Causes of sunken fontanelle

Fontanelles - sunken Information | Mount Sinai

Sunken fontanelles; Soft spot - sunken

Sunken fontanelles are an obvious curving in of the "soft spot" in an infant's head.

The sutures or anatomical lines where the bony plates of the skull join together can be easily felt in the newborn infant. The diamond shaped space on the top of the skull and the smaller space further to the back are often referred to as the soft spot in young infants.

The fontanelles should feel firm and very slightly concave to the touch. A noticeably sunken fontanelle is a sign that the infant does not have enough fluid in its body.

Considerations

The skull is made up of many bones. There are 8 bones in the skull itself and 14 bones in the face area. They join together to form a solid, bony cavity that protects and supports the brain. The areas where the bones join together are called the sutures.

The bones are not joined together firmly at birth. This allows the head to change shape to help it pass through the birth canal. The sutures gradually gain minerals and harden, firmly joining the skull bones together. This process is called ossification.

In an infant, the space where 2 sutures join forms a membrane-covered "soft spot" called a fontanelle (fontanel). The fontanelles allow the brain and skull to grow during an infant's first year.

There are normally several fontanelles on a newborn's skull. They are located mainly at the top, back, and sides of the head. Like the sutures, fontanelles harden over time and become closed, solid, bony areas.

The fontanelle in the back of the head (posterior fontanelle) most often closes by the time an infant is 1 or 2 months old.
The fontanelle at the top of the head (anterior fontanelle) most often closes within 7 to 19 months.

The fontanelles should feel firm and should curve inward slightly to the touch. A noticeably sunken fontanelle is a sign that the infant does not have enough fluid in their body.

Causes

Reasons a child may have sunken fontanelles include:

Dehydration (not enough fluid in the body)
Malnutrition

When to Contact a Medical Professional

A sunken fontanelle can be a medical emergency. A health care provider should check the infant right away.

What to Expect at Your Office Visit

The provider will perform a physical exam and ask questions about the child's symptoms and medical history, such as:

When did you first notice that the fontanelle looked sunken?
How severe is it? How would you describe it?
Which "soft spots" are affected?
What other symptoms are present?
Has the baby been ill, especially with vomiting, diarrhea, or excessive sweating?
Is the skin turgor poor?
Is the baby thirsty?
Is the baby alert?
Are the baby's eyes dry?
Is the baby's mouth moist?

Tests may include:

Blood chemistries
CBC
Urinalysis
Tests to check the baby's nutritional status

You might be referred to a place that can provide intravenous (IV) fluids if the sunken fontanelle is caused by dehydration.

Goyal NK. The newborn infant. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 113.

Wright CJ, Posencheg MA, Seri I, Evans JR. Fluid, electrolyte, and acid-base balance. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 30.

Last reviewed on: 2/2/2021

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Sunken fontanel: Causes, picture, and complications

A sunken fontanel occurs when the soft spot on a baby’s skull becomes more deep set than usual. One of the major causes is dehydration.

The human skull is made up from several bones that are connected by tough fibrous tissue called sutures. These sutures give the skull some flexibility, allowing the head to pass through the birth canal.

Where several sutures meet, they create a fontanel. Fontanels make the skull flexible enough for the brain to grow. When a child is born, it will have several fontanels on the skull, but the ones on the back (posterior) and top (anterior) of its head are the most well-known.

For many babies, only the larger anterior fontanel is open after birth. People refer to this fontanel as the soft spot.

Sometimes, the smaller posterior fontanel is also open and may be felt at birth but soon closes.

Over time, this flexibility becomes less necessary, so the fontanels close up, and sutures harden.

The anterior fontanel should curve slightly inwards but remain relatively firm. It is not always visible, particularly under hair. In some cases, the dip may be very pronounced and noticeable. This is a sunken fontanel, which requires medical attention.

Share on PinterestA baby’s skull can have a soft spot, which is called a fontanel.
Image credit: Nojhan, 2005.

Dehydration is the primary cause of a sunken fontanel.

Dehydration occurs when an infant does not have sufficient fluid in their body to maintain normal functioning. This can happen for a many reasons, including:

vomiting
not drinking enough fluids
diarrhea
fever
urinating too often

Dehydration in children can range from mild to severe. More severe cases will require immediate medical attention to avoid complications.

A sunken fontanel can be a sign of dehydration. Other symptoms will usually be present and can include:

dry tongue and lips
dry, cool skin
rapid heart rate and breathing
infrequent urination
no tears when crying
sunken eyes

It is also possible, though uncommon, for a sunken fontanel to be a sign of malnutrition. Malnutrition can result from a calorie deficit or an underlying condition, such as malabsorption syndrome.

