What should be the fontanelle. When the fontanelle overgrows in newborns

Many fears of a young mother are associated with fontanelles - soft areas on the head of a newborn baby. It's scary to even touch the fontanelles - what if a careless movement injures the child's brain? In addition, it is rumored that fontanelles that are too large or too small can be signs of serious illness ...

A bit of anatomy

As you know, the skull consists of many bones connected by seams (they are not even, but jagged, zigzag lines). In the prenatal period, the bones of the skeleton are laid as plates of dense membranous tissue, which are later replaced by cartilaginous tissue, and then by bone. Ossification of the flat bones of the roof (upper and lateral parts) of the skull, in contrast to the long tubular bones of the extremities, bypasses the stage of cartilage, i.e. ossification points appear in the center of the membranous plates. Subsequently, the process of ossification spreads to the sides, capturing an ever larger area of ​​each bone, until it reaches its edges. This process almost entirely takes place during the period of intrauterine development, therefore, most of the skull roof by the time the baby is born is already represented by bone tissue, although the latter is significantly different from the bone tissue of adults: it is much thinner, more elastic, and rich in blood vessels. However, even before the start of extrauterine existence, the baby faces an important and difficult test - the birth process. And nature, of course, perfectly prepared a small organism for it. The fact is that some marginal areas of the bones do not ossify by the time of delivery and are still represented by plates of connective, or membranous, tissue. These are the areas at the junction of several bones, they are called fontanelles.

By the time of birth, the baby usually has six fontanels - two unpaired and two paired. The most "famous" is the large, frontal, or anterior, fontanelle, located on the vertex, at the junction of the two frontal and two parietal bones. It has a diamond shape, its dimensions at the time of birth are about 3 cm (from 2.2 to 3.5 cm).

Another unpaired fontanelle, called the small, posterior, or occipital, is located at the back of the head, at the point of convergence of the two parietal and occipital bones. It has a triangular shape and small dimensions - about 5 mm. In half of the cases, it may already be closed by bone tissue by the time of birth, in the rest, it closes during the first month of the baby's life.

Paired fontanelles are located on the sides of the head. Known wedge-shaped fontanel, located in the temporal region, at the convergence of the frontal, parietal, sphenoid and temporal bones of each side. Behind the ear, at the junction of the occipital, temporal and parietal bones, is the mastoid fontanelle.

An increase in fontanelles at birth can be a consequence of prematurity or a violation of the intrauterine ossification process, as well as a congenital symptom (expansion of the fluid spaces of the brain). Complete closure of the lateral and occipital fontanelles for birth in combination with the small size of the anterior fontanelle may be a sign of congenital microcephaly (pathological decrease in the size of the head and, as a rule, of the brain).

The occipital and lateral fontanelles, in contrast to the anterior fontanel, normally close shortly after the birth of the baby, therefore, when they say "fontanelle" in the singular, they mean the anterior, or large, fontanelle.

So, the integument of the brain in the fontanel area is represented by the membranes of the brain (pia mater, arachnoid and dural), membranous connective tissue, a thin layer of adipose tissue and skin.

Why are fontanelles needed?

The fontanelles, being compliant areas, perform an extremely important function: they allow the bones of the skull to go over each other during childbirth (this is called the "head configuration"), which greatly facilitates the passage of the head through the narrow birth canal. After childbirth, the large fontanelle that remains open serves as a shock absorber in case of accidental blows of the baby's head. And finally, the fontanelle is actively involved in heat regulation in general and heat exchange in the brain in particular. When the temperature rises above normal through the large fontanelle, additional natural cooling of the brain and meninges occurs. Due to the imperfection of thermoregulation mechanisms, the infant's body, in comparison with the body of adults, overheats much more easily, and the brain of babies is much more sensitive to various kinds of negative influences. That is why the additional role of the fontanelle in heat transfer is so important.

Size and timing of fontanelle closure

The large fontanelle has a maximum size (from 2.2 to 3.5 cm) at the time of birth. In the first days after childbirth, due to the "straightening" of the bones of the skull and interosseous sutures, the absolute size of the fontanel may slightly increase, but this does not reflect the true growth of the fontanel, but is associated with a slight change in its shape. Subsequently, the size of the fontanel begins to decrease steadily, its closure occurs in a period of 6 to 18 months. There are cases when the fontanelle closure normally occurs earlier (from 3 to 6 months) or later (up to 2 years).

