary in order to know how the growth and development of the brain and the strengthening of the skull occur. Today, several specific norms can be identified that indicate the optimal size of the fontanel by month. To obtain the necessary data just use special tables, which are available on forums for young mothers and other similar resources.

After birth, the size of the main fontanel is 3 by 3 centimeters, but sometimes the data from the table differs from reality. The presence of smaller or larger sizes cannot be excluded, and such deviations are not considered something dangerous or unacceptable. Over the course of a month of life, the fontanel will increase in size, but this is not a reason to sound the alarm. Any such incidents indicate severe compression of the skull during growth. However, after some time, the previous shape returns due to the elastic tissues that envelop the inside of the skull. In addition, the rapid increase in the size of the fontanel explained by brain development and growth. In most cases, actual dimensions are comparable to those presented in the table.

Fontana in a two-month-old baby

In the second month of life, the size of the fontanel may decrease. You may not even notice such changes, since they are minor. However, the local pediatrician will definitely take this feature into account. It is not easy to accurately determine the optimal size at two months of age based on tables. Here it is necessary to take into account the size after birth. In most cases, they are 22 by 25 centimeters. At such an early age, closure of such a pulsating formation should not be expected. If the fontanel is hidden for some reason, it is better to call a doctor and tell about what happened, because such an incident can be extremely undesirable for such a baby.

Too early closure of the fontanel before three months indicates a serious pathological deviation, with the exception of atypical head circumference sizes due to the individual characteristics of the baby. Among the reasons for early overgrowth of the fontanel may be the following:

present in the body excess calcium which comes with food;
the brain is underdeveloped;
the presence of craniosynostosis - a specific disease that appears against the background of endocrine diseases or rickets, when there is previously closure of the sutures of the skull and other symptoms;
presence of any brain abnormalities(very rare);

A trained person can say that early overgrowth of a fontanel is a sign of a serious illness. neurologist specialist. Only after the doctor has established an accurate diagnosis can certain measures be taken to prevent negative consequences and further development of the anomaly.

Fontana in a child in adulthood

Overgrowth of the fontanel at the age of three months is noticed in only 1 percent of children. According to the table, the average size is 23-24 millimeters. If your child is in the 1 percent category, you don’t need to sound the alarm or drag your baby to hospitals. If for some reason the large fontanelle has closed, although there are no deviations in terms of general development, most likely you should not be afraid of the presence of pathologies and oddities. If the head circumference is appropriate for this age, excessive vigilance will be unnecessary.

Four-year-old children are characterized by significant changes in terms of the size of the pulsating formation on the head. During this period they are no more than 20 millimeters. It is then that the fontanel becomes completely overgrown, but complete ossification is uncharacteristic. There is no point in sounding the alarm if overgrowth has slowed down. Perhaps, after an examination by your local pediatrician, you will be advised to give your baby vitamin D or increase the amount of calcium consumed, which is contained in maternal nutrition.

Already at 5 months of age, the size is reduced to 17 millimeters. Until 6-7 months, the fontanel will completely disappear. If this does not happen, most likely the child has individual differences from the statistical average, so this phenomenon remains quite normal. As for the average indicators from the table, they look like this:

8-9 months – 14-15 millimeters;
9-10 months – 12-14 millimeters;
10-11 months – 9-11 millimeters;
11 months – one year – 5-8 millimeters;

In most cases, complete overgrowth occurs at one year of age, and sometimes earlier. Again, it all depends on the individual properties of the child and physiological differences from other children.

If your baby was born ahead of schedule, it is possible that the size of the pulsating formation on the head will be impressive and will not correspond to the table. Often, premature babies have large objects, and in addition to the front and back, there are also lateral ones. For this reason, the development of such children may differ from their peers, so if the fontanelles heal more slowly, there is no need to worry. Very often the healing process ends at one year of age or even later. However, do not worry if you notice a delayed action. Even if your baby is seriously delayed in development, his growth will soon stabilize.

Often, the fontanel begins to overgrow only at 1.5-2 years of age. In rare cases, this happens when the baby turns 2.5 years old.

