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The norms of the fontanel in infants. The fontanel in a newborn: when it overgrows, what it should be, why it pulsates, does not close The crown of the child does not heal

The speed of overgrowth of the fontanel is very individual. It all depends on its initial size (0.6-3.6 cm), on the calcium-phosphorus balance in the baby's body. Be that as it may, but it is the speed of overgrowth of the fontanel that causes particular concern and anxiety among the parents of the child. Let's figure it out, but what if the fontanel does not overgrow ...

Norms, norms, norms...

The maximum size of the fontanel at the time of birth is within 2.2-3.5 cm. Due to the expansion of the interosseous sutures and the bones of the skull, the size of the fontanel may increase slightly, but this is primarily due to a change in its shape. After that, the size of the fontanel will steadily decrease, and complete closure will occur on average at 12-18 months of the baby's life. But these terms are very, very conditional. Cases have been recorded when the closure of the fontanel occurred both at an earlier and at a later date, and at the same time was the norm.

Does not grow. Is it dangerous?

Of course, the period of overgrowth of the fontanel in each case is individual. However, if parents notice that a large fontanel is overgrowing too slowly, it is advisable to seek help from a neurologist. And the doctor will definitely determine whether there is a reason for concern by prescribing an ultrasound examination of the brain for greater fidelity.

If the fontanel is really late in closing, then this may indicate:

  • About genetic predisposition. In 1982, a special WHO commission concluded that both the size of the large fontanelle and the speed of its closure are genetically determined factors.
  • About rickets. Insufficient calcium content in the body, which is directly related to a low intake of vitamin D, can lead to later closure of the fontanel and rickets. As a result, the bone tissue changes, the child's gait is disturbed, and his legs are bent. Signs of rickets: the baby is restless, sleeps poorly, sweats profusely, the baby's hair rolls out. It is possible to prevent the late closure of the fontanel and the associated rickets by normalizing the child's calcium-phosphorus metabolism. For the purpose of prevention, children are prescribed vitamin D.
  • About hydrocephalus (excessive accumulation of fluid in the brain). This disease is manifested by increased intracranial pressure. As a result, the child becomes restless, he has muscular dystonia, sleep disturbances or excessive drowsiness, tearfulness, changes in the vessels of the fundus. In addition, with hydrocephalic syndrome, there is a significant monthly increase in head circumference, and in especially severe cases, even divergence of cranial sutures. That is why, first of all, doctors focus on the growth rate of the child's head, and not on the size of the fontanel.

A young mother constantly worries if her baby’s fontanel is normal, is it too big or, on the contrary, small? In this case, you do not need to listen to the advice of grandmothers, only the pediatrician will be able to say after examining the condition of the fontanel in the baby. I am sure that every mother should have a general idea of ​​​​what a fontanel is and what deviations from the norms can be, so that once again there is no cause for concern.

Many mothers came to my appointment, who trembled when I felt the fontanel of their children. This is, of course, extreme. But the other extreme is a completely irresponsible approach to this issue. Remember, ordinary manipulations (washing your hair, combing, examining a pediatrician) cannot violate the integrity of this area.

The fontanel in infants - what is its role and normal form

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, at which time the bones of the skull are constantly growing and changing. By the way, even if the fontanel closed a little ahead of time, this does not mean that now the bones will stop growing.

Along with the sutures of the skull, which are open until the age of 19, the fontanel 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 that during the birth process, the bones of the skull can take the desired shape for passage through the birth canal of a woman. That is why newborns often have a rather strange head shape in the first days.

After childbirth, this area also performs very important functions:

  1. 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 can occur after the baby falls. During this period, parents can make a mistake: dress the baby and accidentally hit his head, the baby can fall off the sofa or bed, and many other cases. But these injuries will not affect the health of the child, because the brain, upon impact, rests against the soft connective tissue of the fontanel. The time of full tightening coincides with the age of the child, when he is already firmly on his feet and the risk of falling is significantly reduced.
  2. The fontanel is involved in the thermoregulation of the baby. Due to the imperfection of the process of heat transfer, small children often overheat or become hypothermic. There are regular mothers who are very fond of wrapping the child in a way that is not in accordance with the air temperature. In order for the child to return to his usual temperature again, it is enough to remove the cap.
  3. Thanks to this area of ​​the skin, children undergo an ultrasound of the brain.

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

The size of the fontanels in a newborn and an older child

The posterior fontanel 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 form of a rhombus, the size of which varies from 5 mm to 30 mm. In order to calculate the size of this area, it is necessary to measure the distance between the most distant points and divide the resulting number by 2. Usually, longitudinal (along the main axis of the skull) and transverse (across the longitudinal axis of the skull) dimensions are determined. The dimensions are recorded in the form of two numbers: 1.1x0.5 cm.

The size 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 fontanel is tightened by about 24 months. I noticed that in boys this process is somewhat faster than in girls. If a baby is born with an anterior fontanel 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 non-ossified part of the skull will completely tighten. Most recently, we opened a service on our website Question and Answer, and guess which one of the first questions our reader asked.. If you still have questions about why the fontanel does not overgrow, then welcome to our FAQ section .