The size of the large fontanelle and the rate at which it closes are genetically determined factors. No one has yet succeeded in changing a person's genetic predisposition. These conclusions were reached by a special WHO commission, which in 1982 conducted a worldwide statistical study on the dependence of the physical and mental development of a child on the size of the fontanelle and the speed of its closure.

Nevertheless, perhaps the largest number of parenting experiences is associated with the size and timing of fontanelle closure. To this day, one can hear "horror stories" and myths in this regard.

Neither a kiss nor brushing the hairs over the fontanel area can harm the baby.

The first myth. "If the fontanelle is too large, it is most likely rickets." The size of the fontanelle does not correlate in any way with this disease. In the "blooming" phase, when there is a significant softening of the bones, softening of the bony edges of the fontanel can also be noted, but this will not affect the size of this formation. In addition, rickets also have other symptoms.

The second myth. "If the fontanelle is too small, vitamin D should not be given, even if it is accompanied by clear signs of rickets." If the baby has obvious signs of rickets - an increase in neuro-reflex excitability, a decrease in muscle tone, a sour smell of sweat, an increase in the frontal and parietal tubercles on the bones of the skull, a change in the ratio of calcium and phosphorus ions according to biochemical data (we do not include baldness of the nape as an independent symptom, since significant hair loss occurs in all infants at the age of about 3 months), - he is shown the appointment of vitamin D and calcium preparations (homeopathic preparations that normalize calcium-phosphorus metabolism in the body can serve as a worthy alternative). This therapy, with the correct dosage regimen, is not able to accelerate the closure of the fontanelle.

The third myth. "If the fontanelle does not overgrow for too long, it is either rickets or hydrocephalus." The size and timing of the closing of the fontanelle are very ambiguous indicators. The fontanelle may be larger than the average size, but close rather quickly, and vice versa. We have already talked about the symptoms of rickets above. An increase in intracranial pressure may be accompanied by anxiety of the baby, sleep disturbances, muscular dystonia, changes in the vessels of the fundus. At the same time, parents may notice general symptoms - drowsiness or sleep disturbances, anxiety, tearfulness. And doctors will pay attention to muscle tone, fundus, fontanelle, measure head growth, etc. In addition, with hydrocephalic syndrome (an increase in the amount of fluid in the brain), there is a significant increase in the monthly increase in head circumference, in severe cases - divergence of the edges of the cranial sutures, divergence of the edges of the already overgrown fontanelle. That is why doctors are guided not by the size of the fontanel, but by the growth rate of the baby's head.

The fourth myth. "If the fontanelle closes too quickly, the brain will have nowhere to grow, and mental disability will develop." It has long been proven that the growth of the skull is carried out not so much at the expense of the fontanel area, but at the expense of the sutures, therefore, the "early" closure of the fontanelle does not harm this process at all.

The fifth myth. "It is better not to touch the head in the fontanelle area - you can damage the brain." Such fears are also unfounded. Despite the apparent vulnerability of this area, the brain is reliably protected by numerous layers of tissue. Therefore, neither kissing, nor drying with a towel, nor brushing the hairs over the fontanel area can harm your baby.

What will the doctor pay attention to?

During the examination, the doctor will definitely evaluate the fontanel area. At the same time, he will be faced with the following questions:

• Are the corresponding fontanelles open or closed? Is it appropriate for the child's age?
• If the fontanelles are open, what are their sizes? Have they increased or decreased since the last inspection? Are fontanelles symmetrical?
• Are the fontanel edges pliable or too soft? Normally, the edges of the fontanelle should be elastic and pliable. If they are too soft, this may indicate the development of rickets - a typical growth disease, manifested by a lack of bone formation and mineralization and their softening mainly due to a lack of vitamin D during the period of the most active growth of the baby.
• What is the condition of the soft (membranous) fontanel area? Normally, the fontanelle repeats the configuration and level of the skull bones (if you examine the baby while lying down) or sinks slightly (if you take it on the handles in an upright position). On palpation, it is easy to push it with the fingertips, while arterial pulsation is clearly felt. When crying, the fontanelle bulges a little, becomes a little more tense. Significant bulging and tension of the fontanelle, accompanied by a decrease or cessation of arterial pulsation and remaining at rest, makes one suspect an increase in intracranial pressure and / or an increase in the amount of cerebrospinal fluid in the spaces of the brain (this condition is known as hypertensive-hydrocephalic syndrome). The cause of this condition can be complications of the course of pregnancy and childbirth, and even an overdose of vitamin D. Bulging and tension of the fontanel can also be one of the symptoms (inflammation of the meninges). As a rule, the listed changes in the fontanelle state are accompanied by other symptoms - anxiety and crying or, on the contrary, increased drowsiness of the baby, vomiting, fever, refusal to eat and / or difficulties in taking it. That is why you should inform the pediatrician about all the features of the baby's behavior you have noticed, and in emergency cases, do not delay calling an ambulance. Significant retraction and lethargy of the fontanelle (when the fingers, when pressed on this area, almost do not encounter resistance) develop as a result of dehydration against the background of severe diarrhea and / or vomiting.

