When to examine the fontanelle in a newborn?

An infant's skull bones are not fused in the first place. Instead, there are spaces between the bones to accommodate the way the baby moves out of the mother's pelvis. Joint lines on the skull indicate the location of these soft spots called the fontanelles. These gaps allow the bones to overlap as the baby moves during labor. Therefore, after the baby is born, a safe newborn fontanel examination is also part of a comprehensive examination. So when to check the fontanelle in the newborn?

An infant's fontanelle is an opening in the wall of a baby's skull where the bones have not yet developed together. Although they may seem like undeveloped areas on your baby's head, newborn fontanels are actually an important part of a baby's normal development. Because the fontanelle has two important roles for your baby:
During birth: By leaving space for the bones of the skull to move during birth, the fontanelles allow the baby's head to come in. slip through the narrow appendage of the mother without causing distortion or damage in the baby's brain. Facilitating Growth: An infant's head grows faster during the first two years than at any other time in life. The space between the bones of the skull creates the space needed for brain expansion during this period of rapid development. Most people know about the large infant fontanelle on the top of a baby's head, but this is not the only one. In fact, babies have two fontanels:
Anterior fontanelle: Located on the top of the head, this newborn fontanel is diamond-shaped, the font most people are familiar with. It measures about 1 to 3cm at birth, but can be larger or smaller. Posterior fontanelle: Smaller than anterior fontanelle and located at the back of the child's skull, triangular in shape. It is usually less than 1⁄2 cm in size at birth.

The skull fragments from birth are discrete, connected to each other through loose joints to create conditions for the infant's brain to develop rapidly in the first days of life. However, once the bone grows to the point of filling the gap, the infant's fontanel will be considered closed.
Newborn fontanelles will close in the following order:
Posterior fontanelle: 1 to 2 months Anterior fontanel: 9 to 18 months The above dates are the average fontanel closure time range. However, infant fontanelles that may close earlier or later are considered normal.

Although the care of a newborn fontanelle is not too complicated, parents need to know how to do a basic newborn fontanel exam to recognize what is normal and know what to watch for.
Newborn fontanels should always look flat against the baby's head. This means that the fontanelle of the newborn does not appear to be swollen, bulging, or recessed relative to the skull.
When examining an infant's fontanelle, by gently running your fingers over the top of the baby's head, the soft spot at the anterior fontanel should feel soft and flat with a slight downward curve.
Anterior fontanel may protrude or bulge if the child is fussy, vomiting, or when lying down. However, the fontanelle will be flat again if the baby is held upright and calm and comfortable. This is a normal phenomenon so parents should not be too worried.
Besides, if parents observe while examining the fontanelle of the newborn and notice that the fontanelle seems to be beating in accordance with the baby's heartbeat, this is also completely normal.
Although the soft spot in the anterior fontanel is the space between the bones of the skull, a strong sclera at the opening protects the soft tissue and the brain inside. So, along with performing a safe at-home newborn fontanel exam, parents can also:
Touch their baby's head, even on the fontanel software Wash and clean the scalp Use a baby comb or comb comb her hair Wear a cute headband for a baby girl

Newborn fontanelles can provide signs of a baby's health. Here are some things to look out for when examining a newborn's fontanelle:
4.1. Concave fontanelle. A concave, slightly inward curvature is normal. However, a persistently dimpled fontanelle can be a sign of dehydration, which occurs when a child doesn't drink enough fluids or loses more fluid than his or her body is absorbing.
Your baby may become dehydrated if:
Has difficulty with breastfeeding, including breastfeeding or formula feeding Has diarrhea, vomiting or fever Place the baby in a hot environment and high temperatures . Besides, other symptoms of dehydration in babies to note are babies not having enough urine as usual, lethargy, irritability, dry mouth and fussy but no tears.
If your child shows signs of dehydration and you observe that his or her fontanel is dimpled, take your child to see a pediatrician immediately. Dehydration in infants and young children is considered a medical emergency and requires prompt intervention to avoid the risk of hemodynamic effects and subsequent life.
4.2.Inflated fontanelle According to natural physiology, actions that increase the pressure inside a child's skull for a short time, such as when a child is fussy or vomits, causes the fontanelle to swell more than is normal. However, if the baby's fontanel continues to bulge when the crying stops or even when the baby is resting, it could be a sign of an unusual problem.
A bulging fontanelle can mean there is increased intracranial pressure caused by fluid accumulation or an inflammatory response that causes edema in the brain. This is a warning sign for dangerous diseases that can affect the central nervous system and need to be treated immediately. If your baby's soft spot feels hard or bulging, call your pediatrician.
4.3.Very large fontanelle Anterior fontanelle that is abnormally large or does not close within the expected time frame may be a sign of certain medical conditions such as hypothyroidism, Down syndrome, or neonatal vitamin D deficiency causing rickets, hypothyroidism, and hypothyroidism. nutrition .
If you are concerned that your baby's soft tissue has not closed or the fontanelle closes late after about 1 year of age, talk to your child's pediatrician. At this point, the doctor will monitor by examining the infant's fontanelle during each physical examination from birth until the fontanelle process is complete.
4.4. The fontanel closes too soon Although very rare, some children may have the fontanel close too early. Sometimes, parents cannot easily feel the soft spots on the baby's skull and seem to have closed completely. As a result, both brain development and the shape of a baby's head can be affected by this condition.
The cause of the fontanel closing too early is thought to be due to pressure building up inside the child's skull. However, most cases of early fontanelle closure are mild and may not require treatment. However, in many cases, surgery may be required to reduce intracranial pressure and allow the child's brain to develop normally.
In summary, a safe newborn fontanel examination is a step to check right after birth, when the baby is discharged from the hospital and for regular follow-up visits. Although there is nothing special that needs to be done to take care of the fontanelle, parents should still arm themselves with the knowledge of how to examine a newborn's fontanelle to understand why the fontanelles appear abnormal. If you are worried or feel any suspicious signs about your child's fontanelle, tell your pediatrician, as this may be a symptom of a medical condition so that the child can be examined and treated promptly.
With many years of experience in examining and treating diseases in children, now the Pediatrics Department at Vinmec International General Hospital has become one of the major health care centers, capable of examining children. screening and treatment of many specialized diseases in children. Therefore, if the child's fontanel shows abnormal signs, parents can take the child to Vinmec International General Hospital for examination and receive support and advice from doctors and nutritionists.