Please note that neither a decrease in the timing of closure, nor their increase, are pathological. The process of tightening the fontanel occurs in each child individually and depends on the following factors:

  • The child is premature. Usually premature babies are slightly behind their peers in physical development, this is manifested in the later overgrowth of a non-ossified area on the baby's head. But by the age of 3, everything levels out and children begin to develop in the same way.
  • Growth rate. With good nutrition, a 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.
  • Feeding method. In a breastfed baby, this area closes earlier than in a formula 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 in the body of vitamin D3.
  • hereditary diseases. It has been established that Down's syndrome, congenital hypothyroidism or achondrodysplasia (a genetically determined violation of bone formation), hydrocephalus can slow down the fusion of the fontanel. Microcephaly (small head) or craniosynostosis, on the other hand, results in very early closure.

What can be deviations from the norm?

Normally, this area may be slightly sunken or slightly convex. Not normal closing age - earlier than 3 months. If the child is older - everything is in order. The fontanel may occasionally pulsate, especially during periods of arousal 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 disappear with age, you must definitely contact a neurologist who will prescribe an ultrasound of the brain (neurosonography).

What type of fontanel is considered abnormal:

  • the fontanel is strongly sunken, and at the same time, the child has dehydration due to an illness that was accompanied by vomiting, diarrhea, and fever.
  • when this area sticks out strongly, while the child has a fever and even convulsions are possible. This condition requires the immediate call of an ambulance. If there are no symptoms, but for a long time you notice that the fontanel swells too much, then contact your pediatrician. This may be a symptom of meningitis, encephalitis, or a tumor. Self-treatment 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 a neurologist;
  • urinalysis to conduct a Sulkovich test and determine whether the baby's body absorbs calcium well.

Important! This article contains general information only and is not intended to replace the advice of a qualified professional.

Any newborn baby has small marks on the head - fontanelles. Immediately after birth, the baby develops six marks, four of which close in the first weeks of life. The fifth mark, located on the back of the head, disappears by two or three months. The sixth remains on the baby's head the longest. Knowing what a fontanel is and what function it performs will help parents to more clearly imagine the process of growth and formation of their child.

What is a fontanel

The fontanel in a child is an empty space between the parts of the skull, closed by a dense membrane. The baby also has sutures resulting from the connection of two bones of the skull. Fontanelles appear in the junction of several bones. Some time after birth, these parts of the skull become ossified, and the corresponding marks disappear. The first five out of six membranes close in all children at about the same time, but the formation of the sixth fontanel in a newborn child is a purely individual process. Among its main functions are the following:

  1. The main function is to help in the easy passage of the head through the birth canal. During childbirth, the shape of the baby's head is slightly deformed. Tapering, it passes forward more easily through the birth canal. Often, in a baby, immediately after birth, you can find bones that have found each other. Such defects quickly pass, and the shape of the skull is restored.
  2. Another no less important purpose of this physiological phenomenon is to help in the active growth and development of the brain. In the first year of life, the baby's brain grows rapidly and intensively. The membranes provide the necessary space for this process, expanding the cranium and allowing the brain to grow to the desired size and volume.
  3. The free space between the parts of the skull provides thermoregulation of the brain. In newborns, heat transfer in the body is at the stage of formation and development. Because of this, babies overheat easily. When the child's body temperature reaches approximately 38 degrees Celsius and above, the fontanelles turn on the ventilation function, thereby preventing the brain from overheating.
  4. The fourth function is depreciation. Physiological marks that occur in children immediately after birth provide protection for the baby from possible shocks and injuries. This is not a reason to leave a small child unattended, because a small membrane will not be able to protect the fragile bone structure of an infant from serious blows or concussions.
  5. The last role of the fontanel in a small child is to help in the medical study of the brain. The membranes greatly simplify the conduct of neurosonography, ultrasound and other examinations in order to identify potential pathologies and diseases at an early stage. These membranes help medical professionals control the development and formation of the brain, and if problems are detected, apply timely treatment.

Large and small fontanel in a child

The dimensions of the membranes are calculated by the formula in which the longitudinal and transverse diameters are added, after which the sum is divided by two. The result obtained is indicated as the size of the membrane. Immediately after birth, the parameters of this mark on the back of the head average 0.5-0.7 mm. This is a small fontanel, which closes by the second month of a child's life.

A large fontanel is usually well palpable and stands out. Almost all parents are concerned about the question of whether the size of the large fontanel of their small child is normal, how soon it should disappear and what to do if it does not overgrow for a long time. Doctors say that there is no strict time frame for closing the membrane. Each child develops this process differently.

A large fontanel in a newborn child usually has the shape of a diamond, each side of which is approximately 25 mm. In most cases, the mark disappears at 12-18 months. According to statistics, in the case of boys, this process proceeds faster. There is no relationship between the size of the membrane and the time of its closure. The first three months of life, the mark will increase intensively, since during this period the process of active brain growth usually occurs.