Once again, I would like to note that only a doctor with his knowledge and experience can examine and evaluate fontanelles, while parents should observe the condition and behavior of the baby as a whole, since the symptoms themselves from the sutures and fontanelles are never the only isolated manifestations of this or other condition or disease.

However, if parents have questions or concerns about the appearance and condition of the baby's fontanelles, consult a doctor.

Dorofeya Apaeva, pediatrician, Moscow

The fontanelle is an elastic area between the bones of the newborn's skull, which are not yet fused.

What is fontanelle

Inside the womb, the baby's skull has not yet acquired its final shape. Only after the baby is born will it be fully formed. When the child passes through the birth canal, the skull changes its shape and the head stretches a little, so it is easier to move. This is due to the fact that the bones of the skull are not yet completely fused together. After the baby is born, the head gradually becomes round, but the joints of the bones in the skull do not immediately grow together and have soft depressions, they are called fontanelles. With age, the skull becomes solid.

Forms, sizes, functions of fontanelles

There are six fontanels in total at birth, but most of them close during the first few months of a baby's life. The largest fontanelle is located almost in the center of the head, it has a diamond shape. Not all have the same size, minimum 2 cm, maximum 3.

The second is located in the back of the head and has the shape of a triangle, its size is maximum 5 mm. Not all babies have it pronounced, in some it closes in the womb.

The next 4 are arranged in pairs. Two in the temporal part in the form of wedges on both sides and the other two behind the ears, resembling a heart in shape. They are very small and close almost immediately, therefore, the fontanel is usually spoken in the singular and mean large.

Functions of fontanelles

At the birth of a child, and its passage through the birth canal, in order to prevent damage to the brain, nature conceived the presence of magical tissues on the skull, which are at its junction. They help to change the shape of the head during childbirth, making the bones of the skull flexible. The tissues themselves are protected by a membrane.

Also, the fontanelle is responsible for the thermoregulation of the body, preventing overheating of the brain.
Performs a protective function against brain damage in infancy.
Indicator function. By the shape and appearance of the crown, you can determine whether the child is developing correctly.

The condition of the fontanelle is checked at the moment when the child is in a horizontal position, at rest, the best time for the child's daytime sleep.

What determines the size of the fontanelle at birth?

The size of the fontanelles is influenced by the intrauterine development of the baby and the degree of maturity. If they are more than normal, then this may mean prematurity or hydrocephalus. Closed fontanelles at birth indicate that the baby may have microcephaly. That is, the head is not proportionally small, and hence the brain.

Head of a newborn baby: size, shape of fontanelles

Deviations from the norm:

Constant pulsation of the fontanelle, which does not go away with age

Usually, the fontanel pulsates slightly in a child, this is due to the fact that the main head arteries pass exactly in that place and the heartbeat is felt in the same way as when measuring the pulse. With age, this disappears when the fontanelle overgrows, but if the pulsation is too active, then it is worth examining the small heart.

The fontanel is too large

An oversized fontanelle may be associated with impaired development of the brain, hydrocephalus is usually suspected. Premature babies may also have the same problems, that is, the fontanel is too large.

Late fontanelle closure

The fontanel does not close for a long time due to a lack of nutrients, in particular vitamin D. Perhaps this means that the baby develops rickets. During this disease, the boundaries of the fontanelle soften and do not tighten for a long time.

Bulging fontanelle

The bulging fontanelle may be due to increased cranial pressure. He also periodically swells due to the nervous tension of the crumbs, with severe crying. If this form persists all the time, you should contact your doctor.

Why does the child have a sunken fontanelle

It can fall through or sink due to the fact that the baby's body does not have enough water. This is a sign of dehydration. In this case, the baby needs to be additionally fed, but be sure to inform the doctor about this.
According to the condition of the fontanelle, usually the doctor can conclude about the health of the baby. Is it developing correctly and is everything okay. However, it should be borne in mind that each child has a different fontanel overgrowth, or rather at different times. Experts have established a direct link between the period of overgrowth of the fontanelle and heredity, but up to 2 years, all the large fontanelle closes.

