# Delayed closure of Anterior Fontanel



## usmcwfe (Aug 17, 2006)

Not sure if this is the right place to post this but here goes anyway.. My dd is 23 months. She still has a soft spot. It is closing, the difference is noticable month to month. Our doc goes from being very unconcerned to highly concerned about this. She is growing, gaining weight and meeting all of the appropriate developmental milestones. She was about a month early.. Now he wants bloodwork done to look at thyriod levels and a cranial ultrasound. I'm not sure what he's looking for, or if he is either for that matter. Anyway, I'm personally not worried but after this appt I feel very anxious. We delayed vax and didn't do the traditional "well baby" schedule of visits. So they already give me the stink eye when we visit. Any experience with this???


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## lindberg99 (Apr 23, 2003)

I remember my son's neurologist saying something about his fontanel still being open. But he didn't seem concerned about it so I didn't think much of it. DS was about 18 months then and the fontanel was still pretty big. I remember being kind of paranoid about it but interestingly, I can't remember when it closed. I guess he was 2.

Anyway, I read that they are supposed to be closed by the middle of the second year (so 18 months) in MOST babies. But obviously it can close later than that as my DS is almost 9 yo and never had any health issues. He does have a big head, maybe if the head is big they take longer to close?

DS was a preemie and had a head U/S and it was definitely not a big deal so if the doctor does think your son should get that, don't get too stressed about it. The tech puts a bunch of gel on the child's head and runs a wand over it.

I would bet it's nothing but I guess doctors always want to double check everything.


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## tanyalynn (Jun 5, 2005)

I didn't realize fontanels were supposed to close so early. Huh. And back then we were doing all the WBVs so our ped had plenty of visits to mention it. My daughter seems fine, and I'm sure her fontanel was open quite a bit beyond 18 mos. I guess I'd read to see if you should be seeing other signs of something wrong besides the fontanel--would that be the only sign of the things your doc is worried about? Maybe the doc isn't a great fit for your family--once I found one that had the same level of concern about things in general as I tend to (some seem to run a heckuva lot of tests), it was much more comfortable overall, and you'd be able to have a better rapport and discuss it more fully (or be told that it's a non-issue).

eta: as comparison, my daughter's head is normal, even a tad small, and hers is the one with the fontanel that closed late, whereas my son has quite the big head, and his fontanel was never as prominent as hers, and seemed to close much earlier.


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## emaye_to_2 (Jan 16, 2008)

I'm so glad you posted this! My DD had a delayed closure of her anterior fontanel as well and I had always wanted to post here about it. I did tons of research about it because I did think it was weird but if you read the literature there is a broad range of normal plus the "norms" they use are not that good and unless something else is wrong or suspicious I would not be worried. My DD's fontanel finally close after age 2. It's up to you but my pedi never recommend a head CT or anything else she just knew it was a variation of normal.


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## usmcwfe (Aug 17, 2006)

Quote:


Originally Posted by *emaye_to_2* 
I'm so glad you posted this! My DD had a delayed closure of her anterior fontanel as well and I had always wanted to post here about it. I did tons of research about it because I did think it was weird but if you read the literature there is a broad range of normal plus the "norms" they use are not that good and unless something else is wrong or suspicious I would not be worried. My DD's fontanel finally close after age 2. It's up to you but my pedi never recommend a head CT or anything else she just knew it was a variation of normal.

This is what I kind of think is happening. First off, our doc is not a pediatrician. He's a naval doc and anytime he has any sort of question about his younger patients he calls one of the pediatricians in town. So I doubt he has practical experience with the variation in what a normal fontanel does... Today I've been questioning even doing the ultrasound. She has absolutely no developmental issues or health issues that would lead us to believe there is a problem.. Do you remember how far after your dd's 2nd b-day did it close?


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## emaye_to_2 (Jan 16, 2008)

My DD was around 2.5 years I think, she's 3 now. I know at her 24 month appt the doctor acknowledged that it was still open but was not concerned.

I cannot figure out how to attach a paper for you here. There's one that you could show your doctor that was writting in 2002 by Gaetano. Besides that, the "norms" were created back in 1949!

The range of normal closure in the medical literature is 4 to 26 months. So I would not let them do anything before that.

From the paper: "It is important for the physician to realize that a persistent open anterior fontanel beyond the accepted ranges of closure can be a normal outlier".

"Persistent open anterior fontanel can be a common finding in children. This normal variant must be recognized, given the vast number of well-child exams done annually."

:-D


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