How many months does it take


The fontanel can close at any time. This usually happens between three months and two years. In some babies, it overgrows earlier, in others - later. For comparison, we present the results of statistical studies, according to which in 1% of crumbs the mark on the head closes up to three months, in 40% - from a year to a year and a half, and in 95% of newborns - by two years. In the remaining five percent, the fontanel overgrows only after two years.

The process of formation of the bone tissue of the cranium in each case proceeds individually. In children from the same parents, characteristic marks disappear at different ages. If the mother consumed too much calcium during pregnancy, there is a possibility that the free space between the parts of the skull will tighten faster. Young parents should not worry about this. It is important that this process takes place within the time limits. If the baby is not worried about well-being, he develops normally, there is no need for worries.

Retraction and protrusion of the fontanel


The fontanel in an infant sticks out a little when there is increased intracranial pressure or other neurological disorders. A bulging fontanel is not the only symptom that indicates the appearance of health problems. If you find that the membrane on your head is slightly swollen, do not panic, but it is better to immediately consult a doctor.

A sunken fontanel is usually a typical sign of dehydration in a baby. This happens with vomiting and prolonged diarrhea in a small child. In this situation, the newborn needs to provide plenty of fluids. It is necessary to contact the pediatrician to find out the reasons that led to dehydration and, as a result, the sinking of the fontanel.

If the fontanel pulsates, is it worth worrying


Many parents, noticing that the child has a pulsating membrane on the head, panic. You shouldn't worry. This is a completely natural and normal phenomenon. Pulsation corresponds to the heart rhythm. The reason for its appearance is the flow of blood flowing to the brain with each heartbeat. In all children, the pulsation is expressed in different ways: in some it is stronger, in others it is weaker. But if there is no pulsation at all, this indicates the appearance of problems with pressure. In this situation, it is better to consult a doctor.

When should a child's fontanel close?

As noted above, in all children, the space between the parts of the skull overgrows at different times. The large fontanel usually closes between the ages of three months and two years. Often there are cases when characteristic marks disappear earlier or later than the due date. This is a purely individual process that will definitely happen in. If the mark drags on too quickly or, conversely, does not overgrow for a long time, it is better to consult a doctor who will help determine the cause of the anomaly and give appropriate recommendations.

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Parents always have a lot of questions, for example, what sizes of a large fontanel are considered the norm, why is it large or small, the measurement of a large fontanel, and so on. Through research, it was found that many parents do not touch its location on the child's head, as they are afraid of harming the baby's brain. This is a misconception, since the fontanel is a dense shell, the function of which is protection. It is located on the crown of the child, shaped like a rhombus. Why is a large (also called anterior) fontanel needed? In order to make it easier for the baby to be born, passing through narrow birth passages. This is a kind of shock absorber that helps the cranial plates move and move apart. If you look closely at it, you can see a slight pulsation, especially noticeable when the baby cries. You can touch it, and some doctors even advise gently massaging it while combing.

How does a large fontanel close in a child?

The size of a large fontanel of a newborn is approximately 2x2 cm in area, but an excess of 1-3 cm in size is considered a variant of the norm. In the first month, a significant increase in size is possible. And by 3-4 months it decreases to 1x1cm. In the period from 12 to 18 months, a large fontanel should normally close completely. But these terms are averaged, and for each child, closing occurs at its own time (as well as the terms of teething or the first steps).

What conditions of a large fontanel should alert parents? Prevention

Parents must visit the children's doctor without fail, doing this regularly for up to a year. And the pediatrician, for his part, will make sure that the baby does not lag behind his peers in development and takes the necessary measures in time.

One of the external indicators of the normal development of a child for pediatricians, neurologists and other pediatric specialists is the fontanel in newborns. It is a small soft pulsating area on the baby's head, under which the brain tissue is located close enough. The surface of the fontanel is covered with a dense film with a small fluff.

Fontanelle of a newborn baby

  • The fontanel of a newborn greatly facilitates the process of childbirth, both for the baby and for the mother. Passing the birth canal, the bones of the skull are compressed, and therefore the head of the newborn for the first time after childbirth looks elongated. Then the shape of the head is restored;
  • The presence of a fontanel provides optimal spatial conditions for normal brain growth at the pace that is laid down by nature;
  • The fontanel is involved in the regulation of heat transfer of the baby and the environment. If the child's body temperature exceeds 38 degrees, then the brain tissue naturally cools through the fontanel;
  • Due to the ability to shrink, the fontanel can act as a shock absorber in case of an accidental fall of the child.

Large and small fontanelles

Where is

Determining where the fontanel is located in a newborn baby is quite simple.

A large diamond-shaped fontanel measuring 2 by 2 centimeters is located right in the middle of the crown, or, as they usually say, on the top of the head.

A small fontanel is located on the back of the head. Its size is about half a centimeter.

When overgrown

A large fontanel overgrows by about one year of age of the child, sometimes there are slight deviations from this parameter up to about one and a half years. But if the child meets the age norms in other respects, then there is no reason for concern.

