Fontanelles: what all new mothers need to know about soft spots
Newborn heads are often quite oddly shaped. Read this article for information related to your newborn's head - what is normal and what is not.
After months of waiting, your baby is almost here. And while you probably have an image in your mind about how your precious bub will look like, you may be quite surprised to see he looks nothing like it when he is born!
Peeling skin, acne and a misshapen head are just some of the strange features many newborns sport at birth. These features may linger on for a few days, or even weeks following birth (of course, in your eyes he is still perfectly adorable!)
This article is all about the newborn head — which may not be as sweetly round as you imagined it to be — and brings you information related to this topic, giving all you expecting and new mums one less thing to worry about.
As long as you know what is normal and what is not when it comes to your newborn’s head, there’s no need to be anxious.
There are actually two soft spots, or fontanelles, located on your newborn’s head — one on the top and the other at the back.
These spots serve two very important purposes: (a) they helped your little one’s skull shift and mould to pass through your birth canal, and (b) they create room for your baby’s rapidly expanding brain after birth.
According to neonatal experts, the bigger, diamond-shaped soft spot located at the top of your baby’s head can be up to two inches wide. It starts to close when your little one is around six months old and closes completely when he is around 18 months old.
The second soft spot located on the back of your baby’s head is harder to find, around half an inch wide and usually triangular in shape.
Don’t be surprised if you catch your baby’s fontanelles pulsating in time to his heartbeat! While you might find this scary, Dr Tia Hubbard, nursery paediatrician at the University of California at San Diego Medical Center, tells you not to worry, and that the soft spots are tougher than you think.
“It is supposed to be soft, because it allows for the rapid growth of the brain that occurs in the first year of life. But you can touch it; it’s not that fragile,” she tells WebMD.
Also, the soft spots are covered by thick, fibrous membranes that protect your baby’s brain. Still, you or other caregivers should not be bouncing or shaking your newborn baby. Neither should others (older siblings included) be actively touching or poking these soft spots.
During birth, pressure from your birth canal often causes the bones that make up your baby’s skull to shift and overlap in order to pass through the birth canal.
With all this pressure on his skull, don’t be surprised to see your little one has a pointy head or cone-shaped skull at birth.
This is more likely if you have a long labour, or a vacuum is used to assist with the birth, and less likely if you have a C-section, or your baby is born feet-first.
Your baby’s cone-shaped head is perfectly normal, and within a few days, his head will become more rounded.
Another thing you may notice about your baby’s head at birth is how big it looks compared to the rest of his body. Again, this is normal and as your baby fills out, his head will match the rest of his body.
Because the plates that make up your baby’s skull are still relatively soft and malleable even after birth, laying him down with his head in the same position can push his head out of shape, resulting in a flat spot.
This is known as positional plagiocephaly, say neonatal experts at KK Women’s and Children’s Hospital (KKH).
“Plagiocephaly does not affect the development of a baby’s brain, but if not treated it may change their physical appearance by causing uneven growth of their face and head,” they say.
Your baby’s flat head is almost always no cause for concern, except for cosmetic reasons, and over the next few weeks and months this flat spot should round out.
Here are some tips (adapted from Mayo Clinic) related to what you can do at home to help encourage the rounding out of your baby’s head:
- Tummy time: Ensuring your baby gets adequate tummy time each day will help with this by strengthening the muscles in your baby’s neck and encouraging better head control. This “will help your baby keep pressure more evenly distributed on the skull.”
- Carry your baby more often: Holding your baby more often when he is awake will help ease pressure on your baby’s head from car seats, carriers and infant swings.
- Change direction: While it’s really important that you keep placing your baby on his back to sleep, try alternating the direction your baby’s head faces when you place him down to sleep*. You could also change the direction your baby’s head faces in the cot — so near the cot foot one day and near the cot head the next day. Also try alternating the arm you hold your baby with at each feeding.
- Creative interaction: If you baby is awake and on his back, position yourself on the opposite side of his flat spot and coo, talk or sing to him so he is encouraged to look your way. You could also try changing the position of your baby’s cot in the room, so he has interesting new things to look at.
The auntie next door, your mother-in-law or even your own mother may have a few ‘remedies’ for your baby’s flat head which they will eagerly recommend, like using their hands to ‘mould’ baby’s head, almost like making rice dumplings — this is okay as long as too much pressure is not exerted.
Please avoid using the following:
- Beansprout/ donut pillow: experts strongly discourage the use of any bedding in your baby’s cot (even a flat pillow) to prevent the risk of Sudden Infant Death syndrome.
- Sarong/hammock/yao lin: Dr Michael Lim — a consultant for the Paediatric Pulmonary & Sleep Service, Department of Paediatrics, National University Hospital — advises against placing babies to sleep in a hammock/sarong/yao lin due to the potential health risks. Look out for our article on yao lin soon.
Sometimes, when treatment is necessary, KKH medical experts suggest you consult with a specialist (plastic surgeon) if your baby’s flat spot has not corrected itself when your baby is between four to eight months of age.
Treatment is usually provided by a team including a plastic surgeon, orthotist and paediatric physiotherapist, and may involve your baby wearing a special moulded helmet or band that applies gentle pressure, easing away the flat spot.
For best results, your baby will have to wear the helmet for 23 hours a day through the treatment period. The helmet will be adjusted on a regular basis to allow for the growth of your baby’s head.
At birth, your baby might be as bald as your grandfather (and stay that way for months!), have a downy fuzz covering his head, or have a shockingly full head of thick hair.
Keep in mind that the hair he has a newborn often won’t often resemble the locks he’ll have as a child. Also, newborn hair often falls out in the first few weeks, growing back in a different texture or colour.
If your baby is placed on his back to sleep with his head in the same position very frequently, then you may also notice a bald spot on his head. Changing the position of his head (see above) will help with both the bald spot and in preventing a flat spot on his head.
Also known as seborrhoeic dermatitis, this condition causes the skin of your baby’s scalp to peel, presenting as scaly pink to red patches on the affected area.
For more on cradle cap, including remedies, please read this article about your newborn’s (peeling) skin.
More often than not, the oddities related to your baby’s head will go away on their own, or with a little help from you. But sometimes, you may notice signs that indicate a more serious problem.
A sunken soft spot could indicate dehydration, and a bulging fontanel may be a sign of pressure on the brain, say experts. Call your baby’s doctor immediately if you notice either.
If you notice your baby is holding his head titled to one side very frequently, this could be due to a muscular condition such as torticollis.
Consult your baby’s paediatrician in this case, who may recommend physical therapy. This will help stretch the affected muscles, letting your baby change his head position without discomfort.
Very rarely, two or more of the plates in a baby head may fuse early in a condition known as craniosynostosis, according to Mayo Clinic medical experts.
What this does is cause other parts of the baby’s head to look misshapen as the brain grows, and pushes them out of shape.
Treatment for this involves surgery to separate the fused plates of the baby’s skull.
Parents, as mentioned before, many common issues related to your newborn’s head should sort themselves out on their own.
However, as always, your baby’s paediatrician should be your first port of call for all matters related to your baby’s health.