Bulging Fontanel In Babies

When an infant is born, it has six fontanels. Among these six fontanels, the largest one is the anterior fontanel and is the most important one. On average, the anterior fontanel measures around 2.1 cm and it takes about 14 months for this fontanel to close. However, sometimes, the anterior fontanel starts to become abnormally large due to a variety of reasons. This is what is defined as a bulging fontanel. When this happens, the head of the baby will look larger than its normal size and it may also look a bit out of shape.^[1,2,3]

Bulging Fontanel in Babies can be caused due to certain conditions like hypothyroidism, Down syndrome or increased intracranial pressure. It should be noted that a bulging fontanel in babies is a medical emergency and the baby should be taken to the hospital immediately.^[1,2,3]

Aside from the reasons mentioned above, sometimes the fontanel may start bulging for benign reasons but that that does not mean that the baby should not be taken to the emergency room. It is vital for the baby to be examined by a physician to identify the cause of the bulging fontanel and rule out serious conditions like meningitis.^[1,2,3]

As stated, bulging Fontanel can be caused due to many reasons which include

Hydrocephalus: This is one of the most common causes for Bulging Fontanel in Babies. Hydrocephalus refers to a condition in which there is a buildup of fluid in the ventricles of the brain. This fluid buildup then exerts pressure on the tissues of the brain causing the brain to swell. Hydrocephalus may be present at birth and is called as congenital hydrocephalus. If it develops after birth it is termed as acquired hydrocephalus.^[3]

While the cause of Congenital Hydrocephalus is not known there are certain risk factors that include infections in the mother like rubella. Bleeding in the brain that is commonly seen in premature babies is yet another risk factor for congenital hydrocephalus. It is also seen in children who have injuries during birth. Any genetic abnormality that affects the development of brain is also one of the causes for congenital hydrocephalus.^[3]

Some of the possible causes for acquired hydrocephalus include infection of the spinal cord or brain like bacterial meningitis. This most likely happens when the baby has high fever. Brain and spinal cord injuries like a blow to the head may also lead to acquired hydrocephalus causing Bulging Fontanel in Babies.^[3]

Some of the other causes for Bulging Fontanel in Babies include transient intracranial hypertension. This is a condition in which the baby develops high blood pressure temporarily in the brain resulting in swelling. This usually happens after the baby has had an infection. As stated, this condition is temporary and most of the time resolves spontaneously but it is still considered to be a medical emergency and the child should be taken to the hospital.^[3]

Excessive crying also at times causes Bulging Fontanel in Babies. This is because crying puts pressure in the brain from the cerebrospinal fluid. This is again a condition that resolves spontaneously but again the child must be taken to the hospital for a checkup to rule out other causes. The same goes for excessive vomiting which is also one of the common causes for Bulging Fontanel in Babies.^[3]

Additionally, excessive vomiting may occur due to a potentially serious underlying condition and hence the child should get a thorough checkup to identify the cause of the vomiting. Sometimes, certain vaccination may also cause the brain to swell up causing Bulging Fontanel in Babies. Why this happens is not known but experts believe that fever that results due to vaccinations may be a cause for it. Certain medications and nutritional deficiencies are also believed to be the causes of Bulging Fontanel in Babies.^[3]

As stated, Bulging Fontanel in Babies is an emergent medical situation and the child should be taken to the emergency room immediately. This is because Bulging Fontanel in Babies suggests build up fluid around the brain. This collection of fluid may cause significant damage to the brain and therefore urgent assessment is a necessity.^[2,3]

It may also signal certain life threatening underlying conditions which need to be treated immediately. Bulging Fontanel in Babies can be a scary sight for both parents as well as caregivers alike. They may even worry about potential invasive treatments that may be required. However, it should be noted that early treatment is in the best interest of the baby. The early a diagnosis is made and treatment is started the better is the overall prognosis for the child. Any delay in treatment may result in permanent damage to the brain.^[2,3]

As stated above, Bulging Fontanel in Babies is a medical emergency and requires hospitalization. The physicians work towards identifying a cause at the fastest possible time for best outcomes. To start with, the physician will ask questions about the development of the bay, any medical known conditions, or whether they have been sick of late. Blood work will be done and radiographs of the brain including CT and MRI scans to identify a possible cause for Bulging Fontanel in Babies.^[3]

Additionally, a spinal tap may also be done. A spinal tap will show whether any infection is responsible for the bulging fontanel. However, many physicians do not do it if the child has a normal growth and no history of any sickness or medical conditions. The baby will then be admitted for close monitoring. If Bulging Fontanel in Babies is caused due to crying or transient hypertension then the condition may start resolving quickly. However, for other causes treatments are determined accordingly.^[3]

If Bulging Fontanel in Babies is caused due to meningitis then antibiotics will be given to the baby. If the baby has known congenital hydrocephalus then constant support and care will be required on the part of the parents and caregivers. The baby will also need physical and occupational therapy. If Bulging Fontanel in Babies is caused due to a trauma or injury then treatment will be determined depending on the type and extent of the injury.^[3]

Bulging Fontanel in Babies is a condition that may not always be prevented. However, there are some steps that can be taken to prevent the baby from getting infected.^[3]

• It should be ensured that people wash their hands thoroughly with soap and water and or use a sanitizer before approaching a baby.^[3]
• The bay should be kept away from a person who is sick or has an infection, especially in these times of the pandemic.^[3]
• It is important for pregnant females to be checked up regularly to decrease the risk of any indwelling infections or likelihood of a premature delivery.^[3]
• It should be made sure that the baby is held properly and belted properly when driving to prevent any head injuries.^[3]
• All the vaccinations should be up to date and a proper diet chart for the baby prepared by a nutritionist should be followed.^[3]

In conclusion, Bulging Fontanel in Babies is a medical emergency and in such cases the baby should be taken immediately to the nearest emergency room. There can be numerous causes for Bulging Fontanel in Babies of which some are benign and resolve spontaneously. This however does not mean that the child should not be taken to the hospital for a checkup.^[1,2,3]

The early a diagnosis is made and treatment given the better will be the outcome for the baby. In cases of congenital causes for Bulging Fontanel in Babies such as congenital hydrocephalus which do not have a cure proper support structure is required for the baby along with proper physical and occupational therapy to give the baby a better quality of life and allow him to thrive despite a Bulging Fontanel.^[1,2,3]

It should also be noted that parents should ensure that their babies are kept away from sick people and parents should wash and sanitize their hands when approaching the baby to prevent any infection that may result in Bulging Fontanel.^[1,2,3]

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