A small fontanel in children born at term is already closed. However, it happens that it was discovered after childbirth. Then its closure should be expected in two to three months.

The speed and time of closing the fontanelles mainly depends on how much the baby's body is provided with calcium. If there were no deviations in the mother's diet, the optimal regimen for taking multivitamins was observed, then the overgrowth of fontanelles usually occurs normally.

Deviations in development

Knowing the timing when the fontanel overgrows, as well as the size, you can see any deviations, avoid and prevent the development of many dangerous diseases in newborns. Among them are a few:

  1. Rickets. This disease is almost the most common cause of late closure of the fontanel. As a rule, this happens in premature babies who are rarely exposed to the sun, who have a lack of calcium and vitamin D. Read the article >>>;
  2. Hypothyroidism. A decrease in the amount of thyroid hormones can also be the reason for slowing down the process of overgrowth of the fontanel;
  3. Down Syndrome. Too large sizes of the fontanel indicate the presence of this disease along with other characteristic signs;
  4. Overgrowth of the fontanel ahead of time may indicate an excess of calcium , as well as testify to diseases such as craniostenosis, microcephaly;
  5. A depressed fontanel is also a serious symptom. This phenomenon indicates acute dehydration of the body.

(image is clickable)


A careful examination of the child by specialists, parents of the baby's condition will be the key to early detection of abnormalities and will contribute to the correct appointment of preventive treatment.

Reasons for the early closure of the fontanel

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Fontanelle too small or fontanel closing too fast

Protruding fontanel?

Most often, a bulging fontanel is observed against the background of diseases that are accompanied by an increase in intracranial pressure: meningitis, encephalitis, tumors, intracranial bleeding, increased intracranial pressure for another reason.

If a bulging fontanel is combined with one or more of the following symptoms, you should call a doctor as soon as possible:

  • Strong temperature;
  • The bulging of the fontanel arose after a head injury, a child's fall;
  • Vomit;
  • Drowsiness or excessive irritability of the child;
  • Strabismus;
  • Convulsions or epileptic seizures;
  • Loss of consciousness;
  • Bulging fontanel for a long time without other symptoms.

Fallen fontanel?

Most often, the retraction of the fontanel is observed due to dehydration of the child against the background of temperature, diarrhea, and repeated vomiting. If a sunken fontanel is found, the child should be given plenty of fluids and a doctor should be contacted to treat the disease that caused dehydration.

Fear of harm

Many are very much afraid of somehow damaging the fontanel. Remember! - it's practically impossible. Despite the apparent softness of the fontanel, it is very durable, and it cannot be damaged by ordinary manipulations (washing, bathing, combing, etc.).

Video:

Newborn baby. It is a soft area on the parietal part of the head between the parts of the skull. This area does not have bone tissue, but is closed by a strong membrane. The fontanel in infants makes it possible to shrink during childbirth during the passage of the baby through the birth canal.

What are fontanelles in newborns?

Newborn babies have six fontanelles. The largest is the front, the second largest is the back. There are two more mastoid and two wedge-shaped. Two main fontanelles usually remain open after childbirth: frontal (large) and occipital (small).

Sizes of children's fontanelles

The large fontanel resembles the shape of a rhombus. It is considered normal if its size is in the range of 1-3 centimeters. Most often, such a fontanel in children is 1.7-2.5 centimeters. And at the age of three months, it decreases to 1-1.5 centimeters.

To correctly determine the size of the frontal fontanelle, add its longitudinal and transverse diameters and divide the resulting sum by 2. The small fontanel resembles the shape of a triangle. Its dimensions usually do not exceed 0.7 centimeters. Although most often a child is born already with a closed small fontanel. But do not worry if the size and shape of the fontanel in a child differs from the standard ones. Each child is individual. A pediatrician should be consulted to determine if this is a concern.

Timing of fontanel closure

Four lateral fontanels in full-term babies close at birth, in premature babies - in the first few days after birth. The occipital fontanel in infants is completely closed at 2-3 months. But there are no exact deadlines for closing the largest fontanel. It's a very individual process. It can overgrow by 12 months, or maybe at 1.5 and 2 years. In recent years, thanks to the acceleration of children, the frontal fontanel disappears by 10 months.

What is the reason for the early closure of the frontal fontanel?

Closing of the fontanel before the third month of the baby's life is considered early. Usually this is due to the expectant mother's enthusiasm for taking multivitamins and the result of which are small and fairly dense fontanelles in the child. Therefore, you should follow the norm in taking vitamins according to the duration of pregnancy.

Why is it dangerous?

Early closure of the fontanel has a significant effect on the full development of the brain, impeding its normal growth. The danger lies in the fact that early overgrown

the fontanel can be the cause of serious illness in infants. Very rarely (but there is still a chance) a baby can have one of two diseases: an anomaly in the development of the brain and craniosynostosis. These diseases are accompanied by a number of other symptoms. If the child's fontanel closes early, but the circumference of his head is normal, this means that the child is healthy.

What is the reason for the late closure of the fontanel?

Late closure of the frontal fontanel is associated with a low content in the baby's body and limits the intake of vitamin D3. And this leads to a change in bone tissue.

