Normal fontanelles vary greatly in shape and closure time in normal children. In order to understand whether a fontanelle is abnormal or not, it is necessary to first know the normal fontanelle and its variations very well. The anterior fontanelle is most commonly used in clinical evaluation. There are six fontanelles in the newborn period, and the anterior fontanel is the most prominent and largest. The anterior fontanelles are in the form of a 2.5 cm wide lozenge. Evaluation of anterior and posterior fontanelles is more important in the clinic. The fontanel examination of the newborn forms the basis of neurodevelopmental evaluation. Neonatal head examination is performed by evaluating head shape, head circumference, sutures overlapping, anterior fontanelle and posterior fontanel dimensions. The fontanel examination is performed when the child is calm, not crying, and in an upright position. Early or late closure of fontanelles is a part of some diseases and syndromes. Achondroplasia, hypothyroidism, Down syndrome, increased intracranial pressure, and rickets are some of the many diseases that cause the fontanel to be enlarged or delayed in closing. In a normal fontanelle, there may be a slight rise and fall, such as a heartbeat, on examination performed in an upright position. Receiving a severe pulsation may be a sign of a serious illness. The swelling of the fontanel may be a clue to diseases such as meningitis with increased intracranial pressure, while the collapse of the fontanel may be a sign of diseases in which the fluid balance is disturbed, such as dehydration. In addition to physical examination, blood tests, transfontanel ultrasonography, computed tomography and magnetic resonance imaging methods are used in the evaluation of the fontanel. If the vitamin D level in children is within normal limits, there is no need to discontinue the use of protective vitamin D in case of premature closure of the fontanelle. One of the most curious situations is the closing time of the fontanelles. The anterior fontanel should close between 3 months and 18 months. If it closes before the 3rd month or after the 18th month, the pediatrician should definitely evaluate it.
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