It is important to understand that premature babies should be placed under special control by pediatricians and the slightest hint of the presence of any pathology should be indicated during the next examination by a specialist. If the child is really developing poorly or is sick with something, the doctor will prescribe appropriate treatment, taking into account all the subtleties and individual properties of the premature baby. If you notice any strange behavior in your baby, do not delay seeking help from your pediatrician.

Why does the fontanel heal poorly?

Many mothers wonder why the overgrowth of the fontanelle is not going well enough. In most cases, this is determined by the following factors:

full term;
poor nutrition;
intensity of development;
heredity;

If such a natural process occurs earlier than expected, the baby may have to be registered with a local pediatrician. The main thing is not to be indifferent to changes in behavior and other manifestations of pathology, reporting what is happening to an experienced specialist. In this case, your child’s growth and development will occur in the best possible way.

A young mother is constantly worried whether her baby’s fontanel is normal, whether it is too big or, conversely, small? In this case, there is no need to listen to the advice of grandmothers; only a pediatrician will be able to tell after an examination what condition the baby’s fontanel is in. I am sure that every mother should have a general idea of what a fontanel is and what deviations from the norm there may be, so that there is no cause for concern once again.

Many mothers came to see me and trembled when I felt the fontanel of their children. This is, of course, an extreme. But the other extreme is to approach this issue completely irresponsibly. Remember, ordinary manipulations (washing your hair, combing, examination by a pediatrician) cannot disrupt the integrity of this area.

Fontana in babies - what is its role and normal shape

As the brain grows, so do the bones of the child's skull. The most productive period for this is the first 2 years of a baby’s life, during which time the bones of the skull are constantly growing and changing. By the way, even if the fontanel closes a little prematurely, this does not mean that the bones will now stop growing.

Along with the sutures of the skull, which are open until the age of 19, the fontanelle occupies an important place in the growth of the size of the skull. The main function of this non-ossified part of the baby's skull is so that during the birth process the bones of the skull can take the desired shape to pass through the woman's birth canal. This is why newborns often have a rather strange head shape in the first days.

After childbirth, this area also performs very important functions:

In the first two years of life, the bones of the skull can still transform. This protects the child's head from serious injuries that may occur after the baby falls. During this period, parents may make a mistake: while dressing the baby and accidentally hitting their head, the baby may fall off the sofa or bed, and many other cases. But these injuries will not affect the child’s health, because upon impact the brain will rest against the soft connective tissue of the fontanel. The time for complete tightening coincides with the age of the child when he is already firmly on his feet and the risk of falling is significantly reduced.
The fontanel is involved in the thermoregulation of the baby. Due to the imperfection of the heat transfer process, young children often overheat or become hypothermic. We regularly meet mothers who really like to wrap their baby in a way that is not in accordance with the air temperature. For the child to return to his normal temperature again, it is enough to remove the cap.
Thanks to this area of skin, children undergo an ultrasound of the brain.

It is worth noting that after birth a child has 6 fontanelles. We, pediatricians, pay special attention to only two, because the other 4 are overgrown during the first week of the baby’s life.

Sizes of fontanelles in a newborn and older child

The posterior fontanelle in a newborn is on average 0.6 mm. By about 8 weeks of age, it completely closes in a child.

Typically, the anterior fontanel has the shape of a diamond, the dimensions of which vary from 5 mm to 30 mm. In order to calculate the size of a given area, it is necessary to measure the distance between the most distant points and divide the resulting number by 2. The longitudinal (along the main axis of the skull) and transverse (across the longitudinal axis of the skull) dimensions are usually determined. Dimensions are recorded in two numbers: 1.1x0.5 cm.