Reasons for the rapid growth of fontanelle

If your child's fontanelle closes earlier than other children, this is not abnormal. Only the closure of the fontanel before the child is three months old is considered a pathology. The fontanelle can quickly overgrow with a large amount of calcium in the baby's body, which can be observed if the mother, for example, eats a lot of foods containing calcium.
In addition, in breastfed babies, the fontanelle usually closes faster than in artificial babies. In extremely rare cases, if the fontanelle closes before the age of three months, the cause may be in diseases such as microcephaly (abnormally small size of the head and brain with normal sizes of the rest of the body) and craniosynostosis (too early fusion of the skull bones, accompanied by a small head size and increased intracranial pressure).

What time does the child's fontanelle close?

When a baby is just born, he has as many as six fontanels. Four of them are very tiny, so they overgrow in the first couple of days of life. The posterior or small fontanelle heals in about eight weeks, but the anterior or large fontanelle often causes anxiety in the parents. The anterior fontanelle may not overgrow until the age of two. It is during this period - from birth to two years old - that the child's brain is actively growing, and with it, the skull.
But in some children, the fontanelle closes much earlier than at two years old. For some - a year old, for others - even earlier.

Should you worry if your baby has a small fontanelle?

The size of the fontanelle in children is just as individual as the timing of overgrowth. If one child has a larger fontanel, this does not mean that your baby has a small one. The size of the fontanelle does not affect the child's development, health or well-being.

Precautions for early fontanelle closure

As already mentioned, the closure of the fontanelle before the age of three months is considered early, everything else is the norm. During a routine examination of the baby by a pediatrician, the doctor must check the condition of the fontanelle. By the way, do not worry when the doctor probes the fontanel - he cannot damage it in any way. The timing of the fontanelle closure is not the main sign of the normal development of the child's brain. If you notice that the baby's head is disproportionately small in relation to the rest of the body, then you need to consult a doctor even if the fontanelle has not yet closed.

Last updated article: 05/03/2018

The baby was recently born. He looks so small and defenseless. There are special formations on the head of the crumbs - fontanelles. New parents are often afraid to even touch the head, not to mention combing and washing their hair. In addition, there are rumors that it is possible to injure the brain of a crumbs when inaccurately pressing on the fontanel in newborns. There is a lot of talk and prejudice around this area on the head of the child. But is the fontanelle so easily injured in newborns? Is it true that its size and closure time play a huge role in the diagnosis of serious diseases in a child?

Pediatrician, neonatologist

The skull of a newborn is made up of bones that are joined together by sutures. The bone tissue on the baby's head is thin, pliable, and rich in blood vessels. Some areas on the head do not ossify, they are membranous tissue. They are located at the junction of several bones and are called fontanelles.

How many fontanelles does a newborn have? Many will be surprised to learn that a child is born with six fontanels.

Where are the fontanelles of a newborn?

The neonate's large fontanelle is the most prominent fontanelle, located at the crown of the head between the frontal and parietal bones. It got its name for a reason. Its size is quite large and averages 3 cm. The shape of the large fontanelle is diamond-shaped, and upon closer examination, you can see the pulsation.

Why is the fontanel pulsating? The thin connective tissue that forms the fontanel allows you to see the pulsation of the vessels of the brain and fluctuations in the cerebrospinal fluid. This is an absolutely normal physiological process; you should not worry about the pulsation of the fontanelle.

The small fontanelle in a newborn is located posterior to the large one at the junction of the parietal and occipital bones. This fontanelle looks like a triangle about 5 mm in size. Often, children are born with an already closed small fontanelle, in the rest it closes within one to two months.

Two paired fontanelles can be found in the temporal regions. These are wedge-shaped fontanelles. Another pair of fontanelles, mastoid, is found behind the ear. All of them close shortly after the birth of the child and have no diagnostic significance.

Why is a child born with fontanelles?

Everything in the human body is not without reason, and the child is no exception. The baby's body is a complex system, each organ has its own unique function.

What is the function of the fontanelle in newborns?

1. The fontanelle plays an important role during childbirth. Thanks to this formation, the baby's head shrinks and passes through the birth canal more easily. The shape of the head of a baby born naturally is elongated, dolichocephalic. Over time, the configuration of the head changes, becomes normal, round.
2. The child is growing rapidly, and with it the baby's brain. The bones of the skull become denser, increase in size, and the fontanelle overgrows. The presence of the fontanelle and sutures of the skull creates favorable conditions for the growth and development of the brain.
3. The fontanelle helps the baby maintain a normal body temperature, is involved in thermoregulation. When pronounced (more than 38 degrees Celsius), the fontanel helps to cool the brain and meninges.
4. Shock-absorbing function. Although the fontanelle seems to be very unreliable and fragile, it helps to protect the brain if the baby falls.

