Fontanels at the baby of
Many fears of young mother are connected with fontanels - soft sites on the head of the newborn baby. Even it is terrible to touch fontanels - and suddenly the careless movement injures the child`s brain? Besides, it is rumored that too big or small fontanels can be symptoms of serious diseases...
A little anatomy
It is known that the skull consists of many bones connected between themselves seams (they represent not the flat, and jagged, zigzag lines). In the pre-natal period of a bone of a skeleton are put as plates of dense webby fabric which are replaced later with cartilaginous tissue, and then - on bone. Ossification of flat bones of a roof (top and lateral parts) skulls, unlike long tubular bones of extremities, passes a cartilage stage, i.e. points of ossification appear in the center of webby plates. In the subsequent process of ossification extends in the parties, taking the increasing area of each bone, does not reach its edges yet. This process almost entirely happens even during pre-natal development therefore the most part of a roof of a skull by the time of the birth of the kid is already presented by a bone tissue though the last also considerably differs from a bone tissue of adults: it is much thinner, elastic, rich with blood vessels. However even prior to extra uterine existence important and difficult test - patrimonial process is necessary to the baby. And the nature, of course, as well as possible prepared for it a small organism. The matter is that some regional sites of bones do not stiffen by the time of childbirth and fabrics are presented still by plates connecting, or webby. Sites in junctions of several bones are those, they - that also are called fontanels.
By the time of the birth the kid, as a rule, has six fontanels - two unpaired and two steam rooms. Most “known“ - big, frontal, or forward, the fontanel located on the top in a junction of two frontal and two parietal bones. It has the diamond-shaped form, its sizes by the time of the birth make about 3 cm (from 2,2 to 3,5 cm).Other unpaired fontanel called small, back, or occipital is located
on a nape, in the place of a convergence two parietal and an occipital bone. It has triangular shape and the small sizes - about 5 mm. In half of cases it can be already closed by a bone tissue by the time of the birth, in the others - is closed within the first month of life of the baby.Pair fontanels are located
of the head on each side. The wedge-shaped fontanel located in temporal area, in the place of a convergence of frontal, parietal, wedge-shaped and temporal bones of each party is known. Behind an ear, in a junction of occipital, temporal and parietal bones, the mastoidal fontanel is located.
Increase in fontanels at the birth can be a consequence of prematurity or violation of pre-natal process of ossification, and also a symptom of congenital hydrocephaly (expansion of liquid spaces of a brain). Full closing by the birth lateral and occipital fontanels in combination with the small sizes of forward can be a sign of a congenital mikrotsefaliya (pathological reduction of the sizes of the head and, as a rule, a brain).
Occipital and lateral fontanels, unlike forward, are normal closed soon after the birth of the baby therefore when tell “fontanel“ in singular, mean forward, or big, a fontanel.
So, brain covers in fontanels are presented by brain covers (soft brain, web and firm brain), webby connecting fabric, a thin layer of fatty tissue and skin.
Why fontanels are necessary?
Fontanels, being pliable sites, carry out extremely important function: they allow bones of a skull to come at each other in the course of childbirth (it is called “a head configuration“) that considerably facilitates passing of a head on narrow patrimonial ways. After the delivery remaining opened a big fontanel carries out function of depreciation at casual blows of the kid the head. And at last, the fontanel actively participates in thermoregulation in general and a thermal exchange of a brain - in particular. At temperature increase above normal through a big fontanel there is an additional natural cooling of a brain and brain covers. From - for imperfections of mechanisms of thermal control the infantile organism, in comparison with an organism of adults, overheats much easier and the brain of babies is much more sensitive to any negative influences. For this reason the additional role of a fontanel in heat exchange is so important.
the Sizes and terms of closing of a fontanel
the Big fontanel has the maximum sizes (from 2,2 to 3,5 cm) at the time of the birth. In the first days after the delivery at the expense of “raspravleniye“ of bones of a skull and interosseous seams the absolute sizes of a fontanel can increase a little, however it does not reflect the true growth of a fontanel, and is connected with little change of its form. In the subsequent the sizes of a fontanel begin to decrease steadily, its closing happens from 6 to 18 months in time. Cases when normal closing of a fontanel happens in earlier (from 3 to 6 months) or later (till 2 years) terms are known.
the Size of a big fontanel and speed of its closing - genetically caused factors. Still nobody managed to change genetic predisposition of the person. The special commission of WHO which in 1982 conducted the world statistical research on questions of dependence of physical and intellectual development of the child on the size of a fontanel and speed of its closing came to these conclusions.by
Nevertheless, perhaps, with the sizes and terms of closing of a fontanel connected the greatest number of parental experiences. To this day it is possible to hear “horror stories“ and myths in this respect.