Sizes of a large fontanel by month

Age, months	Size, mm
0-1	26-28
1-2	22-25
2-3	23-24
3-4	20-21
4-5	16-18
5-6	16-18
6-7	16-18
7-8	14-16
8-9	14-15
9-10	12-14
10-11	9-12
11-12	5-8

The anterior fontanelle closes at about 24 months. I noticed that this process goes a little faster in boys than in girls. If a baby is born with the anterior fontanelle larger than usual, this does not mean that it will take longer to close. Despite the fact that the table shows average values, this does not mean that with a slight deviation from the norm, something goes wrong with the child. Do not worry ahead of time and about the age when this unossified area of the skull will completely heal. Most recently, we opened a service on our website Question and Answer, and guess what one of the first questions was asked by our reader... If you still have questions about why the fontanel does not heal, then welcome to our Questions and Answers section .

Please note that neither a decrease in closure periods nor an increase in them are pathological. The process of tightening the fontanelle occurs individually for each child and depends on the following factors:

The baby is premature. Typically, premature babies are slightly behind their peers in physical development, this is manifested in the later healing of the unossified area on the baby’s head. But by the age of 3 everything evens out and children begin to develop equally.
Growth rate. With adequate nutrition and good weight gain, the fontanel usually closes earlier. Conversely, if the baby’s diet is overloaded with proteins or carbohydrates, the fontanel may grow together a little later.
Method of feeding. In a breastfed baby, this area closes earlier than in a formula-fed baby. This is due to the fact that breast milk contains nutrition that is more balanced and suitable for the baby’s gastrointestinal tract.
Deficiency of vitamin D3 in the body.
Hereditary diseases. It has been established that Down syndrome, congenital hypothyroidism or achondrodysplasia (a genetically determined disorder of bone formation), hydrocephalus can slow down the fusion of the fontanel. Microcephaly (small head) or craniosynostosis, on the contrary, lead to very early closure.

What deviations from the norm may there be?

Normally, this area may be slightly sunken or slightly convex. Not normal age of closure - earlier than 3 months. If the child is older, everything is fine. The fontanel may occasionally pulsate, especially during periods of excitement of the child; many mothers notice this and get scared, but this is considered normal and confirms that the baby is healthy. Another option is when the pulsation occurs constantly and does not go away with age, you should definitely contact a neurologist who will prescribe an ultrasound of the brain (neurosonography).

What type of fontanelle is considered abnormal:

The fontanel has fallen greatly and at the same time the child has dehydration due to an illness that was accompanied by vomiting, diarrhea, and fever.
when this area protrudes strongly, the child has a fever and even possible convulsions. This condition requires an immediate call to an ambulance. If there are no symptoms, but for a long time you notice that the fontanel is swollen too much, then contact your pediatrician. This may be a symptom of meningitis, encephalitis or a tumor. Self-medication in this case is unacceptable!

What examinations are carried out if a deviation from the norm is suspected:

consultation with an endocrinologist;
a trip to a geneticist and neurologist;
a urine test to perform a Sulkowicz test to determine whether the baby’s body is absorbing calcium well.

Important! This article contains general information only and is not intended to substitute for advice from a qualified professional.

The process of giving birth to a baby is so meticulously “thought out” by nature that it provides for all the moments so that the child can be born healthy. In order for the small body to pass through the mother’s birth canal, its head takes on an oblong shape and is slightly flattened on the sides. The baby has gaps between the bones of the skull, which are filled with plates of connective tissue. These intervals are called fontanelles , and parents have quite a lot of different questions about them. However, most of them - and there are six fontanelles after birth - quickly overgrow. Therefore, parents often simply do not notice that there were so many of them. But the main one - the frontal or greater fontanel (abbreviated as BR) remains for a longer period. After all, its function is also to provide shock absorption, protecting against injuries and fractures during a fall.

We will discuss in the article below when the crown of a newborn becomes overgrown and how this process occurs.

When does the fontanelle close up in newborns?

Young parents often worry whether everything is going well and are looking for information about when the large fontanelle closes up. The older the baby gets, the more worried parents become about this. But in fact, even after the baby is one year old, and the crown remains, there is no need to worry. After all, in children this process is normally completed before the age of 1.5 years. But if you are still overcome by a certain concern that the process is progressing late, it is better to visit a doctor who will help determine when the child’s fontanelle closes up in a particular case.

