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Baby soft spot closes


5 Warning Signs From Your Baby’s Soft Spot – Cleveland Clinic

When you’re a new parent, you learn that you need to protect that soft spot, or fontanelle, on your baby’s head. It rarely requires much attention, but it reminds you just how fragile your infant is.

That’s why, if something changes — is the soft spot sunken in a little? — you may worry there’s something wrong.

A change in the fontanelle isn’t always a major problem, but it can sometimes reveal internal issues, says Violette Recinos, MD, Section Head of Pediatric Neurosurgery at Cleveland Clinic.

“It is a good indicator of the baby’s potential hydration status and brain status,” she says. “It’s like an automatic pressure sensor.”

What is the fontanelle?

The fontanelle is the space between different plates of a baby’s skull that will eventually come together. This aspect of an infant’s skull structure typically allows for easy delivery through the birth canal and for rapid head growth during the first year of life, Dr. Recinos says.

There are actually two soft spots — one at the back of the head and another on top. The posterior one closes within a few months of birth, while the top fontanelle typically remains until just past a child’s first birthday.

Dr. Recinos explains what changes in the fontanelle can tell you about your infant’s health.

Sunken in soft spot

This is often a sign of dehydration, she says. It may occur if your child is sick and not getting enough fluids.

What you should do: See your pediatrician if the sunken appearance persists and you can’t get your baby to take in more fluids.

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Swollen soft spot

After a fall, a swollen soft spot (particularly if it’s accompanied by vomiting) is sometimes a sign of head trauma.

What you should do: Seek medical treatment right away.

Bulging soft spot

Fluid buildup (hydrocephalus) can cause rapid head growth and can make the soft spot look “full,” Dr. Recinos says.

A bulging fontanelle also might signal internal bleeding or a tumor or mass causing pressure in the head.

What you should do: If their soft spot is bulging, that’s a reason to seek care from your pediatrician, she says.

Seek emergency care if your infant exhibits fatigue, vomiting or unusual mental status along with the fontanelle’s fullness. Treatment for these conditions may include surgery to insert a shunt that relieves fluid buildup or to remove any underlying mass, Dr. Recinos says.

Disappearing soft spot

Most of the time the soft spot is obvious, particularly on a newborn. But at times it can seem to disappear quickly.

This may scare parents, but it typically means it’s just a “quiet fontanelle,” not that it has fused together prematurely, Dr. Recinos says.

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As long as your child’s head is growing normally, all is probably well, she says. But your pediatrician may suggest an imaging test to make sure the fontanelle is still open.

Occasionally, though, the skull bones do close earlier than normal on one side, causing craniosynostosis. Depending on which bones fused, the baby may develop an abnormal head shape. For example, sagittal craniosynostosis, the most common form, results in a longer head that is shaped somewhat like a football.

What you should do: Children with craniosynostosis may need surgery to open the fused bones and reshape the skull. In some cases, the child will wear a helmet afterward until the site heals and the head shape normalizes.

Soft spot that doesn’t close

If the soft spot stays big or doesn’t close after about a year, it is sometimes a sign of a genetic condition such as congenital hypothyroidism.

What you should do: Talk to your doctor about treatment options.

The bottom line? If you have any questions or concerns about your baby’s soft spot, it’s a good idea to check in with your pediatrician to make sure all is well.

About the fontanelle | Pregnancy Birth and Baby

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What is a fontanelle?

A fontanelle is a ‘soft spot’ of a newborn baby’s skull. It is a unique feature that is important for the normal growth and development of your baby’s brain and skull. Your health team will check your baby’s fontanelles during routine visits.

If you touch the top of your baby’s head you can feel a soft spot in between the bones — this is a fontanelle.

A newborn baby’s skull is made up of sections of bone known as plates that are joined together by fibrous joints called sutures. The sutures provide some flexibility and allow your baby’s head to narrow slightly as it travels through the birth canal. The sutures also enable your baby’s head to grow in the first years of life.

There are 2 fontanelles on your baby’s skull. These are the skin-covered gaps where the skull plates meet. The anterior fontanelle is at the top of your baby’s head, and the posterior fontanelle is located at the back of your baby’s head.

Illustration showing the anterior and posterior (front and back) fontanelles of a baby's skull.

When will my baby’s fontanelles close?

The posterior fontanelle usually closes by the time your baby is 2 months old. The anterior fontanelle can close any time between 4 and 26 months of age. Around 1 in every 2 babies will have a closed fontanelle by the time they are 14 months old.

Can I touch my baby’s fontanelles?

Yes, you can gently touch your baby’s fontanelles. If you run your fingers softly along your baby’s head you are can probably feel them. Your doctor will touch your baby’s fontanelles as part of their routine medical examination. There is no need to be concerned or worried about touching your baby’s fontanelles as long as you are gentle.

What does a normal fontanelle look like?

Your baby’s fontanelle should feel soft and flat. If you softly touch a fontanelle, you may at times feel a slight pulsation — this is normal. If a fontanelle changes, or feels different to how it usually does, show your doctor or midwife as it may be a sign that your baby’s health may need to be checked.

Sunken fontanelle

If you notice that your baby’s fontanelles are low or sunken, your baby may be dehydrated.

However, you may notice other signs of dehydration in your baby before their fontanelles becomes sunken.

Other signs of dehydration include:

  • having fewer wet nappies
  • not feeding well
  • loosing fluids from vomiting or diarrhoea
  • perspiration (or sweating) in very hot weather
  • being less alert or floppy

Bulging fontanelle

A bulging or swollen fontanelle may be a sign of a number of serious but rare conditions including meningitis or encephalitis (infections in the brain), cerebral haemorrhage (bleeding in the brain), hydrocephalus, an abscess or another cause of increased pressure in the brain.

If you think that your baby’s fontanelles are bulging or sunken, seek medical advice immediately.

What if a fontanelle closes too soon?

Your baby’s fontanelles may close early. This can happen for several reasons. Your baby may have hyperthyroidism (high levels of the thyroid hormone) or hyperparathyroidism (high levels of parathyroid hormone). Another cause of early fontanelle closure is a condition known as craniosynostosis. Craniosynostosis occurs when one or more of the fibrous joints (sutures) between the bone plates in a baby’s skull fuse too early, before the brain has finished growing. As the brain continues to grow, it pushes on the skull from the inside but cannot expand into the closed over area. This causes the skull to have an unusual shape.

If you notice that your baby’s fontanelles seem to have closed early, if you can feel a ridge along your baby’s skull, or if you think that your baby’s head has an unusual shape, take your baby to see their GP or paediatrician.

What if a fontanelle doesn’t close?

Your baby’s fontanelles may not close on time for several reasons. Common reasons for delayed fontanelle closure include congenital hypothyroidism (low thyroid hormones from birth), Down syndrome, increased pressure inside the brain, rickets and familial macrocephaly (a genetic tendency to have a large head).

If one or both of your baby’s fontanelles haves not closed by the time they are 2 years old, speak to your GP or paediatrician.

If you have any concerns about your baby’s fontanelles you should make an appointment to see your child health nurse, GP or paediatrician.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
Children’s Health Queensland Hospital and Health Service (Craniosynostosis), American Family Physician (The Abnormal Fontanel), Australian Family Physician (The 6 week check - An opportunity for continuity of care), WA Health (Bulging Anterior Fontanelle), The Royal Children's Hospital Melbourne (Clinical Practice Guidelines: Dehydration)

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Last reviewed: February 2022


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