Nature has carefully “thought out” the process of bringing a child into the world. She took into account all the details, thanks to which the baby is born healthy. In order for the baby to quickly pass through the mother's birth canal, its head transforms and takes on an oblong shape, slightly flattening on the sides. Between the bones of the baby’s skull there are spaces filled with connective tissue plates. These areas are called fontanelles, and young parents have many different questions regarding them.

After birth, a baby has 6 fontanelles, most of which close very quickly. Therefore, parents simply do not notice them. But the main one is the frontal, or large, fontanelle, which remains open for a long period. It is responsible for shock absorption, protecting the child from injuries and fractures during a fall.

When should a fontanel grow? You will find the answer to this question in our publication.

Where are they located?

The most noticeable of the fontanelles is the greater fontanel (BR). It is located between the parietal and frontal bones and is quite large, because its size is about 3 cm. This area has diamond shape and if you look closely you can see how it pulsates a little.

Many parents, wondering when a child’s fontanelle should close up, are also interested in why it pulsates. This happens because in this area there is thin connective tissue, allowing you to see the blood vessels of the brain and fluctuations in the cerebrospinal fluid. This process is physiological and absolutely normal. There's no need to worry. You can also find a small fontanel on the newborn’s head. It is located behind the large bone, where the parietal and occipital bones connect. It has the shape of a triangle and its size is 5 mm. Very often, children are born with the small fontanel already closed. In other babies, it closes within 1 or 2 months.

A careful examination of the child's head reveals two paired fontanelles located in the temporal regions. In another way they are called wedge-shaped. The second pair of fontanelles, called mastoid, is located behind the ear. All of them close quite quickly and have no diagnostic significance.

When does a child’s fontanelle close up?

When trying to find the answer to this question, it is necessary to take into account the physical characteristics of the baby and many individual parameters. There are no strict criteria according to which complete healing of the described area occurs. But most pediatricians are inclined to believe that overgrowth without deviation from the norm occurs between the ages of 6 and 18 months. In some cases, the fontanel closes at 6 months or when the baby turns one year old. This occurs much less frequently between the ages of 3 months and 2 years. It all depends on the individual characteristics of the baby.

You shouldn’t obsessively think about how long it should take for your child’s fontanel to heal. After all, every baby is a unique creation; all children have their own characteristics and physiological properties of the body. And if the neighbor’s boy has already healed, but your baby has not yet, there is no need to sound the alarm.

Factors influencing the rate of fontanel closure

If you are interested in the question of when a fontanel should heal, you need to understand that there are some factors that influence the speed of healing. So the process depends:

• From hereditary predisposition. It is important to understand that the size of the fontanelles during the birth of the baby and the speed of their overgrowth primarily depend on genetic characteristics.
• From the gestational age at which the baby was born. If the baby is born early due date, he is a little behind in physical development. Therefore, the period of closure of the fontanelles is long.
• On the concentration of calcium and vitamin D in the child’s body. If a baby has a calcium deficiency, then his parents will definitely ask themselves the question of when the fontanel should heal, as they will notice deviations from the norm. If there is an excess of vitamin D in the body, the depression will disappear ahead of schedule. However, the child’s diet comes in second place here. After all, the main reason for deviation from the norm is metabolic disorder.
• Whether the mother took any medications during pregnancy. Doctors noted that there is a direct relationship between the size of the fontanelle and the intake of multivitamins, as well as the diet of the pregnant woman.

It should be remembered that hereditary predisposition directly affects the size of the fontanel in a newborn.

What is the norm?

Immediately after the baby is born, the doctor examines the area and evaluates it. After that, he monitors the condition during monthly examinations. The pediatrician must pay attention to the size of the crown, the rate at which it decreases, as well as the density of the bones that surround it.

If the baby is healthy and full-term, the size of his fontanel is 2.5-3.0 cm. The doctor determines the diameter by palpating the skull and taking a measurement between the opposite sides of the rhombus. He will also consult the mother and tell her approximately when the baby’s fontanelle should close.

If the baby is large and was born at 41-42 weeks, the fontanel may be smaller.

If the baby is premature, the size of his crown is 3.5 × 3.5 cm. In addition, it is worth knowing that a child who is already 1 month old may have a larger BR than at birth. Indeed, during this period, active growth of the brain occurs and the bones diverge.

It is quite difficult to determine exactly what the parietal area of ​​a baby should be like. at different ages. However, there are approximate parameters, and here they are:

• At three months of age, the size is 1.8-2.0 cm.
• Upon reaching six months, the baby's fontanelle decreases to 1.8-1.6 cm.
• At 9 months, this area measures 1.3-1.4 cm.
• By the age of one year, the size of the fontanelle is reduced to 0.4-0.8 cm.

This guideline is approximate. And all because:

• Each baby has a different fontanel size at birth.
• The process of tightening the BR does not depend on its size.

It is very important to ensure that the area being described is not too tense and that the fontanelles are at the level of the skull bones. Minor swelling or sinking, as well as pulsation, are allowed.

In addition, it is very important that the frontal and parietal bones located around the crown are sufficiently dense, without areas of softening.

Deviation from the norm - should I worry?

How long does it take for a fontanel to heal and what is considered a deviation? Doctors consider ossification of the fontanelle too early at the age of 3 months. This situation can occur as a result of the following pathologies:

• Craniosynostosis. In this case, a rapid tightening of the fontanel and complete fusion of the cranial sutures occurs, which prevents the normal development of the brain. Pathology can be congenital or acquired. In most cases, it is accompanied by other disorders in the child's development.
• Microcephaly. With this disease, we can talk about severe deviations in the development of the central nervous system. A pronounced symptom is a reduced size of the head, a violation of proportions relative to other parts of the body.
• Anomalies of brain development. Here we are talking about violations of its structure, reduction in size and weight.

