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A fontanel is more commonly known as a soft spot. When a baby is born, they typically have several fontanels where bones of their skull haven’t fused yet. A newborn has fontanels on the top, back, and sides of their head. Usually, only the anterior fontanel, which is on the top of the head towards the front, can be seen and felt. This is the one called the soft spot. In some babies, the posterior fontanel, which is found toward the back of the head, can also be felt, though it’s much smaller.
It’s important for new parents to understand what a fontanel looks and feels like. A baby’s soft spot should feel relatively soft and curve inward very slightly.
Changes in texture or appearance can be a sign of serious health issues. Parents should watch for soft spots that are curved outward on their baby’s head and feel firm. This is known as a bulging fontanel and may be a sign of brain swelling or fluid buildup in the brain. These can cause pressure inside the skull to rise and may result in damage to the baby’s developing brain.
A bulging fontanel is an emergency. If your child is experiencing this symptom, seek medical attention immediately.
A bulging soft spot can be a sign of several very serious conditions. The consequences of not seeking treatment right away can be dire. For instance, encephalitis, a common cause of bulging fontanels, can lead to permanent brain damage or even death in severe cases.
Some of the most common causes of a bulging fontanel are:
A 2003 article in American Family Physician identifies the following additional conditions, along with numerous others, as possible causes:
There are several factors that can make a soft spot appear to be bulging when in reality there’s no danger. Common things babies do such as lying down, vomiting, or crying can be mistaken for your baby having a bulging fontanel.
To determine whether your infant actually has a bulging fontanel, first try to calm them down, and then position them so their head is upright. If you succeed in doing this and the soft spot still appears to be bulging, seek medical attention for your child immediately.
Don’t wait to make a doctor’s appointment, go to the nearest emergency room. This is especially crucial if your baby has a fever or seems extremely sleepy.
Because there can be many explanations for these symptoms, your doctor will collect as much information as possible about your child’s condition.
Your doctor will perform a physical examination of your infant and will likely ask:
Be sure to tell your doctor about any other symptoms you’ve observed, including marked drowsiness, an elevated temperature, or irritability beyond what’s normal for your child.
Depending on the answers you provide and other symptoms that may be present, your doctor may order one or more tests, such as an MRI or CT scan, to make a diagnosis.
Lumbar puncture, or a spinal tap, may also be performed. This involves taking a sample of cerebrospinal fluid from your baby’s lower spine to check for disease and infection in their nervous system.
Treatment will depend on the underlying cause of your baby’s symptoms.
There’s no definite way to prevent fontanels from bulging. This is in large part because the symptom has so many potential causes.
However, it’s important that parents and other caregivers avoid unnecessary hospital visits by learning how to distinguish between a soft spot that temporarily appears to be bulging and one that’s actually protruding.
Written by: Krista O'Connell
Medically reviewed on: Feb 22, 2016: Karen Richardson Gill, MD, FAAP
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