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January 23, 2007
Q: Soft Spot Closed Too Soon?
Q:
My 5-month-old daughter's soft spot has already closed. This was brought to the attention of her pediatrician; he had a cat-scan done and said that there is nothing to worry about. Everything that I have read states that the soft spot should be re-opened. Do we need a second opinion?
A:
I would like to refer you to some resources that confirm what had already been heard from the pediatrician.
(1)
Family Practice Notebook: Fontanelle: http://www.fpnotebook.com/NIC25.htm
According to this excellent (although abbreviated) resource, normal closure of the fontanelle happens between 4-26 months, with a median of 13.8 months. Closure at 5 months is unusual, but not necessarily abnormal. The pediatrician did the completely correct thing in evaluating whether this was a normal or abnormal closure.
(2)
The Abnormal Fontanel / Joseph Kiesler, MD, and Rick Ricer, MD
Am Fam Physician 2003;67:2547-52. http://www.aafp.org/afp/20030615/2547.html
This article also says that early closure can be normal, and describes how to diagnose whether or not it is a problem.
"The diagnosis of an abnormal fontanel requires an understanding of the wide variation of normal."
"Fontanel closure that occurs as early as three months of age can be within normal limits, but careful monitoring of head circumference in such cases is essential to exclude a pathologic condition."
(3)
Pediatric Education / Donna M. D'Alessandro MD. When Should the Anterior Fontanelle
Close? (Monday, April 17, 2006): http://www.pediatriceducation.org/2006/04/17
This article intended solely for doctors -- clinicians and students of pediatrics. It provides a learning example of a child with early closure and no evidence of craniosynostosis, who is closely monitored rather than being treated.
I hope this is helpful. If your family continues to be concerned, or observes an odd shape to the baby's head, you might want to return to her pediatrician with notes of any changes, or ask for a second opinion.
Posted by pfa at January 23, 2007 10:31 AM