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. Show
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.
 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 fontanelleIf 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: Bulging fontanelleA 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.
Reviewed by Dan Brennan, MD on March 11, 2021 When your baby is born, their skull is very soft. The individual pieces of their skull aren’t fused together yet, allowing them to fit through the birth canal with ease. When your baby is born, you may notice a soft indentation on the top of their head. This is perfectly normal and no cause for concern. Once your baby is born, you may notice two soft spots on their head. There is one gap at the top-front of the skull that is most noticeable. The other is smaller, toward the back of their head. Depending on your child and the size of these spots, you may not even notice them. A baby's soft spots are called fontanelles. They allow your baby’s brain to grow larger at a fast rate over their first year of life. It's important to avoid pressing into their soft spots, as it could cause damage to their skull or brain. What should the soft spot look like? The soft spot is often noticeable because it may bulge out when your baby cries or pulses up and down with your baby’s heartbeat. When your baby nurses or takes a bottle, you may see the soft spot move along with the motion of their sucking. When does the soft spot go away? Since the back soft spot is smaller, it usually closes around three months old. The larger spot on the top-front of their skull won’t close until around 18 months old. As your baby ages, you will notice that the spots get smaller and smaller with each passing month until they are barely noticeable. Your child's doctor may examine the soft spot during regular checkups to make sure the development looks correct for your baby’s age. Soft spot. If you notice that your baby’s soft spot appears swollen for an extended period of time, that is cause for concern. It could be a sign that your baby’s head is swelling. If your doctor suspects brain swelling, they may request imaging tests and blood work to find out what’s the cause. Your baby’s soft spot may also be larger due to certain medical conditions, including: A sunken soft spot is just as concerning, as it can be a sign of dehydration. If your baby’s soft spot looks like a significant dent in their head, begin tracking how much they are nursing or taking from a bottle. Depending on your baby’s age, dehydration can become dangerous quickly and will require treatment from your doctor. Craniosynostosis. In rare cases, a baby is born, and their skull fuses together too soon. This could impact brain development and cause your baby’s head shape to appear abnormal. Types of craniosynostosis include: Remember, if you ever have concerns about your baby’s development, talk to your pediatrician. They can answer your questions and do an exam on your baby if they think it is necessary. It is better to address concerns sooner rather than later so that problems may be fixed before they lead to additional health concerns.
An infant's skull is made up of 6 separate cranial (skull) bones:
These bones are held together by strong, fibrous, elastic tissues called sutures. The spaces between the bones that remain open in babies and young children are called fontanelles. Sometimes, they are called soft spots. These spaces are a part of normal development. The cranial bones remain separate for about 12 to 18 months. They then grow together as part of normal growth. They stay connected throughout adulthood. Two fontanelles usually are present on a newborn's skull:
The posterior fontanelle usually closes by age 1 or 2 months. It may already be closed at birth. The anterior fontanelle usually closes sometime between 9 months and 18 months. The sutures and fontanelles are needed for the infant's brain growth and development. During childbirth, the flexibility of the sutures allows the bones to overlap so the baby's head can pass through the birth canal without pressing on and damaging their brain. During infancy and childhood, the sutures are flexible. This allows the brain to grow quickly and protects the brain from minor impacts to the head (such as when the infant is learning to hold his head up, roll over, and sit up). Without flexible sutures and fontanelles, the child's brain could not grow enough. The child would develop brain damage. Feeling the cranial sutures and fontanelles is one way that health care providers follow the child's growth and development. They are able to assess the pressure inside the brain by feeling the tension of the fontanelles. The fontanelles should feel flat and firm. Bulging fontanelles may be a sign of increased pressure within the brain. In this case, providers may need to use imaging techniques to see the brain structure, such as CT scan or MRI scan. Surgery may be needed to relieve the increased pressure. Sunken, depressed fontanelles are sometimes a sign of dehydration. |
How long will it take before the pieces of the skull grow together and the fontanels disappear?
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