Why is it dangerous?

In itself, the late closure of the fontanel does not indicate danger. It is important to study the accompanying symptoms, as this can also be a dangerous signal.

The most common cause of late closure is rickets. It can also be a signal of Down syndrome, achondrodysplasia and other serious diseases. Even if the fontanel that does not close for a long time in infants does not cause concern, you should consult a specialist.

What else can the fontanel “tell” about?

There are a few more "signals" that should not be ignored:

    the fontanel in infants sinks - there is not enough fluid in the body;

    for a long time it is “convex” -;

    enlarged sizes - violation of ossification or prematurity.

The whole body of the baby is the embodiment of fragility and insecurity, but there is the most vulnerable, small, pulsating area on his head - the crown or fontanel. This phenomenon in a newborn is one of the most exciting topics for young mothers, and for pediatricians and pediatric neurologists, it is the most important indicator of the correct development of the child. Let's try to figure out: what it is and what functions the fontanel performs in children.

Fontanelle of a newborn

The soft area on the head of a newborn is the distance or the so-called “window” between the bones of the skull. It is covered with dense, elastic connective tissue - a membrane, which, contrary to prejudices, is quite difficult to damage, and which ossifies and hardens by a certain age. Immediately after birth, the baby, normally, has 6 such "windows".

The largest fontanel in a newborn is located on the top of the head, between the two frontal bones. It is called parietal or anterior unpaired, has a diamond shape and reaches a size of up to 4 cm.

The second unpaired fontanel is located on the back of the head between the occipital and parietal bones.

The rest of the "windows" are called paired, because. are located on the sides of the head - in the temporal regions and behind the baby's ears.


As a rule, all fontanelles, except for the anterior one, are no more than 5 mm in size, and the process of ossification of the connective tissue covering them occurs much faster than the anterior one - during the first two months of a child's life, and sometimes even in the womb. Therefore, most often the parents of a newborn do not know about their existence at all.

What are the functions of the fontanel?

Despite the fact that the fragility of the baby is the cause of fears and concerns for his parents, nevertheless, even it is thought out by nature to the smallest detail. This also applies to the topic of this article. The fontanelles on the baby's head perform a number of important functions:

When does the fontanel grow in newborns?

So, we have already mentioned above that the occipital and lateral "windows" overgrow almost immediately after the birth of the child. But when should the largest anterior fontanel heal?

Experts do not name any specific dates for the ossification of the connective tissues on the head of newborns, because, like any process in the body, it proceeds depending on the individual characteristics of the child's body. There is an opinion that the time of their healing can be genetically determined, and also depends on the sex of the newborn.

If we talk about approximate terms, then, as a rule, the fontanel in newborns heals at the age of 6 months to 1.5 years, sometimes this process can continue up to 2 years of the child. Minor deviations should not be a cause for concern for parents, because. they are considered the norm.


Indicators of the norm of the fontanel and their deviations

As we have already found out, normally, the crown of a newborn closes by about two years, has the shape of a rhombus and is 2 to 4 cm in size, depending on the degree of maturity of the baby. Also, the norm will be a slight increase in the first month of a child's life, due to the rapidly increasing brain size. A slight protrusion or retraction of the membrane relative to the level of the skull bones may also be normal.

However, there are exceptions to everything. Sometimes deviations in the timing of overgrowing or the size of the crown may indicate some pathologies.

For example, a long non-healing, large fontanel in a child may indicate a number of diseases such as, for example:

  • down syndrome
  • hydrocephalus
  • hypothyroidism
  • rickets

Also, a too small fontanel in a newborn may indicate any health problem, i.e. when early ossification of the connective tissue occurs. In this case, we can talk about such deviations:

  • microcephaly
  • craniostenosis
  • developmental anomalies of the brain
  • meningitis
  • excess calcium in the body of a newborn

A cause for concern should be a fontanel that is obviously convex or sunken in shape. This may be an indicator of pathologies such as:

  • meningitis
  • encephalitis
  • tumor formations
  • intracranial pressure

But it should be remembered that any disease has a complex of symptoms, so it is impossible to draw conclusions based only on the "behavior" of the fontanel of a newborn. If there is nothing more alarming in the behavior of the baby, most likely, its development proceeds in the normal mode. Only a specialist can determine compliance with the norm or deviation from it, visits to which should not be neglected.

Why does the fontanel in the baby pulsate?


A completely physiological feature for a healthy newborn is a slight pulsation of the membrane. The fact is that the cerebrospinal fluid, the fluid that fills the ventricles of the brain, constantly circulates in the cerebrospinal fluid pathways. This leads to the pulsation of the brain tissue, which we observe in newborns under the connective tissue that covers the distance between the frontal and parietal bones.

The pulsation of the fontanel of the newborn is also provoked by the beating of the heart - each contraction of it leads to a rush of blood to the brain, this leads to the rhythmic movement of the crown of the child.

