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. New born child six fontanels. 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 hard to see.

Skull growth and the role of fontanelles in a child's life

In most people's minds, the 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. Most fast growth brain, and therefore 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. Due to the large open fontanel, the possibility of elastic deformation of the skull is retained upon impact, which dampens 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. With the "normal size" and "terms of closure" of a large fontanel is associated a large number of misconceptions that 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 of 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 fontanelle, 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 a too large fontanel or slow (late closure) fontanel mean?

Too much big sizes fontanel or its slow (late closure) may be a sign of the following diseases:

Fontanel too large or slow (late closure)

Cause

Other signs of illness

What should be done?

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 vitamin D and too little sun exposure.

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, vitamin D treatment should be started as soon as possible.

congenital hypothyroidism

Congenital hypothyroidism is a fairly rare disease in which there is a decrease in thyroid function. Because thyroid hormones are critical to skeletal growth, one of the most early signs 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, 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, there are short arms and legs, broad head, strongly protruding forehead.

Currently effective methods There is no cure for achondrodysplasia.

Down syndrome

Down syndrome is one of the most common chromosomal diseases in which there are various abnormalities in the mental and physical development 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 reasons

In more rare cases, the slow closing of the fontanelle 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.

Fontanelle too small or fontanel closing too fast

Early closure of the fontanel is spoken of 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, increased function of the 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 cause too early development spring is an anomaly in the development of the brain.

Diagnostics this disease carried out by specialists in the field of neuropediatrics. 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, provide the child with plenty of fluids and contact a doctor to treat the disease that caused dehydration

What does a protruding 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 care of the fontanel

  The baby'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.

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 growth the brain at the pace laid down by nature;
• The fontanel is involved in the processes of regulation of heat transfer of the baby and 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 old 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:

Moms take note!

Hello girls) I didn’t think that the problem of stretch marks would affect me, but I’ll write about it))) But I have nowhere to go, so I’m writing here: How did I get rid of stretch marks after childbirth? I will be very glad if my method helps you too ...

1. Rickets. This disease is almost the most common cause 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)

Careful examination of the child by specialists, detailed description parents of the baby's condition will be a guarantee early detection deviations and will contribute to the correct appointment of preventive treatment.

Reasons for the early closure of the fontanel

(clickable)

Fontanelle too small or fontanel closing too fast

Protruding fontanel?

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;
• 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:

Moms take note!

Hello girls! Today I will tell you how I managed to get in shape, lose 20 kilograms, and finally get rid of terrible complexes. fat people. I hope the information is useful to you!

The fontanel is a webbed formation on the head of a newborn baby, which for pediatricians is one of the indicators of normal development. In fact, by birth, a baby has six formations. Normally, they all tighten soon after childbirth. There remains one soft part of the skull, located in the region of the frontal and parietal bones.

It is this place that often worries parents. They are interested in: when the fontanel in the baby overgrows, is it worth worrying if it seems that the process has dragged on, and other questions.

It is known that thanks to the membranes, the baby's head is stretched at birth, which helps him easily pass the birth canal. The functions of the fontanel do not end there.

• It takes part in thermoregulation of the body. When a baby overheats (which happens to him much more often than adults), the fontanel is involved in heat transfer, thus regulating body temperature and protecting the meninges.
• Connective tissue serves as a kind of shock absorber for the bones of the skull, thanks to which it protects it from injury in case of possible falls and blows to the head.
• The fontanel swells slightly with an increase in intracranial pressure and can signal in time a possible disease of the baby.

Overgrowth terms

Overgrowth of the membrane can occur at 3 months, and maybe at 12 months. It happens that the fontanel overgrows only by 1.5-2 years. This shouldn't be a concern. Physicians know that the speed of closure often depends on heredity.

In the first months of life, a large fontanel may not even decrease, but increase in size. This is due to the intensive growth of the brain. The size of the soft formation after birth varies from 0.6 cm to 3.6 cm. Such a run-up in the range is associated with the individual characteristics of the babies and is considered the norm.

According to statistics, in most boys, the fontanel overgrows earlier than in girls.