Infants with malnutrition will almost always display other signs, including:

being underweight
dry, inelastic skin
dry hair that falls out easily
fatigue or lethargy

Share on PinterestA doctor may visually examine the baby to help diagnose the cause of a sunken fontanel.

A doctor will visually examine the fontanel and gently feel the area to help determine whether the structure of the fontanel is abnormal. An abnormal structure could indicate an underlying problem.

A doctor will also check for signs of dehydration or malnutrition. This could include monitoring the baby’s heart rate and breathing or feeling the skin for dryness and reduced elasticity.

The doctor will ask when a person first noticed the sunken fontanel. They will also ask questions relating to the infant’s overall health, such as whether they have had a fever or bouts of vomiting or diarrhea.

They will want to know about the baby’s feeding habits and whether they have been urinating more or less than usual.

The diagnosis may require blood or urine samples.

If the sunken fontanel is due to dehydration, immediate medical attention may be necessary, sometimes in the hospital.

In a hospital, a doctor will give the infant fluids orally to prompt rehydration. If the infant has been vomiting, doctors may administer fluids into the bloodstream through an intravenous (IV) line.

This treatment will continue until fluid levels reach an acceptable level.

Parents and carers may be able to treat mild cases of dehydration at home by encouraging the infant to drink or feed if they breastfeed. However, people should only try to treat dehydration at home if a doctor has examined the baby and instructed them to do so.

If the cause of the sunken fontanel is malnutrition, treatment will vary depending on the underlying cause. It will typically involve increasing overall calorie intake or a specific nutrient.

In some cases, it may be necessary to deliver nutrients through an IV line or a tube.

Share on PinterestKeeping a baby hydrated and well-fed can help prevent a sunken fontanel from occurring.

It is possible to treat most cases of dehydration quickly and easily.

Malnutrition can be challenging to treat, depending on the cause.

However, the longer an infant goes without treatment, the greater their chances of lasting damage become.

The human body needs to stay hydrated to function. A prolonged period of dehydration can lead to brain damage and even death.

Prolonged malnutrition can lead to developmental delays and disability.

Fontanels occur naturally in infants. It is normal for a fontanel to form an inward curve in infants while their skull is still hardening. But in some cases, it may become sunken, and the cause may need medical treatment.

A sunken fontanel, when accompanied by other symptoms, can be a sign of dehydration or malnutrition.

Some baby’s fontanels always appear slightly sunken even when they are well. Sometimes, a baby is dehydrated but does not have a sunken fontanel. It is vital to know the signs of illness and dehydration in a baby and seek medical help, regardless of the appearance of their fontanel.

Delaying treatment of dehydration or malnutrition can have severe and lasting consequences for the infant’s development. Anyone concerned about a sunken fontanel should speak to a doctor as soon as possible.

reasons and what to do about it

December 14, 2018

Averyanova Sveta

Nature took care of the safety of the baby when passing through the birth canal. On his head there are soft tissues at the junction of the bones of the skull. Thanks to them, the shape of the baby's head changes during childbirth, and then returns to its previous form.

In total, a newborn has six fontanelles, the smallest ones overgrow in a few days. The occipital turns into bone tissue within 2-3 months. The largest fontanel - parietal - completely disappears by two years.

Important! Soft tissues are reliably protected by a special membrane, do not be afraid to crush them with a cap or damage them when caring for the baby.

Temechko serves as an indicator of the child's condition. According to its appearance and shape, the correct development of the baby is judged. A sunken fontanel in a baby can be a sign of a serious illness. Let's figure out why the fontanel sinks, what the sinking looks like and what to do if there is a depression in place of the fontanel.

In this article you will learn

Why there can be a sunken fontanel
How to understand that the fontanel is sunken (signs)
What to do
When to see a doctor

Why there can be a sunken fontanel

but a symptom of other health problems. The confluence of the crown in most cases can be a sign of dehydration in the baby's body. Dehydration is caused by:

insufficient fluid intake, especially when formula-fed or on a schedule;
high temperature with significant sweating, resulting in loss of moisture;
digestive problems with vomiting, diarrhoea, malabsorption of fluids;
presence of infection or virus in the body;
nervous diseases;
perinatal disorders;
hot season.

Important! Dehydration can be prevented through good nutrition and nursing.

Sometimes sinking is a normal physiological process. If the fontanel in the baby has fallen, the reasons may be as follows:

The child is overdue. In this case, this is normal and does not require treatment. By six months, everything is back to normal.
Periodically, the fontanel may droop slightly if the child is held upright.
During crying, the crown is able to retract or protrude.