Myth the first.“ If the fontanel too big, is, most likely, rickets“. the fontanel Sizes do not correlate with this disease at all. In a phase of the “blossoming“ rickets when there is a considerable softening of bones, it is possible to note also a softening of bone edges of a fontanel, but it will not affect the amount of this education in any way. Besides, rickets has also other symptoms.
Myth of the second.“ If a fontanel too small, it is impossible to appoint vitamin D even if it is accompanied by strong indications of rickets“. If at the kid note strong indications of rickets - increase nervously - reflex excitability, decrease in a muscular tone, a sourish smell of sweat, growth of frontal and parietal hillocks on skull bones, change of a ratio of ions of calcium and phosphorus according to biochemical blood test (we do not carry nape baldness as an independent symptom as the considerable hair loss occurs at all babies at the age of about 3 months to this list), - purpose of vitamin D and preparations of calcium is shown it (worthy alternative the homeopathic medicines normalizing kaltsiyevo - a phosphoric exchange can serve in an organism). This therapy, at observance of the correct dose mode, is not capable to accelerate closing of a fontanel.
Myth the third.“ If the fontanel too long does not grow, it either rickets, or hydrocephaly“. the Sizes and terms of closing of a fontanel - indicators very ambiguous. The fontanel can be more middle-aged size, but at the same time quickly enough be closed and vice versa. We already spoke about rickets symptoms above. The concern of the kid, a sleep disorder, muscular dystonia, changes of vessels of an eye bottom can accompany increase of intra cranial pressure. At the same time parents can notice the general symptoms - drowsiness or sleep disorders, concern, tearfulness. And doctors will pay attention to a muscular tone, an eye bottom, a fontanel, to measure a head gain and so forth Besides, at a gidrotsefalny syndrome (increase in amount of liquid in a brain) significant increase in a monthly gain of a circle of the head, in hard cases - divergences of edges of cranial seams, a divergence of edges of already overgrown fontanel is noted. For this reason doctors are guided not by the fontanel size, and by the growth rate of a head of the kid.
Myth the fourth. “If the fontanel is closed too quickly, the brain will have no place to grow, and intellectual inferiority will develop“. it is proved Long ago that growth of a skull is carried out not so much at the expense of area of a fontanel, how many at the expense of seams therefore “early“ closing of a fontanel does not harm this process at all.
Myth the fifth.“ It is better not to touch a head in fontanels - it is possible to injure a brain“. Such fears are also groundless. Despite the seeming vulnerability of this area, a brain it is reliably protected by numerous layers of fabrics. Therefore neither a kiss, nor a wipe a towel, nor combing of volosik over area of a fontanel is capable to do harm to yours to the baby.
what the doctor will pay attention to?
At survey of the baby the doctor will surely estimate also areas of fontanels. At the same time it will be faced by the following questions:by
- open or closed the corresponding fontanels? Whether it corresponds to age of the child? If fontanels are open for
- what their sizes? They increased or decreased since the last survey? Whether the shape of fontanels is symmetric? by
- pliabl or too softened edges of a fontanel? Normal edges of a fontanel have to be elastic and pliable. If they are excessively soft, it can speak about development of rickets - a typical illness of growth, the shown lack of education and a mineralization of bones and their softening generally from - for a lack of vitamin D during the most active growth of the kid.
- What condition of soft (webby) area of a fontanel? Normal the fontanel repeats a configuration and level of standing of bones of a skull (if to examine the kid in a prone position) or slightly sinks down (if to take it on handles in vertical position). At a palpation it is easy to press through it small pillows of fingers, at the same time the arterial pulsation is obviously felt. At shout the fontanel vybukhat a little, becomes a little more intense. The considerable vybukhaniye and tension of a fontanel which is followed by decrease or the termination of an arterial pulsation and remaining at rest forces to suspect increase of intra cranial pressure and/or increase in amount of cerebrospinal fluid of brain spaces (this state is known as gipertenzionno - a gidrotsefalny syndrome). Complications of a course of pregnancy and childbirth and even vitamin D overdose can be the cause of this state. Vybukhaniye and tension of a fontanel can also be one of meningitis symptoms (an inflammation of brain covers). As a rule, the listed changes of a condition of a fontanel are followed also by other symptoms - concern and crying or, on the contrary, the increased drowsiness of the baby, vomiting, temperature increase, refusal of food and/or difficulties at its reception. That is why it is necessary to report to the pediatrician about all features of behavior of a crumb noticed by you, and not to delay in case of emergency a call of “ambulance“. The considerable zapadeniye and slackness of a fontanel (when fingers when pressing on this area almost do not encounter resistance) develop as result of dehydration against a severe diarrhea and/or vomiting.
Once again wants to note that only the doctor with his knowledge and experience can examine and estimate fontanels, parents have to watch a state and behavior of the kid in general as symptoms in itself from seams and fontanels are never the only isolated manifestations of these or those state or a disease.
Nevertheless if parents have questions or fears connected with appearance and a condition of fontanels of the kid it is necessary to see a doctor