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Quick reference medical handouts used by Pediatric offices


My 7-month old baby was diagnosed with premature closure of the anterior fontanelle. Our doctor advised us to get x-rays and a CT scan. A second opinion told us to wait 2-3 months since x-rays at this age might harm the baby. What would you recommend we do?
    
In order to properly answer your question, a short lesson in infant anatomy. The bones of a baby’s skull are held together by fibers called sutures. Mother nature designed things this way for two reasons. First, it allows the newborn’’s head to be flexible and compressible enough to pass through the birth canal. Second, it gives the baby’s skull room to grow as the brain enlarges during the first years of life. The “soft spot” or fontanelle is the area on the infant’’s head where the skull bones do not completely come together. The larger, diamond shaped soft spot on the tope of the head is called the ““anterior fontanelle.”” It can close as early as nine months of age or as late as two years (average 12 to 14 months). Another smaller fontanelle is located on the back of the head and is called the ““posterior fontanelle.”” It generally can no longer be felt by the fourth month of life.

Early closure of the soft spot could mean your child has a condition called craniosynostosis (cranio= head, synostosis = the union of two or more bones to form a single bone). This disorder occurs when one or more of the skull bones joins prematurely before the brain has completed its growth. The danger is that left untreated, compression of the brain can occur.

In our opinion, your child’’s doctor was correct in obtaining the x-rays. Occasionally, the scan will reveal that the soft spot has not really closed and is just difficult to feel. On the other hand, if the sutures have indeed closed prematurely, then we presume your doctor will refer your baby to a neurosurgeon for evaluation of the problem.

Surgery to correct craniosynostosis is not always necessary. However, when it is performed, the reason is to prevent pressure on the brain, provide room for the brain to grow, and cosmetically improve the shape of the child’’s skull.

Because of the potential seriousness of premature closure of the sutures, we would tend to agree with your physician that appropriate x-rays and CT scan are necessary to establish the diagnosis. We are not aware of any harmful effets of the x-ray to the child, and in this case, the benefits far outweight any possible risk.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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