Norm and possible deviations

In a healthy baby, the connective tissue is flush with the skull when lying down and sinks slightly when the baby is held upright. On palpation, a slight arterial pulsation is felt. With tension during screaming and crying, the soft tissue swells a little. The edges of the formation should be elastic, with a slight pressure on the soft tissues, quickly return to normal. Inspection and assessment of the condition of the fontanel should be carried out by a qualified doctor.

The following symptoms should be of concern:

• Too soft edges.
• Excessive bulge and tension of the connective tissue.
• A sunken spring.
• Growing too early.
• Late closing.

Soft edges can be a sign of rickets in a child. Softening of the bones occurs due to a lack of vitamin D, which is essential for the body during the period of active growth of the baby.

Bulge and tension soft tissue indicates high intracranial pressure and may be a sign of diseases such as encephalitis, meningitis, or hydrocephalus. This condition is usually accompanied by anxiety on the part of the child, prolonged unceasing crying, fever, vomiting, convulsions. Sometimes the opposite is true: the baby is lethargic, constantly in a state of drowsiness. When there is at least one of these signs, it is necessary to call an ambulance. Excessive bulge and tension can also occur due to an overdose of vitamin D.

Retraction of the fontanel most often occurs due to dehydration caused by high fever, vomiting or diarrhea. Pathological fluid loss is dangerous, requires examination by a pediatrician, and in case of severe dehydration, hospitalization of the child and appropriate treatment.

Early closure of the fontanel - at 3-4 months - is not always due to the genetics and individual characteristics of the child. Rarely, it is a sign of a serious condition called craniostenosis. Is there any reason for concern, the doctor will decide when he examines the baby.

The fontanel in a child can overgrow for a long time and completely drag on by 2 years, and this is normal. However, after 9-12 months, the process should be noticeable, and the size of the soft formation should gradually decrease.

When this does not happen, pathology is possible. It is necessary to conduct an examination and find out the cause of this condition. The problem may be related to the development of hydrocephalus; be the result of prematurity; indicate the presence of genetic abnormalities, such as Down syndrome, osteogenesis or achondroplasia. Late closure may occur due to rickets, microcephaly, or hypothyroidism.

Any suspicion of deviations in the state of the fontanel requires a thorough examination by specialists.

This will help to identify problems at an early stage and start treatment of the child in a timely manner. Parents need attention so as not to miss the initial signs of the development of serious disorders.

How to get rid of stretch marks after childbirth?

Many fears of a young mother are associated with fontanelles - soft areas on the head of a newborn baby. It’s scary to even touch the fontanelles - what if a careless movement injures the child’s brain? In addition, there are rumors that too large or small can be signs of serious diseases ...

A bit of anatomy

As you know, the skull consists of many bones connected to each other by sutures (they are not even, but jagged, zigzag lines). In the intrauterine period, the bones of the skeleton are laid down as plates of dense membranous tissue, which are later replaced by cartilaginous tissue, and then by bone. Ossification of the flat bones of the roof (upper and lateral parts) of the skull, in contrast to the long tubular bones of the extremities, bypasses the cartilage stage, i.e. ossification points appear in the center of the membranous plates. Subsequently, the ossification process spreads to the sides, capturing an increasing area of ​​\u200b\u200beach bone, until it reaches its edges. This process takes place almost entirely during prenatal development, therefore, most of the skull roof at the time of the birth of the baby is already represented by bone tissue, although the latter is significantly different from the bone tissue of adults: it is much thinner, more elastic, and rich in blood vessels. However, even before the start of extrauterine existence, the baby will face an important and difficult test - the birth process. And nature, of course, perfectly prepared a small organism for it. The fact is that some marginal parts of the bones do not ossify by the time of childbirth and are still represented by plates of connective, or membranous, tissue. These are the areas at the junction of several bones, they are called fontanelles.

By the time of birth, the baby, as a rule, has six fontanelles - two unpaired and two paired. The most "famous" is a large, frontal, or anterior, fontanel located on the top of the head, at the junction of two frontal and two parietal bones. It has a diamond shape, its dimensions at the time of birth are about 3 cm (from 2.2 to 3.5 cm).