After all, we can talk not only about a disease, but also about a certain developmental feature. Therefore, sometimes the answer to the question of at what age a child’s fontanelle closes up is not so categorical. In any case, when visiting a doctor with the baby, the mother should ask him all the questions about how long the child’s fontanel should heal.

What should the crown be like?

The doctor evaluates the characteristics of the fontanel immediately after the child is born, as well as every time during monthly examinations. The pediatrician must pay attention to the size of the crown, the rate at which it decreases, and the density of the bones surrounding it.

What size should a healthy baby's fontanel be? In a full-term baby, its dimensions are 2.5-3 cm. The doctor determines this by palpating the skull and taking measurements between opposite sides of the diamond.

In premature babies, these dimensions are larger - about 3.5 by 3.5 cm. But if a large baby was born at 41-42 weeks, then the crown may be smaller. Interestingly, a baby at the age of 1 month may have even more BR than at the time of birth. The thing is that during this period the brain is actively growing, and therefore the bones diverge a little.

Therefore, it is difficult to determine exactly what kind of BR a baby should have at a certain age. However, in some sources you can still find certain indicators:

at three months – 1.8-2 cm;
in six months - 1.8-1.6 cm;
at nine months - 1.3-1.4 cm;
in one year - 0.4-0.8 cm.

But it should be understood that these indicators are just a rough guide. This is due to the fact that:

the size of the fontanelle is initially different for all children;
the way the fontanel tightens in children does not depend on its size; A large one can last up to a year, a small one sometimes does not heal until a year and a half later.

But it is very important to ensure that the fontanelles are at the level of the cranial bones and are not too tense. It is possible that the spring will sink or swell a little, and its pulsation is also possible.

It is also important that the parietal and frontal bones surrounding the crown are dense, and there are no areas of softening noted on them.

If the fontanel does not close, what should you do?

You need to visit a doctor and consult with him if the fontanel has not closed by 18 months. This condition may be normal for the baby. However, we can also talk about certain pathologies.

Disease	What does a fontanel look like?	What research is needed?	How to proceed?
	Lack of calcium leads to softening of bones, including the skull. The BR remains open for a long time, the edges of the bones are soft to the touch. The child becomes lethargic, often sweats during sleep, and the back of his head becomes bald. Bone growths appear on the wrists and ribs, and curvature of the lower leg is noted.	An examination by a pediatrician, a urine sample according to Sulkovich, and a blood test for phosphorus, calcium, and alkaline phosphatase are necessary.	The use of therapeutic doses is practiced .
Congenital	BR does not heal for a long time due to a deficiency of thyroid hormones, which regulate, among other things, bone growth. Disturbed, voice becomes nasal, develops . The fontanel does not last long.	It is necessary to consult with a pediatrician and pediatric endocrinologist, conduct a blood test for TSH, T3 and T4, and an ultrasound of the thyroid gland.	Thyroid hormone replacement therapy is carried out.
Achondrodysplasia	A disease of bone tissue that impairs growth. The skeleton becomes disproportionate, the head becomes massive and wide, the limbs become short. The fontanel does not last long. Genetic consultation is required.	A PCR X-ray of the skull is performed to determine the gene mutation.	Growth hormone is used somatotopin .
	Due to increased cerebrospinal fluid pressure, the cranial bones cannot “come together”. The fontanelle rises above the bones, the head circumference increases. Possible manifestations of seizures, hearing and vision impairment, and developmental delays.	Observation by a pediatric neurologist, EEG, MRI, and ultrasound of the brain are indicated.	Anticonvulsants, diuretics, and nootropics are prescribed. Sometimes shunting is indicated.

If the baby has a very small fontanel, parents need to show the child to specialists - a pediatrician, endocrinologist, neurologist. Sometimes there are cases when the fontanel in a newborn heals already at 3 months. This happens rarely - in about 1% of cases. If the baby’s other indicators are normal, then we are not talking about deviations.

However, in some cases, too small a BR may be evidence of pathology. The table below shows possible conditions in which the baby's fontanel is too small.

