Why is my two month old baby's fontanelle not 'breathing'?

My baby was born in mid-July, and the fontanel at the top of his head is not pulsing or "breathing". Why is this and is this condition dangerous? (Ha My, An Giang)

Reply:

Humans breathe and exchange oxygen in the lungs. The fontanel is not involved in breathing at all, so the common name "breathing fontanel" is incorrect. In some newborns, parents may see the fontanel pulsating when crying or straining, because the area of the baby's brain with the fontanel has not been covered by bone, called the fontanel is not closed.

At birth, the baby's head has two fontanels, the anterior and posterior fontanels, which are soft to the touch when bathing, washing the baby's hair, or putting on a hat. The anterior fontanel is quadrilateral, 2.5 x 2.5 cm in size, covered by a fibrous membrane, and will close at 18 months of age. However, more than 27% of babies have their anterior fontanel closed by 12 months of age.

The posterior fontanel is a triangular structure bounded by the parietal bone and the occipital bone (the bone that does not completely cover the skull). Normally, after birth, this fontanel is very small, only the size of a baby's fingernail, difficult to detect and closes after 2-3 months of age.

If the fontanel closes early but the baby's head circumference is still within the standard and developing normally, it is not a cause for concern. However, babies with early fontanel closure need to be monitored. If the baby's head circumference changes from the standard, the doctor needs to do a thorough examination to find the cause. If the fontanel closes early and the head circumference is small for the age, the baby may have microcephaly.

If the fontanel is dilated and closes late, the child is likely to have rickets, dilated ventricles, increased intracranial pressure, hypothyroidism... If the fontanel is sunken, watch out for dehydration, malnutrition, and slow growth.

Newborns with bulging fontanelles also need to pay attention to some diseases, such as meningoencephalitis, cerebral hemorrhage, hydrocephalus... or use of certain medications, need to be taken to the doctor immediately.

MD.CKII Pham Le My Hanh
Head of Neonatology Department, Neonatal Center, Tam Anh General Hospital, Ho Chi Minh City

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