Another unpaired fontanel, called the small, posterior, or occipital, is located on the back of the head, at the junction of the two parietal and occipital bones. It has a triangular shape and small dimensions - about 5 mm. In half of the cases, it may already be closed by bone tissue by the time of birth, in the rest it closes during the first month of the baby's life.

Paired fontanelles are located on the sides of the head. Known wedge-shaped fontanel, located in the temporal region, at the convergence of the frontal, parietal, sphenoid and temporal bones of each side. Behind the ear, at the junction of the occipital, temporal and parietal bones, is the mastoid fontanelle.

An increase in fontanelles at birth may be a consequence of prematurity or a violation of the intrauterine ossification process, as well as a symptom of congenital (expansion of the fluid spaces of the brain). Complete closure of the lateral and occipital fontanelles at birth, combined with the small size of the anterior one, may be a sign of congenital microcephaly (a pathological decrease in the size of the head and, as a rule, the brain).

The occipital and lateral fontanelles, unlike the anterior one, normally close shortly after the birth of the baby, therefore, when they say “fontanelle” in the singular, they mean the anterior, or large, fontanel.

So, the integuments of the brain in the fontanel region are represented by the membranes of the brain (soft cerebral, arachnoid and dura mater), membranous connective tissue, a thin layer of adipose tissue and skin.

Why are fontanels needed?

The fontanelles, being pliable areas, perform an extremely important function: they allow the bones of the skull to overlap each other during childbirth (this is called the “head configuration”), which greatly facilitates the passage of the head through the narrow birth canal. After childbirth, the large fontanel that remains open performs the function of shock absorption in case of accidental hits of the baby's head. And finally, the fontanel is actively involved in thermoregulation in general and in the heat exchange of the brain in particular. When the temperature rises above normal through the large fontanel, additional natural cooling of the brain and meninges occurs. Due to the imperfection of the mechanisms of thermoregulation, the infant body, compared to the body of adults, overheats much more easily, and the brain of infants is much more sensitive to various kinds of negative influences. That is why the additional role of the fontanelle in heat transfer is so important.

The size and timing of the closure of the fontanel

A large fontanel has a maximum size (from 2.2 to 3.5 cm) at the time of birth. In the first days after childbirth, due to the "straightening" of the skull bones and interosseous sutures, the absolute size of the fontanel may increase slightly, but this does not reflect the true growth of the fontanel, but is associated with a slight change in its shape. Subsequently, the size of the fontanel begins to steadily decrease, its closure occurs in a period of 6 to 18 months. There are cases when, normally, the closure of the fontanel occurs at an earlier (from 3 to 6 months) or later (up to 2 years) terms.

The size of the large fontanel and the speed of its closure are genetically determined factors. No one has yet managed to change the genetic predisposition of a person. These conclusions were reached by a special commission of WHO, which in 1982 conducted a worldwide statistical study on the dependence of the physical and mental development of the child on the size of the fontanelle and the speed of its closure.

Nevertheless, perhaps, it is precisely with the size and timing of the closure of the fontanel that largest number parental experiences. And to this day you can hear "horror stories" and myths about this.

Neither kissing nor combing hairs over the fontanel area can harm the baby.

Myth one. "If the fontanel is too large, it's most likely rickets." The size of the fontanel in no way correlates with this disease. In the “blooming” phase, when there is a significant softening of the bones, softening of the bony edges of the fontanel can also be noted, but this will not affect the size of this formation. In addition, rickets has other symptoms.

Myth two. "If the fontanel is too small, vitamin D should not be given, even if it is accompanied by clear signs of rickets." If the baby has obvious signs of rickets - an increase in neuro-reflex excitability, a decrease in muscle tone, a sour smell of sweat, the growth of frontal and parietal tubercles on the bones of the skull, a change in the ratio of calcium and phosphorus ions according to biochemical data (we do not include nape baldness as part of this list as an independent symptom, since significant hair loss occurs in all infants at the age of about 3 months), he is shown the appointment of vitamin D and calcium supplements ( worthy alternative can serve as homeopathic preparations that normalize calcium-phosphorus metabolism in the body). This therapy, subject to the correct dose regimen, is not able to accelerate the closure of the fontanel.