Disease	What does a fontanel look like?	What research is needed?	How to proceed?
Craniosynostosis	The sutures of the skull and fontanelles fuse very early and quickly. Possible deformation of the skull, jaw, and secondary hydrocephalus.	An MRI, CT scan of the head, and radiography of the skull are performed.	Surgical cutting of sutures.
Increased function of the parathyroid glands	Due to impaired calcium and phosphorus metabolism, the calcium content in the blood increases. The baby's BR closes early, pain in the bones bothers him, the kidneys and gastrointestinal tract are affected, and manifests itself.	Conduct a blood test for phosphorus and calcium, determine the content parahormone in the blood. X-rays of the skull bones and ultrasound examination of the thyroid and parathyroid glands are also performed.	Surgical methods of treatment.
Microcephaly	Due to abnormal development of the brain, the bones of the brain part of the skull stop growing, but the growth of the facial bone continues. The brain remains underdeveloped. Developmental delay is noted.	The child is observed by a neurologist and an ultrasound scan of the brain is performed. Genetic consultation is important.	Symptomatic treatment.

What to do if a child’s fontanel is too large?

A fontanel is considered too large if its size exceeds 3.5 cm. But for immature or premature babies this may be the norm. In such cases, the child’s large fontanelle closes before one and a half years. Often, at the age of 3 months or older, the BR begins to actively decrease, and by this age it gradually closes.

In other cases, it is imperative to consult a pediatric neurologist, conduct an ultrasound of the brain and other necessary studies to exclude hydrocephalus and increased .

Why does the fontanelle pulsate in a baby?

Since the brain is actively supplied with blood, and its vessels are located close to the heart, when the blood flows there is strong pressure and, accordingly, tremors.

This pulsation is transmitted to the cerebrospinal fluid, to the membranes of the brain and the plate that covers the BR. Therefore, if the fontanel pulsates a little at 3 months or at another age, this is normal. But if the BR pulsates very strongly in a child, this may indicate developing diseases. But in this case, as a rule, there are other unpleasant symptoms - intoxication, dehydration, fever, vomiting, etc. In such a situation, you need to consult a doctor, establish a diagnosis and carry out the correct treatment.

What does it mean if a baby’s fontanelle has sunk?

When the BR drops, this is evidence that the baby is malnourished or his body is dehydrated. A sunken fontanel in a child due to loss of fluid can be observed:

in extreme heat;
due to overheating if the child is wrapped up too tightly;
as a result of elevated temperature or intoxication of the body;
after severe vomiting or.

It is very important to immediately replenish fluid loss. If the baby is overheated, he should be cooled and given fluids. In case of intestinal infection manifested by severe symptoms, treatment is carried out in a hospital.

If the fontanel protrudes, what does it mean?

Bulging (elevation above the bone level) of the fontanel may be evidence of increased intracranial pressure - a symptom characteristic of tumors, intracranial bleeding. There are other possible reasons for this phenomenon.

Parents should be very careful and call emergency help if, in addition to the bulging fontanel, the following signs are observed:

elevated temperature;
diarrhea and vomiting in an infant;
disturbances of consciousness;
bulging after head injury;
convulsions.

In the absence of such symptoms and the bulging continues for a long time, you should also contact a specialist. In such a situation, an ultrasound of the baby’s brain may be needed. Whether this is normal or not will be determined by the results of the examination.

Do you need special care?

There is no need to practice any crown care activities. Although the plate covering it is very thin, it is quite durable. Therefore, parents can calmly comb the baby, cut his hair, examine his head, and bathe him. True, you still need to use the comb carefully, since the baby may experience unpleasant sensations with sudden movements.

Conclusions

Despite the fact that normally the process of closing the BR is completed by one and a half years, sometimes certain deviations can occur in healthy children. Therefore, the answer to the question of when a child’s fontanelle should close is not always clear. Parents should be wary of the situation when the fontanel closes in infants under 3 months. If parents have certain doubts about the process taking place, about when the child’s fontanelle closes, it is better to ask a pediatrician.

The process of closing the BR occurs faster if the baby is well fed and quickly gains weight. Most often, in breastfed children, closure occurs faster.