When does the fontanelle heal in a newborn?

We will understand the rates and timing of fontanelle closure.

Dates of fontanelle closure

The large fontanelle in infants grows over the period from six months to one and a half years.

Due to a change in the configuration of the head after childbirth, it is possible to change the shape and size of the large fontanelle. After the head becomes rounded, the size of the crown will decrease.

Half of newborns are born with an overgrown small fontanel. In other children, the fontanelle heals within one to two months.

The rest of the paired fontanelles are rarely seen in a full-term newborn. If the baby was born with lateral fontanelles, they will overgrow soon after birth.

What affects the closing of the fontanelles?

Why are some children born with a dotted fontanelle, which soon overgrows completely, while in others, the depression can be felt up to 2 years old?

1. Hereditary predisposition. The size of the fontanelles with which the baby was born, as well as the time of their overgrowth, primarily depends on genetic characteristics. After talking with grandmothers and asking them about the parents' fontanelles, one can predict how the baby's crown will close.
2. The term of pregnancy at which the child was born. Children born prematurely lag behind their full-term peers in physical development. Approximately by 2 - 3 years, this difference evens out. But premature babies have their own characteristics in development. In particular, longer periods of fontanelle closure.
3. Concentration of calcium and vitamin D in the baby's body. With a calcium deficiency, the overgrowth of fontanelles can be delayed, and with an excess of the element, the depression disappears prematurely. But the baby's diet plays a secondary role here, more often the reason is in impaired metabolism.
4. Taking medications during pregnancy.

There is also a relationship between the size of the newborn's fontanelle and the mother's intake of calcium and multivitamins, and the woman's diet.

But hereditary predisposition plays a primary role in the size of the fontanelle at birth.

The fontanelle does not overgrow in time, is it worth worrying?

This question is answered by Dr. Komarovsky.

The closing of the fontanelles occurs in different ways. Some babies are born with very small fontanels. In others, a large fontanelle can only grow over two years. Both situations are considered normal if the child is feeling and developing normally. It doesn't matter when the fontanelle closes in newborns.

The size of the fontanelle may indicate the development of the disease. But there is no pathology that would manifest itself only by a change in the size of the fontanelle. The child's health and the size of the fontanelle are assessed by the pediatrician at each routine check-up.

When should you worry?

With certain diseases in newborns, it is possible that the fontanelle closes later.

1. Rickets. In addition to the slow closure of the fontanelle, rickets is manifested by a lag in physical development, changes in the musculoskeletal and cardiovascular systems, and a decrease in immunity.The disease is more common in children born prematurely who did not receive vitamin D as a prophylaxis. In a full-term baby, with regular walks and proper nutrition, the risk of developing rickets is minimal.
2. . This is a congenital disorder in which the thyroid gland does not function properly. In addition to changing the timing of the fontanelle closure, with hypothyroidism, lethargy, drowsiness, persistent, abnormalities in the mental and physical development of the child are observed.
3. Achondroplasia. It is manifested by gross violations of the development of bone tissue, dwarfism, and a slow rate of closing the fontanelles.
4. . Disease associated with chromosome abnormalities. With Down syndrome, children have a characteristic appearance, developmental disabilities.

What can the early closure of the fontanelle mean?

In most cases, it does not matter when the fontanelle in the baby is overgrown. This does not affect the development of the brain and intelligence in any way. But there are situations associated with a violation of calcium metabolism, metabolism, in which the fontanelle closes too quickly.

Other diseases, such as craniosynostosis, anomalies in the development of the brain, are very rare, have a severe course and characteristic signs. If the child feels good, develops according to the calendar, the rate of fontanelle closure does not matter.

Fontanel changes

In some serious diseases, the fontanelle condition changes. A bulging or, conversely, sunken fontanelle becomes an "indicator" of pathology, indicating the severity of the disease. Thus, the assessment of the condition of the fontanelle is an important diagnostic feature.

Bulging fontanelle in a newborn

Most often, a bulging fontanelle accompanies meningitis, encephalitis, intracranial hemorrhage. All these diseases are high, for this reason the bulging of the fontanel occurs.