There are some deviations from the norm, which should alert the parents of the newborn and serve as a reason to see a doctor:

  • the fontanel pulsates too intensely
  • does not pulsate at all
  • the pulsation of the crown is accompanied by a strong anxiety of the child: constant crying; bad sleep; regurgitation; refusal to eat, etc.

In the process of growing up and healing the fontanel, the nature of the pulsation will change somewhat.
If the first two months of a newborn's life, the pulsation of the membrane is almost constant and visible to the naked eye, then by about three months of age it will be noticeable only during crying or when the child is very stressed.

How to care for the baby's fontanel?

Young parents consider the fontanel on the head of their crumbs the most vulnerable, easily injured place and simply prefer not to touch it. This is not quite the right approach, because. this area in a child is covered with the same skin as his entire body, therefore, it requires care and hygiene. There are no special rules for caring for a child's crown, it is enough to take into account some of its nuances:


  • it cannot be pressed;
  • comb your hair very carefully without touching the fontanel;
  • protect the newborn from hitting the head during games, swaddling, bathing;
  • if it is necessary to remove the birth crusts from the scalp of a newborn, it must be carefully lubricated with oil half an hour before bathing

Experts also advise regularly changing the position of the baby's body, turning him from side to side, picking him up, laying him on his stomach. When the baby is in one position for a long time, there is uneven pressure on the fontanel area, which can lead to a shift in the bones of the child's skull and, subsequently, to its deformation.

What should be the fontanel of a newborn baby? When should the fontanel close? What does too big or too small fontanel mean? What to do if the fontanel closes too early or too late? Fontanelles 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 from 3 to 24 or more months. Very often, fontanelles and the pace of their closure cause great concern to 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, the speed and limits of closure, as well as what to do if the fontanel closes too early or too late, retracts or bulges. 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. The flat bones of the skull grow in the center and along the edges. A suture is formed at the meeting point of the two bones of the skull. Where three or more bones of the skull meet, a gap in the shape of a polygon is formed. Such gaps covered with strong connective tissue are commonly called fontanelles.
The basis of the fontanel is an extremely strong connective tissue, which gradually ossifies along the edges, which leads to a gradual decrease in the size of the fontanel and its complete closure. Newborns have 6 fontanelles: anterior (largest), posterior (second largest), two mastoid and two wedge-shaped.
In most term babies, only the first two fontanelles are visible - the other four either close very quickly after birth or are so small that they are very difficult to see. Skull growth and the role of fontanelles in a child's life For most people, fontanelles are the only possible space for skull growth, and fontanel closure is associated with the end of skull growth. Actually it is not. The bones of the skull, as mentioned above, grow in the center and along the edges. Fontanelles (mainly anterior and posterior) occupy only a small length of the border between adjacent bones and therefore do not play a big role in the growth of the skull. The main role in the growth of the bones of the skull is played by sutures, which, unlike the fontanelles, remain open until the age of 20. The development of the bones of the skull is strictly dependent on the rate of development of the brain. 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 ensure the elasticity of the child's skull during childbirth and during the first years of life. Indeed, thanks to the fontanelles, 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 child is somewhat flattened on both sides and elongated in an anteroposterior direction. Such an ideal head shape for childbirth is formed during the birth process itself thanks to the fontanelles. Also, due to the elasticity of the fontanelles, 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 large open fontanel, the skull remains elastically deformed upon impact, which absorbs all the kinetic energy of the impact and protects the child from serious injuries. What should be the fontanelles in the norm? Usually, 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 according to a special formula:

(longitudinal fontanel diameter + transverse fontanel diameter)/2 In most newborns, the size of the posterior fontanel does not exceed 0.5-0.7 cm. The posterior fontanel usually closes in the second month of a child's life. Large (anterior fontanel) is usually well visible and always arouses great interest. A large number of misconceptions are associated with the “normal size” and “closing dates” of a large fontanel, which often frighten inexperienced parents. Here are some of them: - At birth, the size of the large fontanel is the same for all children.
- In fact, the normal size of a large fontanelle varies greatly. The limits of the norm of a large fontanel in newborns are 0.6 and 3.6 cm (average size 2.1, 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 a large fontanel must close
- In fact, the timing of the closure of the large fontanel is also individual, like other parameters of the child's development (the beginning of walking, teething, the beginning of coherent speech).
Observations on healthy children showed that in 1% of cases the large fontanel closes at three months, in a year the large fontanel is closed in about 40% of children, and in two years in more than 95% of children. Usually, in boys, a large fontanel closes somewhat faster than in girls. -The smaller the fontanel at birth, the faster it closes.
-In fact, there is no directly proportional relationship between the initial size of the fontanelle and the proximity of the moment of its closure. -Complete closure of the spring means a complete cessation of 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 ​​​​the 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 adult size. - The speed of fontanel closure depends on the intake of calcium and vitamin D in 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, in connection with which they cancel the prevention of rickets with vitamin D and transfer the child to a diet low in calcium. If we take into account that the normal terms for closing the fontanel vary from 3 to 24 months or more, then there can be no question of any “quick” closing of the fontanel in most cases. At the same time, the real threat to the health of the child is not the closure of the fontanel, but the cessation of the preventive use of vitamin D. The appearance of a large fontanel in a healthy child Outwardly, 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 do any harm to the child. What changes in the size or appearance of the fontanel indicate the disease? Usually, when examining a child, the size of a 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 too large fontanel or slow (late closure) fontanel mean Too large fontanelle or slow (late closure) can be a sign of the following diseases: Fontanel 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 fontanelle closure. Most often, rickets develops in premature babies who do not receive preventive treatment with vitamin D and who are too rarely exposed to the sun. In a child with rickets, the edges of the large fontanel are flexible, the back of the head flattens, and characteristic bone thickenings form on both sides of the sternum. Read more about the symptoms of rickets in the Rickets section. If rickets is suspected, the child should be shown to the pediatrician. If the diagnosis is confirmed, treatment with vitamin D preparations should be started as soon as possible. Congenital hypothyroidism Congenital hypothyroidism is a rather 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 can be 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, a 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 therapy. Achondrodysplasia This is a rare congenital disease of the bone tissue, 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. There are currently no effective treatments for achondrodysplasia. Down's syndrome Down's syndrome is one of the most common chromosomal diseases in which there are various deviations in the mental and physical development of the child. Usually, the diagnosis of Down syndrome is established immediately after the birth of a child according to a number of characteristic features, except for a large fontanel: one transverse masonry in the palm of your hand, a characteristic facial expression, a short neck, etc. If Down syndrome is suspected, the child should be shown to the pediatrician. The diagnosis of Down syndrome is confirmed by karyotyping (determination of the number and structure of human chromosomes). Children with Down syndrome need special care and treatment. Other causes In more rare cases, the slow closing of the fontanel or its large size are due to some other congenital diseases of the skeleton. The diagnosis of these diseases can only be made after a detailed examination of the child in specialized pediatric centers. Fontanel too small or fontanel closing too fast An early closure of the fontanel is said only when a large fontanel closes before three months, but even in this case it is not at all necessary that the child be sick. When assessing the condition of the fontanel, it is important to take into account not only its size, related to the age of the child, but also the overall circumference of the child's head. If the fontanel is too small or if it closes before 3 months, but with a normal head circumference, the child should be considered healthy.
The most common causes of early closure of the fontanel are the following diseases Early closure of the fontanel Cause Other signs of illness What should be done? Craniosynostosis A rare disease of the skeletal system, which is characterized by early closure of the sutures of the skull, a small circumference of the skull, increased intracranial pressure, hearing impairment, strabismus and dysplasia of other parts of the skeleton. Craniosynostosis can be congenital or occur against the background of rickets, overactive thyroid or parathyroid glands. Diagnosis of craniosynostosis is carried out in specialized pediatric clinics. Treatment of craniosynostosis is predominantly surgical. Anomalies in the development of the brain Very rarely, the reason for the too early development of the spring is an anomaly in the development of the brain. Diagnosis of this disease is carried out by specialists in the field of neuropediatricians. Treatment depends on the type and severity of the anomaly. What does a bulging (swollen) or sunken fontanel mean? The fontanel of a healthy child should be only slightly above or below the level of the surrounding bones of the skull 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, the retraction of the fontanel is observed due to dehydration of the child against the background of temperature, diarrhea, and repeated vomiting. If a sunken fontanel is found, the child should be given plenty of fluids and contact a doctor to treat the disease that caused dehydration. What does a bulging fontanel mean? Most often, a protruding fontanel is observed against the background of diseases that are accompanied by an increase in intracranial pressure: meningitis, encephalitis, tumors, intracranial bleeding, increased intracranial pressure for another reason.
If a bulging fontanel is combined with one or more of the following symptoms, you should call a doctor as soon as possible: strong temperature Bulging of the fontanel occurred after a head injury, a fall of a child Vomit Drowsiness or excessive irritability of the child Strabismus Convulsions or epileptic seizures Loss of consciousness Bulging fontanel for a long time without other symptoms Proper fontanel care A child's fontanel does not require any special care or protection. The fontanel area can be safely washed while bathing the child, and then blotted (not rubbed) with a towel. Copied from here

Many concerns of parents are associated with a pulsating area on the head of a newborn - a fontanelle. Anxiety causes care for the baby, there is a fear of harming him when exposed to an unprotected area. Parents are especially interested in when the fontanel in an infant overgrows, which is the norm, what deviations are possible.

Peculiarities

The fontanel is formed at the junction of the cranial bones of the child, connected by soft membranous tissue. It is dense enough to protect the brain from external influences: you can not be afraid to wash, comb and stroke the baby's head.

In the process of intrauterine development, 6 fontanelles are formed:

  • Two pairs on the sides (in front of the auricles and behind them) are rather narrow, more like seams. They are delayed by the time of birth or immediately after it and are invisible to parents:
  • Small in the occipital region (approximately 5 mm in diameter) - in most cases it closes during fetal development, more often observed in premature babies. Its overgrowing with bone tissue lasts from several days to two months;
  • The large one, located on the crown of the head, is tightened last. Its dimensions vary between 22-35 mm.

