How easy is it to hurt a baby’s soft spot?
A baby’s fontanels may seem easy to hurt, but in reality, they are not that vulnerable. Still, it is very common to worry that one may have hurt a baby’s fontanel if accidentally pushed or pressed on with too much force.
Learn all about babies’ fontanels here, including the warning signs that your baby’s soft spots are injured or if there is something wrong with them.
Did I hurt baby’s fontanelle?! I accidentally pushed my baby’s soft spot while trying to grab/right his head when he pulled away suddenly. Have I hurt it or him?
How easy is it to hurt a baby’s fontanel and his brain?
Fontanel Facts & The Risk Hurting A Baby’s Soft Spot (Fontanel)
What is a Baby’s Fontanelle?
A baby’s soft spot or fontanel (also spelled fontanelle), is made of a tough, fibrous membrane, formed where skull bones and sutures join. There are several fontanels in a baby’s head. These fontanels allow for the brain and skull to grow during the first year of life. The sutures, later on, mineralize and solidify to join the skull bones together.
A newborn baby has 6 fontanels namely:
- Anterior – this is the most significant clinically, of all fontanels. This offers an insight as to the baby’s hydration status and brain well-being. This fontanel closes between 13 to 24 months.
- Posterior – this fontanel closes within 6 to 8 weeks of birth.
- Mastoid (2) – these fontanels close between 6 to 18 months of age.
- Sphenoid (2) – these fontanels close by the 6th month of age.
Characteristically, these fontanels are flat, soft, yet firm. A sunken anterior fontanel indicates dehydration, while bulging indicates an increase in intracranial pressure (too much fluid in the brain) that may be due to infection, anatomical abnormality, or hemorrhage.
The image below shows the gradual closure of the anterior and posterior fontanels.
Babies born through VBAC often have quite a funny head shape – egg-shaped head – which is due to these fontanels. As moms, we should all be happy that they exist!
This video provides a throrough guide to what the fontanelles are, why we have them and certain conditions that will affect the fontanelles:
How Vulnerable are the Fontanelles?
A lot of parents, myself included the first time, are very afraid to even touch their baby’s fontanel – worried that they will hurt baby’s fontanelle. It is a very special area of a baby’s body and even a target for folk myths as you can read about here. But the soft spot is more like a helmet for the baby’s brain than the opposite. And just think of the pressure on the spot during birth; a baby’s soft spot cannot be that vulnerable!
Certainly, accidents can occur, and direct penetration through the soft spot would happen more easily than through the skull, which is very dangerous. But an unintentional push is not likely to be dangerous unless it was hard. Your child will manifest pain through crying or other abnormalities relating to the brain if he was truly hurt, otherwise, I wouldn’t think too much about it.
So if it is only the case that you happened to push your baby’s soft spot a bit while taking care of your baby, it is very unlikely that he was injured.
If the push was very hard or if you notice any changes in your baby’s behavior (appears extra sleepy, dizzy, or anything like that), do contact a doctor immediately.
Warning Signs from Baby’s Soft Spot
In addition to direct penetration, a hard push, or fall, there are other signs seen on the fontanels (particularly the anterior fontanel) that would give you an insight into whether your baby is healthy or not.
But first, we have to review the normal before we delve into the abnormal signs:
The fontanels are normally soft, yet firm, with a slight depression when touched. In examining the anterior fontanel, the baby should be calm. Crying babies may have bulging or full fontanels. The fontanel should be examined at a supine and upright position. It should reveal a soft opening on the head, not tensed when touched. However, a slight pulsation will be felt when you touch it, which is normal.
1. A Swollen or Bulging Fontanelle
If the fontanel appears swollen or bulging and tensed when you touch it, call your doctor immediately. This should be accompanied by any of the signs and symptoms that will indicate a a traumatic head injury.:
- Persistent vomiting
- Abnormally drowsy or altered mental state
- Limp upper and lower limbs
- Neck rigidity
These signs could indicate increased intracranial pressure brought about by a lot of causes: infection (meningitis, encephalitis), hypoxic-ischemic brain injury, hemorrhage in the brain, brain lesion, or mass, or hydrocephalus. This warrants immediate medical care.
2. A sunken fontanel
A sunken fontanel can indicate dehydration. For babies with a history of diarrhea, low to no fluid intake, or a chronic disease, the fontanels are sunken upon examination.
This is usually accompanied by dry eyes (no tears when crying), sunken eyeballs, poor skin turgor, and loss of appetite (no food or fluid intake). This is another red flag. You have to take your baby to the emergency room ASAP.
3. Premature Closure of Fontanels or Small Fontanels
Closure of fontanels as early as 3 months of age is within normal limits, however, we should monitor the size of the head. Small heads and small fontanels are usually indicative of abnormal brain development. Consult your doctor if your child seems to exhibit this.
Other conditions cause premature closure of fontanels or small fontanels. These are the most common conditions:
- Congenital infections
- Chromosomal defects
- Fetal alcohol syndrome
- Hypoxic-ischemic encephalopathy
- Structural brain defect
- Endocrine problems (hyperthyroidism or hyperparathyroidism)
The premature closure of fontanels yielding an abnormal head shape is called craniosynostosis. Surgery might be needed for normal brain development and growth.
It is not easy as a parent to assess the fontanel. If you are at all worried, talk to a doctor and have your baby examined.
4. Delayed Fontanel Closure or Large Fontanels
Congenital hypothyroidism is the most common cause for delayed closure of fontanels or large fontanels.
Achondroplasia, Down Syndrome, and increased intracranial pressure are also common causes of this condition.
Congenital hypothyroidism is detected during newborn screening. Management includes levothyroxine, which the child may take for a lifetime.
How to Protect My Baby’s Fontnels?
There is not a lot you need to do to protect your baby’s fontanels apart from protecting your baby from falls or any head trauma. Make your home baby-proof by e.g. lowering your bed height, barriers on the stairs, and other elevated parts of your home. Also never leave your baby alone on the bed or changing table, even when newborn.
You do not have to worry about touching your baby’s fontanells.
Conclusion – How Easy is it to Hurt Baby’s Fontanelle?
Fontanels have a significant role in childbirth. They are also indicators of your child’s health status. However, an accidental push to the fontanel without force or effort should not hurt your baby.
Always monitor for other signs or symptoms like incessant crying, abnormal drowsiness, and vomiting, as these could help you assess if your child is suffering from a traumatic head injury. Otherwise, your child should be healthy.
- Fontanelle Myths
- The baby fell off the bed – concussion warning signs
- Accused of child abuse – baby fell
- Baby’s Head Shape: Why It’s Uneven, When to Worry
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