You should not make hasty conclusions and panic ahead of time. Diseases of the brain cannot be characterized only by a bulging fontanelle. But with the accompanying threatening symptoms, you need to urgently consult a specialist.

Alarming symptoms that, in combination with a bulging fontanelle, threaten the life of the child:

• , which strays heavily and soon rises again;
• nausea and vomiting in a child;
• loud cry, irritability or, conversely, lethargy, drowsiness of the baby;
• , loss of consciousness;
• if the fontanelle began to swell after the fall of the crumbs, trauma;
• appearance, eye symptoms.

Sunken fontanelle

If the soft crown has become sunken, this is a symptom of dehydration of the baby. The fontanelle changes, falls below the bones of the skull and indicates an acute lack of fluid in the baby. With repeated vomiting, high temperature, a significant loss of fluid occurs. Dehydration affects the entire body. The skin becomes dry, the formation of cracks on the lips is possible, a violation of the child's well-being.

It is necessary to water the child, organize feeding the baby, if possible. And immediately consult a doctor for proper treatment and replenishment of lost fluid.

What parents should know about the fontanelle? FAQ

1. The child's fontanel is very large. Is it rickets? The size of the fontanelle with rickets may not change at all. It is possible to change the shape of the head, increase the frontal and parietal tubercles, soften the edges of the fontanel. With rickets, the edges of the fontanelle become flexible, pliable, but the size remains the same.
2. With a small fontanelle, vitamin D cannot be prescribed, even if rickets is diagnosed? In addition to the external signs of rickets, laboratory confirmation must be available for the diagnosis. With rickets, the level of alkaline phosphatase, the level of calcium in the blood and in the urine are changed. visible on x-rays of the wrists and tubular bones.With confirmed rickets, vitamin D and calcium are prescribed, and the size of the fontanelles does not matter. Medicines selected in the right dosages do not accelerate the closure of the fontanelles.
3. Long-term overgrowth of the fontanelle may indicate hydrocephalus in a child? Hydrocephalus (hydrocephalic syndrome) occurs when the amount of fluid (cerebrospinal fluid) in the brain increases. This leads to an increase in intracranial pressure and a change in the child's well-being. He becomes restless, moody, sleep is disturbed.When examining a baby, doctors pay attention to the development of the child, muscle tone, increase in head circumference, and the condition of the fontanelle. An increase in head circumference, combined with an increase in fontanelle size and a change in the child's condition, may indicate the development of a disease.
4. If the fontanelle closes too quickly, will the baby's brain stop growing? The growth of the head occurs not only due to fontanelles, but also sutures, enlargement and compaction of the bones of the skull. Even if the fontanelles are completely closed, the head continues to grow.
5. Can your baby's brain be damaged by touching the fontanelle? You can safely touch, kiss, comb the child's head, this will not bring unpleasant consequences. The brain is safely hidden under the membranes and surrounding tissues.
6. How to care for the fontanelle? This area does not require any special care. As with the rest of your baby's skin, your scalp needs to be cared for. After washing with a special baby shampoo, blot the water with a towel. Do not rub the head, blotting is enough.
7. Do I need to take vitamin D if the fontanelle is quickly or slowly overgrown? The question of the advisability of prescribing vitamin D is decided individually in each case. Many factors affect this, including the region of residence of the child, the seasons, the duration of walks.

When prescribing vitamin D, the doctor takes into account the feeding of the baby, the content of vitamin D in the infant formula, the nutrition of the nursing mother and the woman's intake of multivitamins. The state of health of the baby plays a significant role. The need for vitamin D in premature babies is higher than in healthy full-term babies.

The main task of parents is to take care of proper nutrition of the baby, regular walks and proper care. Leave the assessment of the condition of the fontanelle to the specialist. At each routine check-up, the doctor only needs a few seconds to walk over the head and assess the fontanelle.

Parameters by which the condition of the fontanelle is assessed when examined by a doctor

• open or closed fontanelles of the child, whether it corresponds to the age of the baby;
• how many fontanelles were at the time of birth and their number at the moment;
• how the fontanelles have changed, how quickly they decrease, whether the shape of the fontanelles has changed;
• what are the edges of the fontanelle to the touch. Normally, the edges should be elastic, and softening is a sign of a lack of calcium and vitamin D;
• how does the fontanelle relate to the surrounding tissues? A sluggish, sunken or tense, bulging spring is always a sign of pathology.

Let's sum up

The fontanelles are anatomical structures made of membranous tissue located on the baby's head. Due to the presence of fontanelles, the head can freely pass through the birth canal, changing its shape (configuration).

