OpenHealth Q&A

Closure of Anterior Fontanelle: Seeking Guidance

Hello everyone, I could really use some support, and I’m curious to know if anyone else has experienced something similar or has insights into the findings we've encountered. I reside in North Carolina, and my baby was born on April 30th of this year. Just two months after his birth, I discovered that his soft spot had disappeared. Strangely, this change went unnoticed by the doctors, including one during our initial visit after switching physicians, who also failed to examine his head thoroughly. We were referred to a neurologist, who confirmed that she could not detect the soft spot either, though she reassured us that my little one seems to be developing well. During the examination, she performed a typical check, shining a light into his eyes to see if he followed it. One concern we noted was his excessive crying throughout the day, which has improved slightly (we believe it may be related to his formula, and we are addressing it). She recommended a CT scan, which we completed. As of today, my baby has reached the age of 3 months, and I received the results last night, but they only included descriptions without any imaging. I’m seeking clarity on the findings, especially since the neurologist considered the possibility of Craniosynostosis. However, the results referenced a different medical code. The initial visit summary mentioned "small anterior fontanelle closure,” which leaves me puzzled—does this indicate a mere possibility or is it definitive? Moreover, the results indicate that the fontanelles have closed, but the suture lines remain visible. We have a follow-up appointment scheduled for August 5th. Fortunately, there is currently no abnormal head shape observed. He truly is our precious boy. Does this situation imply that we should closely monitor his head growth, given that the sutures are still open? I have concerns about how to recognize if they close as he grows and the potential stress of it possibly becoming problematic, or whether my baby might experience pain in the future. We’ve been told that if Craniosynostosis were the case, addressing it surgically now would be preferable to dealing with it later in life. Alternatively, could it be that the closure we see indicates the potential need for surgical intervention? **INDICATION:** Small anterior fontanelle closure; congenital malformation of skull and facial bones, unspecified (Q75.9). **COMPARISON:** None. **TECHNIQUE:** Axial CT images of the brain were obtained, covering the skull base to the vertex, including parts of the face and sinuses, without contrast. Additional 2D reformatted images were produced and reviewed as necessary. **FINDINGS:** - **Calvarium/Skull Base:** No signs of acute fractures or destructive lesions observed. The mastoids and middle ears show no significant mucosal disease. Both anterior and posterior fontanelles are closed, although the suture lines remain visible. - **Paranasal Sinuses:** No air-fluid levels detected. - **Brain:** No significant vascular territory infarcts. No mass effects or hydrocephalus detected. There is no evidence of acute hemorrhage. **IMPRESSIONS:** Anteior and posterior fontanelles have closed, but the suture lines are still visible at this moment. **AGE:** 3 months. **SEX:** Male. **HEIGHT:** 25.4 inches. **WEIGHT:** 13.4 pounds. **RACE:** White. **DURATION OF COMPLAINT:** Unsure. **LOCATION:** North Carolina. **PRE-EXISTING RELEVANT MEDICAL ISSUES:** None. **CURRENT MEDICATIONS:** None.

Answers (1)

7/30/2025, 3:02:22 PM

OpenHealth AI

It's completely understandable to feel anxious about the closure of your baby's anterior fontanelle and the related findings. Let’s break down what you've shared and focus on the key points to alleviate your concerns.

Main Points:

1. Your baby’s soft spot (fontanelle) has closed earlier than typical for his age.
2. Although there are visible suture lines, no immediate concerns were noted by the neurologist.
3. A follow-up appointment is planned, allowing further evaluation and reassurance.

Explanation: The anterior fontanelle usually closes between 9 to 18 months, so closure at 3 months is earlier than average. However, if the suture lines remain visible, this typically suggests that while the fontanelle has closed, the skull can still expand normally as your baby grows. This is usually not a cause for alarm as long as his head shape appears normal and there are no other concerning symptoms.

Craniosynostosis is a condition where one or more of the cranial sutures close prematurely, which can affect head shape and brain development. The absence of abnormal head shape, along with the normal findings on the CT scan — such as no signs of acute fractures, hydrocephalus, or brain abnormalities — suggests that immediate aggressive intervention may not be necessary.

Next Steps:

1. Monitor Growth: Keep track of your baby’s head circumference as part of regular pediatric check-ups. Your pediatrician can help you measure this and assess growth patterns over time.
2. Attend Follow-Up Appointments: Utilize your upcoming appointment on August 5th to discuss the CT results in detail. Ask the neurologist about the implications of the fontanelle closure and what to watch for as your baby grows.
3. Observe for Signs: Be attentive to any signs of increasing head circumference, vomiting, excessive crying that seems different, or developmental changes, and report these during your next visit.
4. Discuss Concerns Openly: When you meet with the neurologist, communicate all your concerns and ask specifically about the potential need for surgical intervention. Understanding options, timelines, and symptoms to watch for can help ease anxiety.

You’re dedicated to your baby’s health and well-being, and that’s commendable. Monitoring and communicating effectively with your healthcare team will ensure you’re addressing any concerns appropriately. Let me know if you have any more questions or need further clarity on this topic!