Myth three. “If the fontanelle does not grow over for too long, it is either rickets or hydrocephalus.” The size and timing of the closure of the fontanel are very ambiguous indicators. The fontanel may be larger than the average size, but close rather quickly, and vice versa. We have already talked about the symptoms of rickets above. An increase in intracranial pressure may be accompanied by anxiety of the baby, sleep disturbances, muscular dystonia, changes in the vessels of the fundus. At the same time, parents may notice common symptoms - drowsiness or sleep disturbances, anxiety, tearfulness. And doctors will pay attention to muscle tone, the fundus, the fontanelle, measure the growth of the head, etc. In addition, with hydrocephalic syndrome (an increase in the amount of fluid in the brain), there is a significant increase in the monthly increase in head circumference, in severe cases - divergence of the edges of the cranial sutures, divergence of the edges of an already overgrown fontanel. That is why doctors are guided not by the size of the fontanel, but by the growth rate of the baby's head.

Myth four. “If the fontanelle closes too quickly, the brain will have nowhere to grow and mental disability will develop.” It has long been proven that the growth of the skull is carried out not so much due to the area of ​​the fontanel, but due to the sutures, so the "early" closure of the fontanel does not harm this process at all.

Myth five. “It’s better not to touch the head in the fontanel area - you can damage the brain.” Such fears are also unfounded. Despite the apparent vulnerability of this area, the brain is reliably protected by numerous layers of tissues. Therefore, neither kissing, nor wiping with a towel, nor combing hairs over the fontanel area can harm your baby.

What will the doctor pay attention to?

On examination breastfeeding" class="wordlink" title="(!LANG:https://www.7ya.ru/pub/chest">грудничка !} the doctor will definitely evaluate the area of ​​\u200b\u200bfontanelles. In doing so, the following questions will be asked:

• Are the corresponding fontanelles open or closed? Is it appropriate for the child's age?
• If the fontanelles are open, what are their sizes? Have they increased or decreased since the last inspection? Is the shape of the fontanels symmetrical?
• Are the edges of the fontanel pliable or too softened? Normally, the edges of the fontanel should be elastic and pliable. If they are excessively soft, this may indicate the development of rickets - a typical growth disease, manifested by a lack of formation and mineralization of bones and their softening, mainly due to a lack of vitamin D during the period of the most active growth of the baby.
• What is the condition of the soft (webbed) area of ​​the fontanel? Normally, the fontanel repeats the configuration and level of standing of the bones of the skull (if you examine the baby in the prone position) or slightly sinks (if you take it on the handles in an upright position). On palpation, it is easy to push it with the fingertips, while the arterial pulsation is clearly felt. When crying, the fontanel bulges a little, becomes a little more tense. Significant bulging and tension of the fontanelle, accompanied by a decrease or cessation of arterial pulsation and remaining at rest, raises the suspicion of an increase in intracranial pressure and / or an increase in the amount of cerebrospinal fluid in the spaces of the brain (this condition is known as hypertensive-hydrocephalic syndrome). The cause of this condition can be complications during pregnancy and childbirth, and even an overdose of vitamin D. Bulging and tension of the fontanel can also be one of the symptoms.

Many people know that a baby has a soft spot on its head called a fontanelle. Fewer are those who are aware of the existence of lateral and posterior fontanelles. And certainly not everyone is sure why they are needed and what it really is.

• Soft spring

  In infants, the skull is not solid; it is made up of many individual bones. They are connected by a kind of membrane, when the child passes through the birth canal, this helps to flatten the head a little, otherwise natural childbirth would be impossible. In total, newborns have six fontanelles:

  • front;
  • rear;
  • a pair of mastoid lateral;
  • a pair of wedge-shaped lateral.