The size and timing of overgrowth of fontanelles help pediatricians to suspect changes in the state of health of the baby. But even an experienced specialist cannot diagnose only by the size of the fontanel, because each disease has a number of other important symptoms.

Becoming a mother for the first time, every woman experiences fear of such a small and seemingly fragile little body of a newborn. Mothers and grandmothers can increase anxiety, especially when it comes to the baby's crown. The defenseless hole in the head, covered only with skin, must be protected. But nothing will happen to him if the baby is bathed or combed with a children's soft comb. It is in the area of ​​the crown that seborrheic crusts are often formed, they should be removed with special care.

A monthly visit to the pediatrician will be accompanied by a palpation of the pulsating area on the head. The doctor controls the process of overgrowing of the fontanelle and determines with its help the growth rate of the child. The content of our article will tell you about when the fontanelle overgrows in a newborn, the norms and deviations of its closure.

Yes, this is not a mistake. In addition to the largest frontal crown, there are 5 more small fontanels, the existence of which many of the parents do not even know. The crown connects the frontal and parietal plates of the skull, it has the shape of a rhombus, ranging in size from 22 to 35 mm.

At the back of the head is the posterior fontanelle, which connects the pair of parietal and occipital bone. It resembles a 5 mm triangle. Overgrowth occurs quickly - within 2 months after birth. There are often cases when a baby is born without him - this is a variant of the norm.

The smallest are paired temporal wedge-shaped and paired mastoid, located behind the auricles of a newborn.

The meaning of fontanelles, why are they needed

The role of soft areas on the baby's head is great. From a medical point of view, 4 significant functions are distinguished:

• The passage of the child through the birth canal is a great challenge for both the mother and the newborn. To facilitate the birth process, nature made the joints of the bones of the baby's skull mobile. The head can be deformed during childbirth, but then it takes the correct shape.
• The presence of fontanelles helps the baby's skull to adapt to the growing brain during the first year of life.
• The thermoregulation function of the child's body in the first months of life is not yet fully debugged, therefore the boneless spaces of the skull normalize heat exchange, preventing overheating of the brain.
• Moving fontanelles act as shock absorbers for the brain, protecting it from shock during sudden movements and falls.

The most noticeable fontanelle - the crown of the head causes controversy and anxiety among mothers. The rest of the soft zones of the child's skull quickly close and they are no longer remembered.

Crown overgrowth rates

According to averaged data, the gradual ossification of the vertebral region is completed by the end of the first year of life. This is conventionally considered the norm. There are children whose process ends later, at a year and a half. But there are also "hurry-ups" in whom the fontanel zone is tightened with bone tissue already in half a year. Blame for this, mom, who ate a lot of cottage cheese and other calcium-containing foods. It is considered normal to overgrow the boneless part of the crown at the age of 3 months to one and a half years, if the baby has no delays in physical and mental development.

Several factors affect the rate of disappearance of the pulsating section of the crown:

• Baby's gender. In boys, the process of overgrowing is much faster than in girls.
• Hereditary predisposition. A long overgrown fontanelle dimple can be inherited from mom or dad. Don't rush to panic in response to your pediatrician's concerns about a large fontanel. Try to find out from your relatives, and what time the crown of you or your husband has tightened.
• Adequate calcium for the infant. In a properly nourished mother, whose diet is rich in dairy products and, if necessary, supplemented with pharmacy vitamins for nursing mothers, the fontanel will grow in accordance with the norms.
• Vitamin D. Calcium cannot be absorbed without this vitamin. Therefore, if the baby appeared in the fall or winter, then do not be lazy, daily, according to the scheme prescribed by the pediatrician, drip AquaDetrim and its analogues into his food.

Deviations

In the normal state, the fontanel surface is relatively flat. The alarm must be beaten if the crown has sunk or, on the contrary, has risen with a tubercle.

Sinking

In the first case, the changes indicate a lack of fluid in the baby's body. This can happen during the period of acute respiratory infections or acute respiratory viral infections at an elevated temperature. Rotovirus infections, accompanied by vomiting and diarrhea, loose stools for teething - all this can cause tissue dehydration. Full-fledged drinking and taking Regidron will help to normalize the water-salt balance. As soon as the cells are filled with life-giving moisture, the fontanelle will return to its normal appearance.

Bulging

If the crown suddenly becomes convex and strongly pulsating, then you should immediately contact a specialist. This may indicate a serious illness or injury, such as meningitis, intracranial bleeding, or the presence of a tumor.

