Fontanel - Mother's e-Guide

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Neonatal

Fontanels

Fontanels or Fontanelles also known as Soft spots are the openings (gaps) between the bones of the baby’s skull; these bones are immature and as a result not yet fused together. At the point of delivery, the gaps make it easy for the bones of the skull to shift altering the shape of the baby's head for easy passage through the narrow birth canal. Also, the spaces (Fontanels) make provision for the development of the baby’s brain; creating room for the rapid expansion of the brain and head. A newborn possesses up to six fontanelles but there are two basic ones: the Anterior fontanel (located directly on top of the head) and the Posterior fontanel (at back of the head).

Anatomy of the Newborn's Skull

Fontanels do not close at the same time. The closure is a gradual process: Posterior closes between six weeks and three months while the Anterior starts to close by the sixth month and closes completely between the eighteenth month and two years of the baby. However, fontanel can close earlier or later and still be normal as growth rate differs in babies. Hence the specified closure timelines are the standard average time rate and should serve solely the purpose of a guide. Nursing mothers should not hesitate to consult the doctor in case of any strange signs.

Care and Concerns

The back-to-sleep method is advisable. It reduces the risk of Sudden Infant Death Syndrome (SIDS). This strategy can as well increase the chances of plagiocephaly: the flattening of the back or the side of the head; resulting from babies lying in the same position, on either their back or their side all the time. The advocacy of the back-to-sleep campaign therefore is to prevent pressure in one spot as baby sleeps. The baby should be assisted to sleep with his or her back and when awake the pressure on the head should be relieved; by making the baby to sit, play, to enable turning of the head sideways, can be carried around or allowed to spend some time lying with the tummy etc.

Touching the Anterior fontanel (Soft spot) does not pose any danger such as when washing the baby’s head, combing the hair etc. but it must not be pressed to avoid injury. Sometimes, the baby's pulse is noticeable in the fontanel, moving in a rhythmic pattern with the heartbeat of the baby; such action of the Soft spot is tagged ‘Pulsating’.

Basically, care of the fontanels involves knowing how to observe and what exactly to observe. Here are parts of things to watch out for while grasping what is normal and abnormal.

1. The fontanel should look flat against the baby's head. It should not be swollen and bulging or sinking down into the child's skull.

Normally, the fontanel could have a slight inward curve; but indented into the baby's head could as well signifies dehydration which occurs when a baby is under breastfed, experiencing fever, diarrhea or vomiting. In the same vein if the Soft spot is protruding outward known as bulging – this signals either infection, head injury or accumulation of fluid in the brain. Also, it is worth mentioning that severe crying or vomiting by babies can lead to the fontanelles bulging out. Doctors attention should be sought where necessary while the baby is properly breastfed and given adequate water to safeguard from dehydration.

2. A fontanel that does not close within the standard timeframe or unduly bulged is a sign of either Ricket, Hypothyroidism or Down syndrome etc. Contrastingly, when fontanels close too early, it is a deficiency known as Craniosynostosis. These deficiencies should not be taken lightly but addressed with right solutions and antidote.

Essence

Having the knowledge of the fontanelles in terms of the look and feel breeds confidence in the nursing mother. It will equally help to achieve a better shape for the head of the baby preventing it from being flat, cone-shaped or pointy.