A baby can be born with a pathologically large fontanel as a result of prematurity, hydrocephalus (accumulation of excess fluid in the ventricles of the brain), or disorders in the development of the skeletal system. The reduced size of the parietal and complete closure of the remaining fontanelles is possible with a disproportion of a too small skull and brain compared to other parts of the body. Such cases require medical supervision, additional studies to determine the causes. The rate of overgrowth of the fontanel in babies with congenital pathologies may differ compared to children without deviations.

generally accepted norms

The parietal fontanel is characterized by a rhomboid shape, the width and length of which are in the range of 5–35 mm. To calculate the size, you need to determine the maximum dimensions of the soft area along and across, add the resulting numbers and divide by two. The average parameters of the parietal fontanel, depending on age, are shown in the table:

Age (in months) Formula size (cm)
up to 12,6-2,8
1-3 2,2-2,5
3-4 2-2,1
4-7 1,6-1,8
7-9 1,4-1,6
9-10 1,2-1,4
10-11 0,9-1,2
11-12 0,5-0,8

Dimensions are approximate, a deviation of a few mm up or down is acceptable. In the first three months, a slight increase in the fontanel is possible due to the intensive growth of the brain.

There is a dependence on the sex of the child (in boys, the soft area is tightened faster) and heredity: if one of the parents had early or late overgrowth without pathologies, a peculiarity may appear in the infant.

When should the fontanel drag on?

Dr. Komarovsky notes that normally tissue ossification occurs between the ages of 3 and 24 months. The exact time individually, depends on the characteristics of the development of the child. Closure is rare in three-month-old babies - about 1%, in about 40% an overgrown fontanelle is observed at the age of one, by two years the process is completed in 95% of babies. Later overgrowth is possible, in the absence of developmental abnormalities, it is considered normal.

fast overgrowth

The fontanel can drag on for a baby up to 6 months. With normal growth and development, this is not a deviation. The ossification of the soft tissue of the fontanel at the age of up to three months is considered too early. Occurs as a result of pathologies:

  • Craniosynostosis is a deviation in the formation of bone tissue, in which the fontanel is quickly tightened and the cranial sutures are completely fused, preventing the normal development of the brain. May be congenital or acquired, in most cases observed in combination with other developmental disorders;
  • Microcephaly - expressed in a decrease in the size of the head, refers to severe deviations in the development of the central nervous system. The main symptom is a reduced head circumference, a violation of proportions relative to other parts of the body;
  • Anomalies in the development of the brain - violations in its structure, a decrease in size, weight.

Such deviations are rare, not limited to manifestation in the form of a rapidly overgrowing fontanel.

slow closing

This problem is more common, occurs if the baby:

  • Congenital pathologies of the thyroid gland. Manifested by drowsiness, swelling, low activity of the baby, poor appetite, digestive problems, constipation;
  • - Premature babies often suffer from them. It can occur with a lack or calcium in the body. Symptoms are sleep disturbance, appetite, increased nervous excitability, sweating with the appearance of a specific sour smell;
  • Bone disease caused by genetic abnormalities - achondrodysplasia. Accompanied by growth retardation, shortened limbs, leads to dwarfism;
  • Down's disease is a developmental delay.

Serious diseases are quite rare, a comprehensive examination is necessary to confirm the diagnosis. To make a diagnosis, you need to consult a neurologist, an endocrinologist.

Common myths

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The most common misconceptions associated with the overgrowth of the fontanel:

  • Early closure limits brain growth. The bones of the skull are connected by sutures, which are completely fused after 20 years. They provide normal head growth and brain development. In case of early overgrowth of the fontanel, the condition of the seams is checked: if they are not closed, then there is no danger for the further development of the child.
  • Rapid overgrowth is caused by taking vitamin D and calcium supplements. They are prescribed taking into account the development of the baby for the prevention of rickets, only a lack of substances can affect the growth of bone tissue, which slows down the process and increases the period of overgrowth. The very intake of minerals, vitamins does not cause an acceleration of tissue ossification, it is an individual feature or occurs with violations in the development of the baby.
  • If by the year the fontanel in a child does not overgrow, then he has rickets. The disease is manifested by a number of signs and cannot be determined only by the rate of ossification of the membranous tissue on the baby's head.
  • A small fontanel in a baby at birth should grow faster and vice versa. The timing of tightening does not depend on the initial size of the membrane, but on the characteristics of the organism.

There is no exact time when a large fontanel in newborns overgrows . The process takes place individually, it is influenced by various factors. It is impossible to independently make diagnoses in case of deviations from the generally accepted terms for overgrowth of the fontanel. This cannot be the only symptom of serious diseases - they always have additional signs.

It is forbidden to independently prescribe medicines and use folk methods. For the health of the baby, it is important to follow the rule: discuss any concerns with the pediatrician, who, if necessary, will prescribe additional studies. In addition to the size of the fontanel, you need to pay attention to its condition: excessively convex or sunken may be a sign of illness or a deterioration in the child's condition.