23.01.2021

Little fontanel in a newborn

A small fontanel in a newborn is a site of non-ossified tissue of the skull, which has dimensions that do not reach normal values. In total, normally in a child you can find 6 such structures that have a certain localization and close to a specific period of life.

In some cases, the small fontanel in the baby indicates a serious pathology, and in some it is a physiological feature. A pediatrician will help parents understand the reason for such changes.

Norms

The most important for the baby and doctors are the front and back little ones, which not only help in the process of childbirth, but also carry out thermoregulation of cerebrospinal fluid and brain matter (through these formations, excess heat is released). The largest fontanel in the baby is located in the junction of two parietal and two frontal bones and has a diamond shape. It is very easy to find and feel, especially in a newborn.

The back temechka corresponds to the junction of the occipital bone and the parietal pair, the formation in this case looks like a small triangle. Normally, in children, its size does not exceed 10 mm, and overgrowing occurs no later than the first two months of life.

In the diagnosis of diseases, the anterior tempera is still the most important.

Therefore, it is very important to know its normal indicators in accordance with the age of the child (a spread of values ​​of 2 mm is allowed in the direction of decreasing and increasing):

  • by 4 weeks the fontanel size reaches 28-31 mm;
  • at the age of 2 months there is a significant decrease – up to 25-26 mm;
  • at 3 months of age, normal sizes correspond to 21-23 mm;
  • by 4-5 months, indicators reach 18-20 mm;
  • at 6 months, the normal width is 16.5-17 mm;
  • by 7 months of life, it decreases by only 1-1.5 cm and becomes 15.5-16 mm;
  • in 8-9 months, the sizes should not exceed 15 mm;
  • at 10 months of age, the child has a crown with 12 mm;
  • 11 months of life corresponds to 8 mm.

Thus, the largest cartilage formation on the child’s skull should close by the year or as much as a year and a half. If even taking into account the permissible errors, a small fontanel is registered in the child, this means that parents and the doctor need to start a diagnostic search for the cause of this condition.

For this, a detailed survey is conducted regarding the course of pregnancy and the early postpartum period, the nature of the mother’s nutrition is clarified and whether there was any prophylactic or therapeutic medication.

For both a healthy and a newborn with a very small fontanel , the  doctor performs a complete objective examination with an assessment of general, psycho-emotional and somatic development. In some cases, the child is assigned a consultation with a neurologist, infectious disease specialist and geneticist for differential diagnosis.

Also, children with a small fontanel are recommended to conduct such additional studies :

  • Computed tomography of the brain.
  • Electroencephalography.
  • Ultrasonographic study of the substance of the brain.
  • X-ray of the bones of the skull.
Causes of a small fontanel

Why can a newborn have a small fontanel? Of the physiological reasons, hereditary features of the structure of the skull and prolonged intake of vitamins by the mother during pregnancy are distinguished.

In the first case, the small fontanel is a family feature, which is accompanied by a normal circumference of the baby’s head and a full-fledged psychosomatic development corresponding to age. This condition is not dangerous and does not require correction or treatment. The use of complex vitamin preparations during pregnancy can also lead to a small fontanel in a child from birth. As a rule, the consequences are only in the early ossification of the temechka.

In rare cases, the size of the cartilage formation, which has not reached normal levels, means the presence of congenital malformations, intrauterine infections or an incorrect dose of vitamin D3.

The most common pathological causes:

  • Congenital malformations of the brain  (microcephaly, leukomalacia, micropolygyria, etc.). Microcephaly speaks of the underdevelopment of the brain and that its size is much smaller than required. It occurs in case of congenital rubella, toxoplasmosis, herpes virus infection. Leukomalacia is a focal softening of brain tissue, which is the result of most often congenital chickenpox, syphilis, etc.
  • Craniosynostosis.  A small fontanel in a newborn can be a consequence of the pathology of the skeletal system, in which there is an accelerated ossification of the threads and sutures of the skull, as well as the growth zones of the tubular bones. It is observed with rickets, diseases of the thyroid and parathyroid glands.
  • Excess calcium.  A high concentration of calcium and vitamin D ions in the peripheral blood often leads to serious consequences, one of which is the insufficient size of the anterior temples. This explains why the appointment of a vitamin for the prevention of rickets should be justified.

What is not recommended for the expectant mother is to abandon genetic research, screening ultrasound and laboratory tests during pregnancy.

Possible consequences

Is a small fontanel in a newborn dangerous? It is known that any pathological condition in infancy has its early or long-term complications of varying severity.

The most typical consequences of a small fontanel in a newborn with craniosynostosis are deformation of the bones of the skull, strabismus, in more severe cases there is blindness, hearing loss and a delay in mental, mental and physical development. This pathology requires surgical treatment.

With congenital brain defects at an older age, children suffer from severe mental retardation, may have focal neurological symptoms in the form of paresis of limbs, impaired speech, vision and hearing. Often they are diagnosed with cerebral palsy.

Hypercalcemia leads to severe damage to the kidneys, digestive tract and skeletal system, which is manifested by stiffness and contractures of the joints.

Care for a small fontanel

When confirming the physiological genesis of the reduction of the anterior temporal, special actions on the part of the parents are not required.

In some cases, the following recommendations are recommended:

  • to optimize the volume and quantity of breastfeeding;
  • administer vitamin D only strictly according to the indications and in the dosage prescribed by the doctor;
  • protect the supple area of ​​the skull from injury, hypothermia and excessive heat.

Even with good health, the child should regularly visit his pediatrician.

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