If the baby hit his head and after that, in addition to the rising fontanelle, deviations in behavior appeared: he became more capricious or, on the contrary, sleeps all the time, there are convulsions or vomiting - this is a reason to see a doctor.

Ripple

The skin membrane covering the fontanelle throbs, and this is normal. It is bad if there is no pulsation, this may mean that the crumbs have problems with intracranial pressure. The pulsation of the crown zone repeats the beats of a child's heart, indicating every blood flow to the brain.

The fontanelle with generations "overgrown" with various myths, which for the most part are completely unjustified. Mother Nature has deliberately left boneless "windows" on the baby's head. Thanks to them, the baby who takes the first steps often falls and does not receive concussions. To finally reassure yourself about a child's fontanel that does not overgrow for a long time, you can listen to Doctor Komarovsky - the authority of many mothers. He, as always, with humor, understandably and convincingly dispels all mother's fear

INR analysis is the most reliable method for determining blood clotting. Deviations in its values ​​from the norm may indicate serious problems in the body.

What is INR?

Human blood contains a complex protein, prothrombin, which ensures the preservation of its liquid state during circulation through the circulatory system and clotting in case of injury. Determining the amount of prothrombin helps to establish a tendency to bleeding or blood clots.

The INR test is an indicator of clotting.

Blood clotting is determined in three studies:

• PTT - prothrombosed time, which shows how long after the addition of the reagent a fibrin clot is formed in the plasma. Normally, its values ​​should be 11-15 seconds.
• PTI - prothrombin index. This is the relationship between the clotting time of plasma in a healthy person and the clotting time of the patient's plasma. Normal values ​​are 93-107%.
• INR - International Normalized Ratio. It is the ratio between the PTV of the patient and the PTV of the capillary blood of a healthy person. It also takes into account the MIH coefficient (international sensitivity index), which differ for different reagents.

The INR indicator is necessarily determined in pregnant women before surgery or blood plasma transfusion. It is the basis for the selection of the optimal dosage of anticoagulants and other drugs.

If a person is taking anticoagulants and is in a hospital setting, it is recommended to check his INR level daily. And after discharge from the hospital, it is necessary to take the appropriate tests every two to three weeks.

Decoding the results

The INR rate for women and men is different. Moreover, its values ​​also depend on some factors. Consider the average normal INR values:

• the INR norm in healthy women and men is in the range of 0.7-1.3;
• surgical intervention is allowed if the patient's INR is 0.85–1.25;
• for pregnant women, values ​​of 0.8–1.25 are considered normal;
• after heart surgery, the INR may rise to 2.5–3.5, which is the norm;
• when the patient is taking direct anticoagulants, the INR may be 0.8–1.2;
• when taking indirect anticoagulants, the values ​​can increase to 2.0–3.0;
• INR indicators also differ by age: in people over 50, the rate decreases slightly.

If the readings differ from the norm, this may indicate some health problem. Therefore, the results of the study must be deciphered by a specialist in order to detect deviations in time.

To determine the INR values, venous blood is taken

What do the lower values ​​mean?

If the clotting index is low, the risk of blood clots is increased. Because of them, the blood supply to vital organs is disrupted, which can lead to functional failures.

First of all, it is necessary to establish the exact reason why the INR values ​​are below normal. This happens in the following cases:

• deficiency of vitamin K in the body;
• side effect of taking hormonal, anticonvulsant, diuretic drugs;
• physical injuries accompanied by blood loss;
• thromboembolism during pregnancy or after childbirth.

The result of the study can be erroneous if technological errors were made during blood sampling or the taken material was stored for too long. You also need to carry out the correct preparation before the procedure. It is prohibited to consume alcoholic beverages, fried and smoked food for two days before it.

Therefore, if deviations are found, a repeated analysis is required. After establishing the cause, appropriate treatment is selected. Anticoagulants may also be prescribed.

Reasons for increasing INR

A high INR level indicates hypocoagulation. In this case, there is a high risk of bleeding even with minor injuries.

Increased INR values ​​can be observed for the following reasons:

• heart disease, including pre-infarction conditions and heart attack;
• diseases of the liver and gallbladder;
• the presence of malignant neoplasms in the body;
• an increased level of red blood cells in the blood;
• gastrointestinal diseases;
• taking antibiotics and hormones, the side effect of which can be high INR levels.

After 50 years, it is necessary to constantly monitor blood clotting. It is recommended to check the INR level annually. If the patient's INR is above 6.0, he must be urgently hospitalized. In this case, there is a high probability of death.