  After the baby is born, the connective tissue gradually transforms into bone. In pediatrics, some norms have been established regarding the timing of the closure of fontanelles:

  1. The posterior fontanelle closes the fastest of all - in a maximum of 2 months, it can also close by the first month of a baby's life.
  2. Then the wedge-shaped ones close, it takes about six months.
  3. The next mastoid, their closure lasts from six months to one and a half years.
  4. The anterior fontanel can be soft up to the age of two.

  Most of all, moms have questions about the anterior fontanel. At birth, its size is from 2 to 3.5 centimeters. Many are afraid to even just touch this soft area on top of their heads, although a mother can kiss a child on the fontanel or comb her hair without any fear. There are many rumors associated with this area, so mothers start to worry when they think that the size of the fontanel is too large or it is not tightening fast enough. We would like to clarify all the incomprehensible points and thereby reassure young mothers.

  Why is the fontanel big

  In most cases, it just seems to the mother that the fontanel is larger than it should be, but normally it can reach a size of 3.5 centimeters. Sometimes a simple measurement dispels all doubts and confirms that the size does not exceed the norm. There are certain factors that affect the size of this area:

  №	Causes of a large fontanel	Cause description
  1	hereditary predisposition	If one of the baby's grandmothers confirms that the parent was also born with a large fontanel, then this is absolutely not dangerous for the baby and is just a family feature.
  2	Problems during gestation	If the mother was deficient in vitamins, ate irregularly and did not take care of her diet, then this may be one of the reasons for the increased size. A pregnant woman should carefully take care of her menu, take special vitamin complexes and walk more
  3	baby menu	A child who is breastfed usually does not have such problems, but artificial ones sometimes have a large fontanel

  To understand what kind of fontanel tightening dynamics is normal, check out the table:

  Age	Dynamics
  1 month	During this period, no visible changes in size are observed.
  2 months	Sometimes at this age, the fontanel increases slightly. This is the normal version
  4 months	Approximately at this time, the first changes in the direction of decrease begin.
  6 months	The pulsation of the fontanel remains noticeable, so it is difficult to accurately measure changes
  8 months	The area acquires a rounded shape, the pulsation decreases
  1 year	Some fontanelles are delayed by this time, others may remain partially open until the age of 2 years

  Note that no relationship was found between the size of the fontanel at birth and its subsequent changes. Some pediatricians note that in boys this process is faster than in girls.

  If at 8 months the fontanel is still too big and hasn't changed much since the baby was born, tell your pediatrician about it for advice.

  What can a large fontanel say

  In rare cases big size The fontanel can still signal serious problems:

  №	Causes of a large fontanel	Description
  1	Rickets	This is a disease that is characterized by the fact that the child does not receive enough calcium, because of this, the formation of bones occurs with disturbances. It often happens in those babies who do not receive enough vitamin D, they rarely go out into the sun, sometimes this is the result of prematurity. In addition to an unretractable fontanel, one of the symptoms is a thickening of the bones on the sides of the sternum. In this case, you need to show the child to the doctor, most likely, he will be prescribed vitamin D.
  2	Down syndrome	It is clear that this syndrome is diagnosed immediately after the baby is born according to the characteristic appearance and the only transverse fold on the palm, an additional study of the number of chromosomes is assigned. This disease entails deviations in physical development, as well as in mental development. This child needs help. medical workers throughout life
  3	Hypothyroidism	In this disease, the main functions of the thyroid gland are reduced in humans. Additional symptoms: lethargy, lethargy, drowsiness, frequent constipation, refusal to eat. Since the thyroid gland affects the formation of the skeleton, it also indirectly affects the tightening of the fontanel. To accurately determine the diagnosis, you need to donate blood to determine the concentration of hormones. If the disease is confirmed, the doctor prescribes hormone replacement therapy
  4	Chondrodysplasia	The disease is extremely rare, its other name is dwarfism. In babies with this disease, the arms and legs are slightly shorter than in other children, the head is wide, and the forehead protrudes significantly. In modern medicine, the disease is recognized as incurable.
  5	Hydrocephalus	In this disease, an excess amount of cerebrospinal fluid accumulates in the brain. The disease has several stages, depending on the complexity, doctors make predictions. To date, there is an operation that can help the child, and if the disease is detected immediately after childbirth and the operation was performed on time, then the consequences for the child will be minimal.
  6	Apert syndrome	This is a pathology of cranial development, the most striking symptom: anomalies of the hands, for example, fusion of fingers. It is a rare disease that occurs in one in 180,000 babies. Treated with surgery
  7	Clavicular-cranial dysplasia	It is inherited. With this syndrome, developmental disorders of the cranial bones are noted, the clavicles are either underdeveloped or completely absent. It occurs in 1 in a million children born. Doesn't affect at all mental development child
  8	"Glass/Crystal Man" Syndrome	With this pathology, human bones lack collagen, they become too brittle and break from minor impacts. There are 4 types of the disease, differing in severity of manifestations