The described deviations are rare, and manifestations in the form of a rapidly growing fontanel are not enough for an accurate diagnosis. As a rule, the child also exhibits other symptoms of the disease. Every mother will ask at what age a child’s fontanel should close if she observes that it closes more slowly. This deviation from the norm is much more common than the first one and may indicate the following problems:

• Congenital pathologies of the thyroid gland. In this case, the child experiences drowsiness, low activity, poor appetite, constipation, digestive disorders, and swelling.
• Rickets. Quite often this disease occurs in premature babies. It also occurs when there is a lack of vitamin D and calcium in the baby’s body. The child's sleep is disturbed, appetite decreases, and nervous excitability increases. He also begins to sweat a lot, and the sweat smells sour.
• Chondrodysplasia. This pathology is a genetic disease of bone tissue. The child is stunted and has shortened limbs. The disease leads to dwarfism.
• Down's disease, in which

Of course, all parents think about when the child’s fontanelle should close up. Fortunately, serious pathologies are quite rare in children, and in order to confirm the diagnosis, it is necessary to undergo a comprehensive examination.

Doctor Komarovsky's opinion

At what time should a child’s fontanelle close up, according to Dr. Komarovsky? This doctor says that the timing for each baby is purely individual. And there is nothing surprising in the fact that even in a healthy child, the BR may become overgrown only by the age of two; this is normal. It is also unlikely that a baby who develops without warning signs of illness will have rickets or other ailments. You cannot make a diagnosis just because the fontanel heals too slowly or quickly. The doctor also says that in this case, taking additional vitamin D will not hurt. Don't worry about when the fontanelle should close. Komarovsky recommends not to panic without reason.

What does the doctor pay attention to when examining the crown?

Are there parameters according to which the condition of BR is assessed when examined by a doctor? Yes, the doctor evaluates the situation according to the following criteria:

• Examines the fontanelle and finds out how its size corresponds to the baby’s age.
• Establishes how many fontanelles a newborn had at the time of birth and compares their number with today's.
• He looks at how much the fontanelles have changed, at what speed they are shrinking, and whether their shape has changed.
• Feels the edges to prevent them from softening.
• Determines whether the area is flaccid, sunken, bulging or tense.

The doctor not only knows how many months the fontanel should heal, taking into account all factors, but will also be able to determine whether the child’s condition is pathological.

A newborn has a protruding fontanel

Quite often, an overly protruding fontanel is accompanied by encephalitis, cerebral hemorrhage or meningitis. With such diseases, high intracranial pressure is observed, which leads to the described area bulging.

However, there is no need to make hasty conclusions and panic. Brain disease is a serious pathology, and a symptom such as a bulging fontanel cannot be the only one. If parents observe other threatening signs of deviations from the norm in the child, it is necessary to consult a doctor as soon as possible.

Here are the symptoms that you should definitely pay attention to if your child has a protruding fontanel:

• A temperature that is almost impossible to bring down.
• Attacks of nausea and vomiting.
• Lethargy and drowsiness.
• Presence of seizures.
• Baby's loud cry or irritability.
• Loss of consciousness.
• The appearance of strabismus.

You should also be wary if the area begins to bulge after a child has been injured due to a blow or fall.

Sunken fontanel

If you are interested in the question of how long it should take for the fontanel to close, and suddenly you notice that it seems to be retracted into the skull, this may indicate dehydration of the baby. BR changes shape, falling below the bones of the skull and indicates an acute lack of fluid. If there is a high temperature, repeated vomiting and an upset stomach, this indicates a significant loss of fluid. This condition is pathological. The skin becomes dry, the child feels unwell, and cracks appear on his lips.

It is very important to give your baby something to drink or breastfeed. After this, you should immediately consult a doctor in order to correctly replenish lost fluid and get a prescription for further treatment. It's best to call ambulance.

Why does the fontanelle pulsate in a baby?

During the life of the body, there is an active supply of blood to the brain. The vessels of this organ are located close to the heart muscle, and as the blood moves, shocks and increased pressure are observed. In this case, the pulsation spreads to the membrane of the brain and the plate that covers the frontal fontanel. If there is a slight pulsation, then this can be considered normal. However, if the pulsation is too strong, you should consult a doctor to find out the cause of the problem.

Conclusion

The article examined the question of how long a child’s fontanel should become overgrown. Despite the fact that there are norms for the overgrowth of BR and usually this process is completed by one and a half years, in some cases minor deviations occur in healthy babies. Therefore, when talking about when a baby’s fontanelle should close, it is important to understand that there are no clear boundaries. However, parents should be wary if their child’s BR is rapidly fused and he is not yet three months old. In this case, as in others, it is better to seek advice from a doctor.

There is also a faster closure of the fontanelle when the baby eats fully and gains weight well, but this is not a pathology. So, in babies who are on breastfeeding, there is a faster overgrowth of the described area than in artificial babies.

It is strictly forbidden to self-medicate and independently prescribe medications to your child or use folk remedies. It is very important to follow the rule: if you have any suspicions, contact your pediatrician. The specialist will prescribe additional examinations, and this will preserve the child’s health. You should not only pay attention to the size of the fontanel, but also monitor its condition.

Last article updated: 05/03/2018

The baby was born just recently. He looks so small and defenseless. On the baby's head there are special formations - fontanelles. New parents are often afraid to even touch the head, not to mention combing and washing their hair. In addition, there are rumors that you can injure a baby’s brain if you inaccurately press on the fontanelle in newborns. There is a lot of talk and prejudice around this area on the baby’s head. But is it so easy to injure the fontanel in newborns? Is it true that its size and timing of closure play a huge role in diagnosing serious illnesses in a child?

Pediatrician, neonatologist

A newborn's skull consists of bones that are connected to each other by sutures. The bone tissue on the baby’s head is thin, pliable, and rich in blood vessels. Some areas on the head do not ossify and are membranous tissue. They are located at the junction of several bones and are called fontanelles.

