Rouke Baby Record - Physical examination - fontanels

Question 1

What are fontanels

Answer 1

soft, membranous gaps between the cranial bones of a newborn’s skull

Question 2

What is the purpose of fontanels

Answer 2

They allow the baby’s head to shape and compress during childbirth and provide space for the brain’s rapid growth in the first year of life.

Question 3

How many fontanels does a newborn have

Answer 3

6
-anteror
posterior
two mastoid
two sphenoid

The rhomboid-shaped anterior fontanel, located at the juncture of the two parietal and two frontal bones, is the most prominent.

The superior sagittal dural venous sinus is partially situated beneath the anterior fontanel.

The triangular posterior fontanel is located at the junction of the occipital and two parietal bones

Question 4

Which fontanel is largest

Answer 4

anterior

Question 5

Which fontanel is most important for clinical evaluation

Answer 5

anterior

Question 6

What does a bruit heard over the anterior fontanel indicate

Answer 6

arteriovenous malformation

palpation may reveal a normal slight pulsation

heard in kids with HF or hemangiomas

Question 7

What is Macewen’s sign

Answer 7

when a fonantel is closed in a baby with increased ICP percussion over the anterior fonantel will produce a cracked pot sound (dull, lacking resonance) known as the Macewen’ sign

Question 8

In which position should fonantels be examined

Answer 8

both upright and supine positions

Question 9

How can you detect asymmetry of the newborn head

Answer 9

looking at the infants head from above

Question 10

What is HC an important indicator of

Answer 10

brain development

should be monitored over time esp if fontanel closes early

Question 11

When does the posterior fontanel typically close

Answer 11

by 2 months

Question 12

The anterior fontanel can _ in size during the first few months of life

Answer 12

increase in size

Question 13

The anterior fontanel typically closes when

Answer 13

around 12-24 months

boys close earlier than girls usually

Question 14

What are common conditions that are associated with large or delayed closure fontanels

5

Answer 14

• achondroplasia (dwarfism)
• congenital hypothyroidism
• down syndrome
• increase ICP
• Rickets

Question 15

What conditions are associated with small fontanels or early closure

Answer 15

• crainosynostosis (premature closing of one or more cranial sutures, resulting in an abnormal head shape- condition can be idiopathic or caused by hyperthyroidism, hypophosphatasia, rickets, or hyperparathyroidism)
• abnormal brain development

DDx of microcephaly

• Chromosomal defects
• Congenital infections
• Fetal alcohol syndrome
• Hypoxic-ischemic encephalopathy
• Normal genetic variation

palpation of crainosynostosis can revel ridge over suture or lack of movement over suture

Question 16

What are primary differentials for bulging fontanels

5

Answer 16

• meningitis
• encephalitis
• hydrocephalus
• hemorrhage
• hypoxia

palpation of fontanel revewals tense fontanel feeling similar to bone

Question 17

What is the primary ddx for sunken fontanel

Answer 17

dehydration

Other signs include reduced peripheral perfusion, poor skin turgor, and sunken eyes

Question 18

What is first line to assess fontanels

Answer 18

x ray

U/S if concern for venous malformation