  As you may have noticed, most of these diseases are rare, if not exotic. The most common cause of a large fontanel is the prematurity of the baby.

  preterm birth

  A baby is considered premature if it is born at less than 37 weeks of gestation. In Russia on this moment Babies are considered viable from 22 weeks. However, cases of rescue of 20-week-old babies have been recorded.

  There are many factors that affect the timing of the birth of a child. There are reasons that the mother cannot influence:

  • previously, the mother had operations on the uterus or abdominal organs;
  • multiple pregnancy;
  • placenta previa;
  • the gender of the baby is male (boys are more often born prematurely);
  • severe illnesses.

  However, some of the risk factors are the responsibility of the mother:

  №	Factors	Description
  1	Stress	Frequent stress, high fatigue at work, especially at work later dates lead to early delivery. This also includes riding in public transport during rush hour for a significant period of time and refusing to part with heels
  2	Nutrition	Irregular eating, skipping meals can affect the health of the mother. Some pregnant ladies believe that they have gained a lot of weight and drastically limit their diet in pursuit of beauty. This negatively affects the condition of both mother and child!
  3	Mother's age	Prematurity is experienced by minors and ladies of elegant age (closer to 40 years), especially if their first pregnancy
  4	Bad habits	If during pregnancy the mother smokes, drinks or uses drugs, then this is a direct path to premature birth.

  Try to watch your diet, not worry about troubles at work, protect yourself from worries. And of course, do not poison your child with poisons. Some mothers refer to their acquaintances who drank/smoked, and "everything is fine with the child." Each child is individual, in addition, it is impossible to predict the impact of these substances on the health of the baby in the future.

  A large fontanel in the vast majority of cases is not a pathology, rather, a feature of development.

  If you're still worried, then just handle it with care:

  1. No need to put pressure on this tender area. If it is sunk or, conversely, slightly swollen, then contact your pediatrician for advice. You don't need to explore it yourself.
  2. Do not comb your baby's hair too often so as not to disturb the fontanel area. An ungrown fontanel is easy to injure with the teeth of a brush or comb.
  3. Make sure that there are no scratches, abrasions and wounds in this place.
  4. Do not let the baby sleep on one side or only on the back, turn it over. It also contributes to the formation correct form skulls.
  5. If you see crusts or peeling in this place, lubricate them with cosmetic baby oil or cream, then carefully comb them out.
  6. Try to reduce the impact on the fontanel: carry the baby in your arms, put on a hat.
  7. Save your baby from stress and excessive crying, if you continue to breastfeed, then eat more cottage cheese and dairy products.

  Most importantly, do not panic, especially under the age of six months. At this age, it is still impossible to track the dynamics of overgrowth of the fontanel, the doctor should recommend that you add vitamin D to the child's diet (2 drops per day) and continue to monitor the general condition of the baby.

  Summing up

  Dangerous and incurable conditions, which are accompanied by an increased size of this area, are extremely rare. Moreover, they are usually diagnosed immediately after birth. If this did not happen in your case, then the ecology and the modern rhythm of life, which is exhausting, are most likely to blame. future mother and affects her general condition.

  Video - fontanel. Doctor Komarovsky