Find out how to find out how serious the problem is, what it is and what to do to help your child.

Here is what Dr. Komarovsky says about it.

How to understand that the fontanel is sunk (signs)

Normally, the parietal spring is diamond-shaped, it is reliably protected by a dense membrane, does not stick or protrude beyond the bones of the skull. When touched, a pulsation is felt, the number of beats per minute does not differ from the heart rate of the child (the norm for babies is no more than 130 beats).

The table provides information that will help determine if there is a problem with the parietal fossa.

Feature	Normal	Abnormal
Significantly protrudes beyond the bones of the skull	May sag when held upright. During the period of intensive growth of the brain, protrusion is possible.	If at rest it is constantly as if depressed, the fossa is clearly visible or, conversely, protrudes outward.
Pulse rate	Age appropriate.	May pulsate strongly, more than 130 beats per minute.
Size of the fontanel	Norm - a generalized indicator, may differ depending on the genetic features of the structure of the skull.	A significant deviation from the norm by age (we are not talking about a few millimeters, but about an increase of several times).
Overgrowing time	Depends on the physiological characteristics of the child, as a rule, completely closes at 12-18 months.	It is worth consulting a pediatrician if the crown is overgrown before 5 months or has not closed after 2 years.
Presence of additional signs of the disease	None, the child has a normal appetite, he is active.	There are always additional signs that may indicate the presence of dehydration or brain disease.

Important tip! It is necessary to check the condition of the crown of the child in a horizontal position, at rest, for example, when he has a daytime sleep.

According to Dr. Komarovsky, a change in the appearance of the fontanel as the only symptom does not indicate pathology. You should not stuff your child with medicines or force water. In situations requiring treatment, changes in the soft crown always accompany other signs of the presence of the disease:

When dehydrated, the baby becomes sleepy, lethargic, mucous membranes and skin dry up, the baby cries without tears, urination decreases (the norm is 10 wet diapers per day), urine becomes dark, has a pungent odor.
Severe dehydration is deadly, the child urgently needs medical attention.
Typical symptoms of brain diseases: meningitis (high temperature, palpitations, severe headache, loss of consciousness), hydrocephalus (increased head size and intracranial pressure due to excess fluid), etc.
Genetic disorders (hypothyroidism, Down's syndrome) are always accompanied by a general developmental delay.
The presence of rickets affects the timing of the closure of the fontanel, its symptoms: drowsiness, increased sweating, changes in the shape of the head and skeleton, nape baldness, retarded physical and mental development.

What to do

If there are changes in the fontanel, but the child feels normal, plays, eats, does not lag behind in development, then nothing needs to be done. If additional symptoms appear that indicate the presence of a disease, it is necessary to contact a pediatrician for diagnosis and treatment.

Things to do before the doctor or ambulance arrives:

To prevent dehydration, follow these tips:

to avoid overheating, do not wrap the baby up, walk in hot weather;
create comfortable conditions: ventilate the room, do wet cleaning, the optimum temperature is 20 degrees Celsius, the humidity is about 60%;
if the child is bottle-fed, breastfed according to the regimen, and in the hot season, supplement him with water.

When to see a doctor

Babies under one year of age should see a pediatrician every month. During a routine examination, the doctor will definitely pay attention to the condition of the large fontanel, measure the size, and check the pulsation. In case of deviations from the norm, it can be referred for a consultation with narrow specialists. Therefore, with a timely visit to the clinic, it is difficult to miss the developing pathology.

It is different when it comes to an acute condition caused by dehydration or acute brain diseases. In such cases, only a competent specialist knows how to determine the cause of the changes, and can prescribe the correct treatment. Let us dwell in more detail on when you can not do without a doctor.

Emergency medical attention is required if the fontanel retraction is accompanied by the following symptoms:

a sharp rise in body temperature up to 40 degrees;
severe headache;
persistent vomiting and loose stools;
weakness, drowsiness;
muscle spasms, convulsions;
rash on body, marbled skin effect;
dry skin;
dry eyes, decreased salivation;
refusal of food and water;
loss of consciousness.

It is worth calling a pediatrician at home in such cases:

the child has symptoms of a cold, fever, increased sweating;
the fontanel sunk, the child is capricious, urination decreased against the background of a change in the baby's diet, for example, when switching to a new mixture;
on palpation, an increase in the pulse is felt, the frequency of strokes exceeds the norm.

Changes in the soft crown, which can be discussed during a routine examination:

retraction in a horizontal position;
fast or long overgrowth;
oversize.

