The child’s Fontanelle (soft spot)
What are fontanelles?
These are spaces present at birth in between skull bones that are covered by a tough membrane. They are at times called soft spots because of their soft feel relative to the skull. There are four fontanelles. One near the back of the head is the posterior fontanelle. The largest is the diamond shaped anterior fontanelle that may be seen pulsating. The other smaller ones (mastoid and sphenoid) are located in the sides of the head near the ears. The posterior fontanelle closes by 2 to 3 months of age while the anterior by 2 years of age.
Myths about the fontanelle
Pulsation of the fontanelle:
Some mothers get overly concerned when they see the fontanelle pulsating. This is normal and is due to the pulses from the blood vessels in the brain and meninges (layers covering the brain).
Fear of injury to the fontanelle:
Though the fontanelles feel soft, the covering membrane is tough and is very hard to injure or penetrate. There are few cases of penetrating fontanelle injuries in babies and are provbably intentional. Head injury in newborns arises mainly due to trauma during birth. Even the frequent falls that babies get may not result into significant brain injury.
When to get concerned about the fontanelle
This is often due to severe dehydration and the mother should take the child to hospital
A swollen fontanelle may be due to meningitis or increased pressure in the brain (intracranial pressure) that has several causes. This too requires medical attention.
Failure to close of the fontanelle:
In certain disease conditions, the fonatnelles may fail to close. By two years if the anterior fontanelle is still open, the child needs to be evaluated by a doctor.
Possible injury to the fontanelle
As already noted this is not very common. However, head trauma arising from birth trauma may give a child a swelling over the fontanelle (cephalohematoma) which is due to a blood clot collection beneath the skull. This may be serious in some caseas and may lead to severe anemia, yellow discoloration of the eyes and reduced blood pressure in newborns. However, often it is mnor and resolves on its own. The doctor is in position to assess severity.
A penerating injury to the fontanelle by way of a sharp object can direct cause injury to the brain, rapture blood vessels or introduce infection in the brain and its overlying layers(meningitis). It may also lead to leakage of the fluid that bathes the brain(cerebral spinal fluid).