How many fontanelles does a newborn have? Many will be surprised to learn that a child is born with six fontanelles.

Where are the fontanels located in a newborn?

The large fontanel in a newborn is the most noticeable of the fontanelles, located on the top of the head between the frontal and parietal bones. It got its name for a reason. Its size is quite large and averages 3 cm. The shape of a large fontanel is diamond-shaped, and upon careful examination you can see the pulsation.

Why does the fontanelle pulsate? The thin connective tissue that forms the fontanelle allows you to see the pulsation of the blood vessels of the brain and the fluctuations of the cerebrospinal fluid. This is an absolutely normal physiological process; there is no need to worry about the pulsation of the fontanel.

A small fontanel in a newborn is located posterior to the large one at the junction of the parietal and occipital bones. This fontanelle looks like a triangle about 5 mm in size. Children are often born with an already closed small fontanel; in others, it closes within one to two months.

Two paired fontanelles can be found in the temporal regions. These are wedge-shaped fontanelles. Another pair of fontanelles, mastoid, is found behind the ear. All of them close soon after the birth of the child and have no diagnostic significance.

Why is a child born with fontanelles?

Everything in the human body is for a reason, and a child is no exception. The baby's body is a complex system, each organ has its own unique function.

What function does the fontanel perform in newborns?

1. The fontanel plays an important role during childbirth. Thanks to this formation, the baby's head contracts and passes through the birth canal more easily. The shape of the head of a baby born naturally is elongated, dolichocephalic. Over time, the configuration of the head changes and becomes normal and round.
2. The child grows quickly, and so does the baby’s brain. The bones of the skull become denser, increase in size, and the fontanel becomes overgrown. The presence of the fontanelle and sutures of the skull creates favorable conditions for the growth and development of the brain.
3. The fontanelle helps the baby maintain normal body temperature and is involved in thermoregulation. When severe (more than 38 degrees Celsius), the fontanel helps cool the brain and meninges.
4. Shock absorbing function. Although the fontanelle seems very unreliable and fragile, it helps protect the brain if the baby falls.

When does a newborn's fontanel heal?

Let's understand the norms and timing of fontanelle closure.

Timing of fontanel closure

The large fontanelle in infants closes up between six months and one and a half years.

Due to changes in the configuration of the head after childbirth, a change in the shape and size of the large fontanel is possible. After the head becomes round, the size of the crown will decrease.

Half of newborns are born with an overgrown small fontanel. In other children, the fontanel heals within one to two months.

The remaining paired fontanelles are rarely seen in a full-term newborn. If the baby was born with lateral fontanelles, they heal soon after birth.

What affects the closure of fontanelles?

Why are some children born with a pinpoint fontanelle, which soon heals completely, while in others the depression can be felt until 2 years of age?

1. Hereditary predisposition. The size of the fontanelles with which the baby was born, as well as the time for their healing, primarily depends on genetic characteristics. By talking with grandmothers and asking them about the parents’ fontanelles, you can predict how the baby’s crown will close.
2. The gestational age at which the child was born. Children born prematurely are slightly behind in physical development from their full-term peers. By approximately 2 - 3 years, this difference evens out. But premature babies have their own developmental characteristics. In particular, longer periods of fontanel closure.
3. Concentration of calcium and vitamin D in the baby’s body. With calcium deficiency, the overgrowth of the fontanelles may be delayed, and with an excess of the element, the cavity disappears prematurely. But the baby’s diet plays a secondary role here, most often the reason is impaired metabolism.
4. Taking medications during pregnancy.

There is also a relationship between the size of the newborn’s fontanelle and the mother’s intake of calcium and multivitamins and the woman’s diet.

But hereditary predisposition plays a primary role in the size of the fontanel at birth.

The fontanel does not heal in time, should I worry?

Dr. Komarovsky answers this question.

Closing of the fontanelles occurs in different ways. Some babies are born with very small size. In others, the large fontanelle may only close by the age of two. With normal well-being and development of the child, both situations are considered normal. It does not matter when the fontanelle closes in newborns.

The size of the fontanel may indicate the development of the disease. But there is no pathology that would manifest itself only by a change in the size of the fontanel. A pediatrician assesses the child’s health status and the size of the fontanel at each preventive examination.

When should you worry?

With certain diseases in newborns, late closure of the fontanelle is possible.

1. Rickets. In addition to the slow closure of the fontanel, rickets is manifested by a lag in physical development, changes in the musculoskeletal and cardiovascular systems, and decreased immunity.The disease is more common in children born prematurely who did not receive vitamin D as a preventative measure. In a full-term baby, with regular walks and proper nutrition the risk of developing rickets is minimal.
2. . This is a congenital disease in which the thyroid gland does not perform its function properly. In addition to changes in the timing of the closure of the fontanel, hypothyroidism causes lethargy, drowsiness, and constant deviations in the mental and physical development of the child.
3. Achondroplasia. It manifests itself as gross disturbances in the development of bone tissue, dwarfism, and a slow rate of closure of the fontanelles.
4. . A disease associated with chromosome pathology. Children with Down syndrome have a characteristic appearance and developmental abnormalities.

What could early closure of the fontanel mean?

In most cases, it does not matter when the baby's fontanelle closes up. This does not affect brain development and intelligence in any way. But there are situations associated with calcium and metabolic disorders, in which the fontanel closes too quickly.

Other diseases, such as craniosynostosis, abnormalities of brain development, are very rare and have a severe course and characteristic symptoms. If the child feels well and develops according to the calendar, the rate at which the fontanelles close does not matter.

Changes in the fontanel

In some serious diseases, the state of the fontanel changes. A bulging or, conversely, sunken fontanel becomes an “indicator” of pathology and indicates the severity of the disease. Thus, assessing the condition of the fontanel is an important diagnostic sign.

Protruding fontanelle in a newborn

Most often, a bulging fontanel accompanies meningitis, encephalitis, and intracranial hemorrhage. All these diseases are characterized by high blood pressure, which is why the fontanel bulges.

You should not make hasty conclusions and panic ahead of time. Brain diseases cannot be characterized only by bulging fontanel. But if there are accompanying threatening symptoms, you should urgently consult a specialist.

Alarming symptoms that, in combination with a bulging fontanel, threaten the child’s life:

• , which falls heavily and soon rises again;
• nausea and vomiting in a child;
• loud cry, irritability or, conversely, lethargy, drowsiness of the baby;
• , loss of consciousness;
• if the fontanel began to bulge after the baby fell or was injured;
• appearance of eye symptoms.

Sunken fontanelle

If the soft crown has become sunken, this is a symptom of dehydration of the baby. The fontanelle changes, drops below the bones of the skull and indicates an acute lack of fluid for the baby. With repeated vomiting, high temperature significant fluid loss occurs. Dehydration affects the entire body. The skin becomes dry, cracks may form on the lips, and the child’s well-being may be impaired.

It is necessary to give the child something to drink and arrange for the baby to be fed, if possible. And immediately consult a doctor for proper treatment and replenishment of lost fluid.

What should parents know about fontanel? FAQ

1. The child's fontanel is very large. Is this rickets? The size of the fontanel with rickets may not change at all. There may be a change in the shape of the head, an increase in the frontal and parietal tubercles, and a softening of the edges of the fontanel. With rickets, the edges of the fontanelle become flexible and pliable, but the size remains the same.
2. If the fontanel is small, vitamin D cannot be prescribed, even if a diagnosis of rickets is made? Except external signs Rickets requires laboratory confirmation to make a diagnosis. With rickets, the level of alkaline phosphatase, the level of calcium in the blood and urine are changed. visible on x-rays of the wrists and long bones.For confirmed rickets, vitamin D and calcium are prescribed, and the size of the fontanelles does not matter. Medicines selected in the required dosages do not accelerate the closure of fontanelles.
3. Can prolonged overgrowth of the fontanel indicate hydrocephalus in a child? Hydrocephalus (hydrocephalic syndrome) occurs when the amount of fluid (CSF) in the brain increases. This leads to an increase in intracranial pressure and a change in the child’s well-being. He becomes restless, moody, and sleep is disturbed.When examining a baby, doctors pay attention to the child’s development, muscle tone, increase in head circumference, condition of the fontanel. An increase in head circumference in combination with an increase in the size of the fontanelle and a change in the child’s condition may indicate the development of the disease.
4. If the fontanel closes too quickly, will the baby's brain stop growing? The growth of the head occurs not only due to the fontanelles, but also due to sutures, enlargement and compaction of the bones of the skull. Even if the fontanels are completely closed, the head continues to grow.
5. Is it possible to damage a baby's brain by touching a fontanel? You can safely touch, kiss, comb the baby’s head; this will not bring unpleasant consequences. The brain is securely hidden under the membranes and surrounding tissues.
6. How to care for a fontanel? This area does not require any special care. Just like the rest of your baby's skin, your scalp needs to be looked after. After washing with special baby shampoo, blot the water with a towel. Do not rub the head, blotting is enough.
7. Is it necessary to take vitamin D if the fontanel overgrows quickly or slowly? The question of the advisability of prescribing vitamin D is decided individually in each case. Many factors influence this, including the region where the child lives, the seasons, and the duration of walks.

When prescribing vitamin D, the doctor takes into account the feeding of the baby, the vitamin D content in infant formula, the diet of the nursing mother and the woman’s intake of multivitamins. The health status of the baby plays a significant role. The need for vitamin D in premature babies is higher than in healthy full-term toddlers.

The main task of parents is to take care of the baby’s proper nutrition, regular walks and proper care. Leave the assessment of the condition of the fontanel to a specialist. At each preventive examination, the doctor takes only a few seconds to rub the head and evaluate the fontanel.

Parameters by which the condition of the fontanel is assessed during examination by a doctor

• are the child’s fontanelles open or closed, does this correspond to the baby’s age;
• how many fontanelles were there at the time of birth and their number at the moment;
• how the fontanelles have changed, how quickly they are shrinking, whether the shape of the fontanelles has changed;
• What do the edges of the fontanelle feel like? Normally, the edges should be elastic, and softening is a sign of a lack of calcium and vitamin D;
• How does the fontanel relate to the surrounding tissues? A sluggish, sunken or tense, bulging spring is always a sign of pathology.

Let's sum it up

Fontanas are anatomical formations of membranous tissue located on the baby’s head. Thanks to the presence of fontanelles, the head can easily pass through the birth canal, changing its shape (configuration).

The size and timing of overgrowth of fontanelles help pediatricians suspect changes in the baby’s health status. But even an experienced specialist cannot make a diagnosis based only on the size of the fontanelle, because each disease has a number of other important symptoms.

After the birth of a baby, parents have many questions that relate to the structure of his skeletal system and the patterns of its development and growth.

Particular attention and concern is associated with the fontanelles on the baby’s head. Naturally, parents are afraid of damaging them, check the sizes and, of course, ask when the fontanelle normally closes.

Moreover, often the concept of “fontanel” among parents exists in the singular. That is, not all mothers and fathers of babies know that there are several fontanelles.

Maybe this will be a discovery for you, but a newborn has six fontanelles. Most often they say and check the so-called large fontanel. But by the time of birth, all the others may not be closed either.

Today in the article I will describe what fontanelles are and what their significance is for a child. You will know when each one normally closes.

Fontanas: what is it and where?

Skull new born child- not a monolithic structure, where all the bones are fused with sutures, like in an adult. It consists of individual bones connected to each other by loose seams.

In utero, at the initial stages of development, the bones of the fetal skull are dense membranous tissue, in which zones of ossification later appear.

The process of degeneration of membranous tissue into bone occurs gradually from the center to the periphery. Therefore, by the time the baby is born, some plates are still elastic membranous tissue.

The free space that forms at the junction of such incompletely formed bones is called fontanelles.

Despite the apparent fragility and vulnerability of the baby's head in the fontanelle areas, the baby's brain is well protected. It is covered directly by the membranes of the brain, the connective tissue membrane, and on top - the skin.

By the time of birth, babies have six non-ossified places in the skull (fontanelles):

1. The large fontanel is located on the top of the head (between the pairs of frontal and parietal bones) and is shaped like a diamond. Its dimensions vary greatly, but, as a rule, its diameter is 2.0-3.5 cm.
2. The small fontanel is located on the back of the head (between the plates of the parietal bones and the occipital bone). It has the shape of a triangle. It is already clear from the name that it is small in size, up to about 0.5 cm.
3. Lateral paired fontanelles (one on each side):

Functions of the fontanelles

The main function of these non-ossified areas of the baby’s skull is to facilitate the passage of the baby through the mother’s birth canal. They provide some mobility to the bones of the skull.

Thanks to them, the edges of the bone plates, like scales, can fit together when passing through narrow places in the birth canal, reducing the size of the baby’s head.

In medicine, this phenomenon is called configuration of the fetal head. Nature has taken such care to prevent injuries to both mother and baby during childbirth.

Immediately after birth, the newborn's head may be egg-shaped (slightly extended upward and backward). Then the bones of the skull straighten and take their usual position.

Therefore, the size of the fontanelles in a newly born baby and in the same baby a day or two after birth can differ significantly.

The movable and pliable bones of the skull also perform a shock-absorbing function. A child learning to walk may often fall and hit his head. Thanks to the fontanelles, these blows are softened.

And a purely medical function, but a very important one. Thanks to the existing large fontanel, doctors now have the opportunity to carry out ultrasound examination infant brain - neurosonography (NSG). Skin and connective tissue membrane conduct ultrasound rays well, unlike bone tissue.

Therefore, through the fontanel using a small ultrasound sensor, it is possible to detect various disorders in the functioning of the baby’s brain (impaired outflow of fluid from the ventricles of the brain, cysts, increased intracranial pressure, etc.).

The size of the fontanel: what does it depend on?

Below is a table of the approximate sizes of a large fontanelle at different age periods.

Usually the fontanel is measured in two planes. Since this is a rhombus, measure the longitudinal and transverse dimensions between the sides of the rhombus, but not between its corners.

There is a special formula for determining the average size of the fontanel: divide the sum of the longitudinal and transverse dimensions by 2. The normal size of the fontanel of a newborn child is on average 2.1 cm.

The individual size of the fontanelle of a particular child may differ from the average norm. They depend on many factors, ranging from age, genetic predisposition and the state of phosphorus-calcium metabolism, ending with the presence of concomitant pathology (rickets, hydrocephalus, metabolic disorders).

It is worth noting that the trend in recent years is the birth of babies with a small fontanelle, which closes between six months and a year. And in 1% of children, the large fontanelle closes before the age of 3 months.

So far there are no published results of scientific research on this topic and it is not known exactly what this trend is connected with. In my opinion, this is a consequence of the widespread use of multivitamin complexes and calcium supplements by all pregnant women during pregnancy.

Some features of the size and rate of closure of fontanelles are present in premature infants. Thus, they often have paired lateral fontanelles that are still open, and the large and small fontanelles can be large in size.

Therefore, in children who rush to be born prematurely, the fontanelles close later than in their peers born on time.

Timing of fontanelle closure in babies

There cannot be a uniform time frame for the closure of fontanelles, since all children are individual. Paired lateral and small fontanelles can close by the time the baby is born. Often they can last up to 2-3 months of the baby’s life. Both one and the other are variants of the norm.

The large fontanelle, as a rule, closes completely within a period of one to one and a half years. Sometimes this happens later.

By modern medical standards, in some cases, closure of the large fontanel by the 2nd year of life is the absolute norm (for example, in premature infants).

Is a bulging, sunken or pulsating fontanel scary?

Normally, the fontanel is located at the level of the bone edges and is not externally visible on the child’s head. But with certain violations, it can sink in or, conversely, stick out.

The fontanelle is assessed in an upright position and when the child is in a calm state. A slight retraction (felt with your fingers) of the fontanelle when the baby is in an upright position is normal. And with strong screaming or crying, it may bulge slightly.

A slight pulsation of the fontanel, felt by the fingers, is also a normal option. After all, a large cerebral artery passes nearby.

A clearly sunken fontanel (detected visually and by palpation) can be observed in infections accompanied by dehydration. For example, with an intestinal infection, when the child has lost a lot of fluid through vomiting and loose stools.

Sometimes, even at rest, a child can observe a protruding, constantly tense fontanel. This may indicate brain pathology (hydrocephalus, meningitis, increased intracranial pressure).

It is worth saying that a bulging or sunken fontanel is not the only symptom of any pathology, but one of many manifestations. Therefore, based on the condition of the fontanel, one can suspect a problem with the baby’s health, but a diagnosis cannot be made. Other symptoms need to be analyzed as well.

For example, with an intestinal infection, the child will have a fever, vomiting or diarrhea. And only against the background of everything and due to the loss of fluid will the fontanel sink.

Also, with neurological pathology, neurological symptoms come to the fore (vomiting, impaired consciousness, convulsions, strabismus, drowsiness, or, conversely, the child is overexcited). Against the background of these symptoms, bulging of the fontanel is observed.

Also, the cause of a protruding fontanel may be a previous injury.

Fast or slow closure of the fontanel

So, the fontanelle can close normally within a period of three months to two years. Early closure is considered to be overgrowing before three months, and late closure - after 2 years.

It is necessary to competently judge the rate of overgrowth of the fontanel by measuring the size of the child’s head and chest, that is, the monthly increase in these indicators.

When the fontanel closes quickly and the monthly increase in head volume is small, then, of course, it is worth examining the child more carefully and excluding pathology of the skeletal system.

But when the child is developing well, the increase in weight, height and size of the head and chest is normal, then there is no need to worry about the rate of fontanel closure. After all, all processes in the body are individual.

I would like to dwell on the common myth that if the baby’s fontanel is initially small, the nursing mother should limit foods containing calcium and not give the baby vitamin D. This is wrong.

Vitamin D does not in any way affect the rate of overgrowth of the fontanel. But its deficiency, just like the lack of calcium, leads to disruption of the structure (strength) of bone tissue.

Often, when the fontanel closes slowly, they talk about rickets in a child. But it's not right. This diagnosis is not made based only on the rate of overgrowth of the fontanel.

Yes, children with rickets may have late fontanel overgrowth. But its late closure in itself does not prove the presence of rickets. To draw the right conclusion, you need to look at the complex of symptoms.

If a child has rickets, then other symptoms of this disease (moody, hypotonia, deformation of skeletal bones, “frog belly”, late teething) cannot go unnoticed by either the parents or the specialist. After all, parents watch their child every day. And the pediatrician examines the child monthly in the first year of life.

If questions still arise about the late closure of the fontanel and the connection of this symptom with rickets, it is better to be examined by a doctor and rule out disorders of phosphorus-calcium metabolism. To do this, it is enough to take a blood and/or urine test for calcium and phosphorus.

Also, a disease of the thyroid gland such as hypothyroidism (decrease in its function) is manifested by slow overgrowth of the fontanel. But at the same time, there is always a delay in physical development in such children.

Since we have already touched upon the rate of growth in head size in infants, it is worth saying a few words about them. The head circumference of a newborn baby is usually 35 cm. Growth by three months of life is usually +4-5 cm.

Moreover, up to three to four months, the size of the head prevails over the size of the chest. Then the sizes of the chest and head are compared, and after six months the chest volume begins to predominate.

Therefore, there is only one conclusion: if a child grows well and develops according to his age, and the fontanel closes at a special pace, then this is an individual characteristic of your baby. And there shouldn’t be any unnecessary worries about this.

And if you have any doubts, or something is bothering you, consult your pediatrician. If necessary, he will recommend examination by the right specialist.

Although in the first year of life you often have to visit a clinic (pediatrician, neurologist, orthopedist) with your baby. If you strictly follow the schedule of recommended routine examinations, then you simply have no chance of missing the diseases described above. But they are quite rare in practice.

Health to you and your children!

Practicing pediatrician and twice-mother Elena Borisova-Tsarenok told you about the timing of fontanel closure.

INR analysis is the most reliable method for determining blood clotting. Deviations in its values ​​from the norm may indicate serious problems in the body.

What is INR?

Human blood contains a complex protein called prothrombin, which ensures that it remains liquid during circulation through the circulatory system and clots in the event of injury. Determining the amount of prothrombin helps determine the tendency to bleeding or blood clots.

INR analysis is an indicator of coagulation

Blood clotting is determined in three studies:

• PTT is the thrombosed time, which shows how long after the addition of the reagent a fibrin clot forms in the plasma. Normally, its values ​​should be 11–15 seconds.
• PTI – prothrombin index. This is the ratio between the plasma clotting time of a healthy person and the plasma clotting time of a patient. Normal values ​​are 93–107%.
• INR – international normalized ratio. It is the ratio between the patient's PTT and the capillary blood PTT of a healthy person. The ISI coefficient (international sensitivity index) is also taken into account, which differs for different reagents.

The INR indicator must be determined in pregnant women before surgery or blood plasma transfusion. It is the basis for selecting the optimal dosage of anticoagulants and other medications.

If a person is taking anticoagulants and is in a hospital setting, it is recommended to check their INR level daily. And after discharge from the hospital, it is necessary to take appropriate tests every two to three weeks.

Decoding the results

The INR norm is different for women and men. Moreover, its values ​​also depend on some factors. Let's look at the averages normal indicators INR:

• the INR norm in healthy women and men is in the range of 0.7–1.3;
• Surgery is permitted if the patient’s INR is 0.85–1.25;
• for pregnant women, values ​​of 0.8–1.25 are considered normal;
• after heart surgery, the INR may increase to 2.5–3.5, which is normal;
• when the patient is taking direct anticoagulants, the INR may be 0.8–1.2;
• when taking indirect anticoagulants, values ​​may increase to 2.0–3.0;
• INR values ​​also differ by age: in people over 50 years of age, the norm decreases slightly.

If the readings are different from the norm, this may indicate some health problems. Therefore, the results of the study must be deciphered by a specialist in order to detect deviations in time.

What do low values ​​mean?

If your clotting rate is low, your risk of blood clots increases. Because of them, the blood supply to vital organs is disrupted, which can lead to functional failures.

First of all, it is necessary to establish the exact reason why the INR values ​​are below normal. This happens in the following cases:

• vitamin K deficiency in the body;
• side effect from taking hormonal, anticonvulsant, diuretic drugs;
• physical injuries accompanied by blood loss;
• thromboembolism during pregnancy or after the birth of a child.

The result of the study may be erroneous if technological errors were made during blood collection or the material taken was stored for too long. It is also necessary to carry out proper preparation before the procedure. It is forbidden to consume within two days before it alcoholic drinks, fried and smoked food.

Therefore, if deviations are detected, a repeat analysis is required. Once the cause is established, appropriate treatment is selected. Anticoagulants may also be prescribed.

Reasons for increased INR

A high INR level indicates hypocoagulation. In this case there is high risk bleeding even with minor injuries.

Elevated INR values ​​may occur for the following reasons:

• heart disease, including pre-infarction conditions and heart attack;
• liver and gallbladder diseases;
• the presence of malignant neoplasms in the body;
• increased level of red blood cells in the blood;
• gastrointestinal diseases;
• taking antibiotics and hormones, side effect which may have a high INR level.

After 50 years, it is necessary to constantly monitor blood clotting. It is recommended to check your INR level annually. If the patient's INR is above 6.0, he should be urgently hospitalized. In this case, the probability of death is high.

What should the fontanel look like in a newborn baby? When should the fontanel close? What does a fontanelle that is too big or too small mean? What to do if the fontanel closes too early or too late? Fontanas are empty spaces between the bones of the skull covered with a strong membrane. A newborn baby has six fontanelles. Four of them close in the first days of a child’s life, the fifth in the second month of life, and the sixth, the largest (anterior), closes in the period from 3 to 24 or more months. Very often, fontanelles and the rate at which they close cause great concern among parents. In this article we will discuss the main aspects of the development of springs: their number, shape, size depending on the age of the child, speed and limits of closure, as well as what needs to be done in case of closure of the fontanel too early or too late, its retraction or bulging. What are fontanelles and what do they consist of? The skull of a newborn baby consists of a large number of individual and rapidly growing bones. Flat bones of the skull grow in the center and along the edges. A suture is formed where the two bones of the skull meet. Where three or more skull bones meet, a polygon-shaped gap is formed. Such gaps covered with strong connective tissue are usually called fontanelles.
The basis of the fontanel is extremely strong connective tissue, which gradually ossifies at the edges, which leads to a gradual decrease in the size of the fontanel and its complete closure. Newborn babies have 6 fontanelles: anterior ( largest sizes) posterior (second largest), two mastoid and two wedge-shaped.
In most babies born at term, only the first two fontanelles are noticeable - the remaining four either close very quickly after birth or are so small that they are very difficult to notice. Growth of the skull and the role of the fontanelles in the life of a child In the minds of most people, the fontanelles are the only possible space for the growth of the skull, and the closure of the fontanel is associated with the end of skull growth. Actually this is not true. The bones of the skull, as mentioned above, grow in the center and along the edges. The fontanelles (mainly anterior and posterior) occupy only a small length of the border between adjacent bones and therefore are not of great importance in the growth of the skull. The main role in the growth of the skull bones is played by the sutures, which, unlike the fontanelles, remain open for up to 20 years. The development of the skull bones is strictly dependent on the rate of brain development. The most rapid growth of the brain, and, consequently, the bones of the skull is observed during the first two years of a child’s life. The main role of the fontanelles is to provide elasticity to the baby's skull during childbirth and during the first years of life. Indeed, thanks to the fontanels, the bones of the skull of a newborn child remain very mobile, and the size of the child’s skull easily adjusts to the size of the mother’s small pelvis during childbirth. The head of a newly born baby is somewhat flattened on both sides and elongated in the anteroposterior direction. This ideal head shape for childbirth is formed during the birth process itself thanks to the fontanelles. Also, thanks to the elasticity of the fontanels, the shape of the baby’s head takes on a normal appearance a few days after birth.
In the first two years of life, a child falls and hits his head more than in the rest of his life. Thanks to the open large fontanel, upon impact, the possibility of elastic deformation of the skull remains, which absorbs all the kinetic energy of the impact and protects the child from serious injuries. What should fontanelles look like normally? Typically, at birth and during subsequent examinations, the condition of two fontanelles is assessed: the posterior (small) and the anterior (large). The size of the fontanel is estimated using a special formula:

(longitudinal diameter of the fontanel + transverse diameter of the fontanel)/2 In most newborn children, the size of the posterior fontanel does not exceed 0.5-0.7 cm. The posterior fontanel usually closes in the second month of the child’s life. The large one (anterior fontanelle) is usually clearly visible and always arouses great interest. The “normal size” and “timing of closure” of the large fontanel are associated with a large number of misconceptions that often frighten inexperienced parents. Here are some of them: - At birth, the size of the large fontanelle is the same in all children.
- In fact, the normal size of a large fontanel varies greatly. The normal limits for a large fontanelle in newborns are considered to be 0.6 and 3.6 cm. ( the average size 2.1 see formula above). - After birth, the size of the fontanel should only decrease, and an increase in the fontanel is a sign of illness.
-In fact, due to the rapid development of the brain, the size of the large fontanel increases somewhat during the first months of a child’s life. - There is a certain period when the large fontanel should close
-In fact, the timing of the closure of the large fontanel is as individual as other parameters of the child’s development (beginning of walking, teething, beginning of coherent speech).
Observations of healthy children have shown that in 1% of cases the large fontanel closes at three months, at one year the large fontanelle closes in approximately 40% of children, and at two years in more than 95% of children. Typically, in boys, the large fontanelle closes somewhat faster than in girls. -The smaller the fontanelle at birth, the faster it will close.
-In fact, there is no directly proportional connection between the initial size of the fontanel and the proximity of the moment of its closure. -Complete closure of the spring will mean a complete stop in the growth of the skull and leads to an increase in intracranial pressure
-As mentioned above, the bones of the skull grow mainly due to the increase in their central part and the expansion of the edges in the area of ​​sutures. With the exception of the metopic suture (the suture in the middle of the forehead) which closes at about two years of age, all other sutures remain open for the next 18-20 years, making possible growth skull to the size characteristic of an adult. - The speed of fontanelle closure depends on the intake of calcium and vitamin D into the child’s body.
- Calcium and vitamin D can affect the speed of fontanel closure only if they are deficient (in this case, the fontanel closes more slowly).
Very often, parents and local doctors observing their children are concerned about the “quick closure” of the fontanel, and therefore they cancel the prevention of rickets with vitamin D and transfer the child to a low-calcium diet. If we consider that the normal time frame for closure of a fontanel varies from 3 to 24 or more months, then in most cases there can be no talk of any “quick” closure of the fontanel. In this case, the real threat to the child’s health is not the closure of the fontanel, but the cessation of the prophylactic use of vitamin D. Appearance of a large fontanel in a healthy child Externally, a large fontanel in a healthy child looks like a pulsating, diamond-shaped, slightly sunken or slightly convex area of ​​the scalp.
Most inexperienced parents are afraid to touch the fontanel and watch with bated breath as the doctor boldly probes it with his fingers. In fact, a large fontanel is much stronger than it seems and its careful probing cannot cause any harm to the child. What size changes or appearance fontanel talking about illness? Usually, when examining a child, the size of the large fontanel is determined, their relationship with the age and general development of the child, as well as the external characteristics of the fontanel. What does a too large fontanel mean or a slow (late closure) fontanelle Too big sizes a fontanel or its slow (late closure) may be a sign of the following diseases: The fontanelle is too large or slow (late closure) Cause Other signs of illness What should be done? Rickets Rickets is one of the most common causes of slow closure of the fontanel. Most often, rickets develops in premature babies who do not receive preventive treatment with vitamin D and who are exposed to the sun too rarely. In a child with rickets, the edges of the large fontanel are flexible, the back of the head is flattened, and characteristic bone thickenings form on both sides of the sternum. Read more about the symptoms of rickets in the section Rickets. If you suspect rickets, the child should be shown to a pediatrician. If the diagnosis is confirmed, treatment with vitamin D preparations should be started as soon as possible. Congenital hypothyroidism Congenital hypothyroidism is a fairly rare disease in which there is a decrease in thyroid function. Because thyroid hormones are critical to skeletal growth, one of the most early signs Congenital hypothyroidism may cause slow closure of the fontanel. Other symptoms of congenital hypothyroidism may include chronic constipation, lethargy, drowsiness of the child, poor appetite, and swelling. Read more about congenital hypothyroidism and its treatment in the Hypothyroidism section. If congenital hypothyroidism is suspected, the child should be shown to a pediatrician and undergo examinations to determine the concentration of thyroid hormones (T4) and hypothalamus (TSH) in the blood. If the diagnosis is confirmed, the child is prescribed thyroid hormone replacement treatment. Achondrodysplasia This is a rare congenital bone disease, which is characterized by impaired skeletal growth, significant shortening of the limbs and, as a result, dwarfism. In newborns with achondrodysplasia, as a rule, in addition to a slowly closing or large fontanel, short arms and legs, a wide head, and a strongly protruding forehead are noted. Currently, there are no effective treatments for achondrodysplasia. Down syndrome Down syndrome is one of the most common chromosomal diseases in which various abnormalities in the mental and physical development of the child are observed. Typically, the diagnosis of Down syndrome is established immediately after the birth of a child based on a number of characteristic signs, except for a large fontanelle: one transverse lining on the palm, a characteristic facial expression, short neck etc. If Down syndrome is suspected, the child should be shown to a pediatrician. The diagnosis of Down syndrome is confirmed by karyotyping (determining the number and structure of human chromosomes). Children with Down syndrome require special care and treatment. Other causes In more rare cases, slow closure of the fontanel or its large size can be caused by some other congenital skeletal diseases. The diagnosis of these diseases can only be made after a detailed examination of the child in specialized pediatric centers. The fontanel is too small or the fontanel closes too quickly. Early closure of the fontanel is said only when the large fontanel closes before three months, but even in this case it is not at all necessary that the child is sick. When assessing the condition of the fontanel, it is important to take into account not only its size relative to the child’s age, but also the overall circumference of the child’s head. If a fontanel is found to be too small or closes before 3 months, but with a normal head circumference, the child should be considered healthy.
The most common causes of early closure of the fontanel are the following diseases: Early closure of the fontanel Cause Other signs of illness What should be done? Craniosynostosis is a rare disease of the skeletal system, which is characterized by early closure of the cranial sutures, small skull circumference, increased intracranial pressure, hearing impairment, strabismus and impaired growth of other parts of the skeleton. Craniosynostosis can be congenital or occur against the background of rickets, increased function of the thyroid or parathyroid glands. Diagnosis of craniosynostosis is carried out in specialized pediatric clinics. Treatment of craniosynostosis is predominantly surgical. Anomalies of brain development Very rarely cause too early development The source is an anomaly of brain development. Diagnosis of this disease is carried out by specialists in the field of neuropediatricians. Treatment depends on the type and severity of the abnormality. What does a protruding (swollen) or sunken fontanel mean? The fontanel of a healthy child should be only slightly higher or lower than the level of the surrounding skull bones and pulsate noticeably.
A change in the appearance of the fontanel (sunken or, on the contrary, protruding) fontanel may indicate a number of diseases. What does a sunken fontanel mean? Most often, retraction of the fontanel is observed due to dehydration of the child against the background of fever, diarrhea, and repeated vomiting. If a sunken fontanel is discovered, the child should drink plenty of fluids and contact a doctor to treat the illness that caused the dehydration. What does a protruding fontanel mean? Most often, a protruding fontanel is observed against the background of diseases that are accompanied by increased intracranial pressure: meningitis, encephalitis, tumors, intracranial bleeding, increased intracranial pressure for another reason.
If a bulging fontanelle is combined with one or more of the following symptoms, you should call a doctor as soon as possible: High fever Bulging of the fontanelle occurred after a head injury or a child’s fall. Vomit Your child is sleepy or overly irritable Strabismus Convulsions or epileptic seizures Loss of consciousness Bulging fontanel for a long time without other symptoms Proper care of the fontanel The child's fontanelle does not require any special care or protection. The fontanel area can be safely washed while bathing the child, and then blotted (do not rub) with a towel. Copied from here