Parents should monitor the condition of the fontanelle, but they cannot understand why changes occur on their own. All concerns should be discussed with the local pediatrician.

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A fontanelle sinks in a baby: reasons for sinking, why it happens

A sunken fontanel is not always a sign of pathology, but usually requires a medical consultation. The configuration, tension and pulsation of the membranes connecting the bones are indirect indicators of the health of the crumbs. That is why pediatricians carefully examine the head of newborns. If the baby develops normally, the condition of the fontanel is not so important.

Contents:

Causes

The elastic membrane can drop below the level of the bony margins for various reasons.

Dehydration

Retraction of the fontanel is most often a sign of a lack of fluid in the body. This occurs when the mother does not give water between feedings, tightly wraps the crumbs. Also dangerous is insufficient intake of breast milk or artificial mixtures.

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Dehydration can be caused by too dry air or high temperatures in the baby's room. Therefore, you need to dress the baby according to the weather, avoid prolonged exposure to the open sun, in hot weather give small portions of water to drink.

In addition, this condition develops against the background of various pathologies.

Infectious diseases

Diseases caused by viruses, bacteria or fungi are usually accompanied by fever. Heat exchange is disturbed, the child develops shortness of breath, which leads to increased loss of moisture. Many infections occur with vomiting and the appearance of loose stools against the background of intoxication. Due to increased fluid loss in infants, the fontanel sinks. This is typical for food poisoning, dysentery, salmonellosis, influenza.

Indigestion

Fontanelle prolapse is often caused by digestive disorders. Nutrients are not absorbed in the stomach and intestines. This is observed when untimely or incorrect introduction of complementary foods to a small person, too frequent or infrequent feeding.

This condition is accompanied by regurgitation, sometimes turning into vomiting, the appearance of an unstable stool, more often in the form of diarrhea. The baby is worried because of pain in the tummy, breathes often, cries, sweats, which leads to dehydration.

Genetic predisposition

Heredity is important, which determines the uniqueness of the structure of the skull. It lies in the timing of the closing of the bone sutures, the size and strength of the fontanelles.

Neurological diseases

In young children, lesions of the nervous system of various origins are often accompanied by headache, severe vomiting, due to increased intracranial pressure. This distinguishes many neuroinfections - meningitis, influenza.

Perinatal pathology can also lead to dehydration. Cerebral palsy, complicated by neurotoxicosis with convulsive syndrome, in the absence of adequate treatment, causes increased fluid loss.

Other causes

Late-term babies often have a sunken fontanel. With a post-term pregnancy, this is a variant of the norm.

The fontanelle may collapse with intense crying caused by pain or fear. This is due to pressure differences inside the skull.

Fears should cause the membrane to sink in the crumbs in a calm state. It is important to establish constantly or only periodically the fontanel falls below the contact bone edges.

Signs of depression

Parents should know how to check the condition of the fontanel. Carefully touching the elastic membrane in the parietal region with your fingers, you can evaluate the following parameters:

the level of sagging;
pulse frequency;
voltage degree.

These indicators are largely determined by the age, activity, emotions and well-being of the child. A healthy baby has a pulse of about 130 beats per minute.

If the fontanel has fallen below the level of the bones, the following factors should alert:

the number and volume of urination per day - the baby pees less than 10 times and in small portions;
dark urine;
the smell of urine is sharp, reeking of acetone, indicates a pathology.

Other signs of dehydration are dryness, redness and reduced elasticity of the skin. Often, in this case, the conjunctiva of the eye loses its luster and transparency in the crumbs, tearing decreases (crying without tears), dryness of the tongue appears.

Symptoms of intoxication will indicate a pathological condition:

lethargy;
causeless crying;
refusal to eat;
temperature increase.

If you do not provide timely assistance, the skin becomes cold, acquires a bluish tint, lethargy increases. Seizures, loss of consciousness and death may occur.

Which doctor should I contact if the fontanel is retracted?

Mommy should know that a slight collapse of the fontanel is possible when the child is in an upright position and when crying. This is considered the norm. But, if the fontanel has sunk, its pulsation has increased, the number of urination has decreased and the baby's health has worsened, this is a reason to contact a pediatrician.

If necessary, he will prescribe laboratory and instrumental examinations. The doctor will also decide whether it is necessary to consult a neurologist and an infectious disease specialist.

In principle, parents should always pay attention to the condition of the fontanelles and call doctors in case of any alarming signs.

What to do?

When an infant's fontanel sinks, it is necessary to assess its general condition. If the baby feels good, active and cheerful, but the fontanel has fallen just below the level of the edges of the parietal bones, the following simple activities will help: