Enlarged fontanel in a baby: What's it, causes, symptoms, diagnostics, treatment, prevention

Fontanelles – enlarged; Soft spot – large; Newborn care – enlarged fontanelle; Neonatal care – enlarged fontanelle

What is an enlarged fontanel

Enlarged fontanel, also known as "fontanelle bulge", represents a state, in which the "soft spot" of the baby is the area on the baby's head, where the bones of the skull have not yet fused, - seems more, than usual, or bulging out. This condition is commonly seen in premature babies., although term infants may also have an enlarged fontanel. It is not considered a medical emergency, but it is important to understand and eliminate the main cause of the fontanel enlargement.

Causes of fontanel enlargement

The fontanel consists of several small bones and a layer of tissue with small blood vessels, that connect with the brain and body. This helps the baby's brain grow and allows room for movement and expansion of the skull bones during the first months of growth..

The most common cause of an enlarged fontanel is non-union of the skull bones.. In some cases, this may occur as a result of a large fontanel at birth., or may occur over time as a result of the accumulation of a large volume of cerebrospinal fluid.

The second most common cause of an enlarged fontanel is hydrocephalus., which occurs, when there is excess cerebrospinal fluid in the brain, putting pressure on the skull. This extra fluid can seep through the fontanel, causing it to bulge out.

The most common diseases, causing an increase in the fontanel in a child:

• Down's syndrome
• Gidrocefaliя
• intrauterine growth retardation (ZUR)
• Miscarriage

More rare causes:

• Axondroplazija
• Apert syndrome
• Clavicular cranial dysostosis
• congenital rubella
• neonatal hypothyroidism
• Brittle bones
• Rickets

Symptoms of an enlarged fontanel

A symptom of an enlarged fontanel is a bulge in a soft spot, often occurring with larger head circumference, than normal. Depending on the cause of the, other symptoms may include:

• Frequent headaches
• Sleep disorders
• Fussiness
• Vomiting
• Low weight
• Seizures
• Fever

While the baby's fontanel may be soft or hard to the touch, an enlarged fontanel usually appears very soft or is accompanied by physical manifestations due to the accumulation of fluid inside the skull.

When to see a doctor

If you notice a bulging fontanel in your child, best to see a doctor. An enlarged fontanel is usually very noticeable, and should be treated as soon as possible, even if it's not an emergency.

The doctor will evaluate the fontanel, including any possible causes or risk factors, and determine, what is the best course of action. If a health worker is not available, go to the nearest hospital for further medical advice.

Questions, that your doctor may ask

If you suspect, that your child suffers from an enlarged fontanel, the doctor may ask some questions, to determine the cause and the best course of action. These may include:

• What is the age and medical history of your child?
• When did you first notice your child's fontanel protrusion?, and does it seem, that it's getting bigger?
• Has your child had any unusual symptoms or changes, such as shortness of breath, headaches or vision changes?
• Are there any other potential underlying causes, such as birth complications, family history of hydrocephalus or recent head trauma?

Diagnosis of an enlarged fontanel

If the doctor suspects, that your child has an enlarged fontanel, he may order some tests to confirm the diagnosis. They may include imaging tests, such as MRI (Magnetic resonance imaging) or CT scan (CT scan). If the doctor suspects, what causes hydrocephalus, an ultrasound may be ordered to examine the amount of fluid, surrounding the brain.

Treatment of an enlarged fontanel

Treatment for an enlarged fontanel depends on the underlying cause.. If the cause is hydrocephalus, the doctor may recommend a shunt, constituting a device, which removes excess fluid and reduces pressure on the skull. If the cause is a large fontanel at birth or an excess of cerebrospinal fluid, the doctor may suggest medication, help reduce the amount of fluid in the brain.

Home treatment and prevention of an enlarged fontanel

It is important to remember, what if your child has an enlarged fontanel, it is better not to try to treat it with home remedies. Also, do not try to administer any medication without consulting your doctor..

Nonetheless, there are some things, which you can make at home, to reduce the risk of fontanel enlargement. Stay tuned, so that your child has a lot of rest and is active. Check, that your baby eats well-balanced meals and takes regular breaks while breastfeeding. Besides, take extra care when protecting your child's head and neck, since trauma to the head or neck can lead to an increase in the fontanel.

Besides, make sure, that your child has a safe sleeping environment. Avoid these items, like big pillows, which are too bulky and can put pressure on the fontanel. Finally, keep a close eye on your child's fontanel; if you suspect, that he is unusually large, make an appointment with a doctor as soon as possible.

Prevention of an increase in the fontanel in a child

An enlarged fontanel can often be prevented, if the underlying cause is treated or avoided. The primary prevention of an increase in the fontanel is to eliminate any underlying diseases., which can cause it to swell. If the child has a disease, in which the amount of fluid in his or her brain increases, it is important to see a doctor as soon as possible, to deal with it.

Also important, so that your child has a lot of rest and is active, well balanced diet, protection from head and neck injuries and a safe sleeping environment, which does not put pressure on the fontanel. Following these steps may help reduce your child's risk of developing an enlarged fontanel..

Used sources and literature

Kinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, St. Geme JW, Bloom NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 609.

Piña-Garza IS, James KC. Disorders of cranial volume and shape. In: Piña-Garza IS, James KC, eds. Fenichel’s Clinical Pediatric Neurology. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 18.