Sutures - separated
Separation of the suturesSeparated sutures are abnormally wide spaces in the bony joints of the skull in an infant.
Considerations
The skull of an infant or young child is made up of bony plates that allow for growth. The borders where these plates come together are called sutures or suture lines.
In an infant only a few minutes old, the pressure from delivery may compress the head. This makes the bony plates overlap at the sutures and creates a small ridge. This is normal in newborns. In the next few days, the baby's head expands. The overlap disappears and the edges of the bony plates meet edge-to-edge. This is the normal position.
Diseases or conditions that cause an abnormal increase in the pressure within the head can cause the sutures to spread apart. These separated sutures can be a sign of pressure within the skull (increased intracranial pressure).
Increased intracranial pressure
Increased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain injury.
Read Article Now Book Mark ArticleSeparated sutures may be associated with bulging fontanelles. If intracranial pressure is increased a lot, there may be large veins over the scalp.
Bulging fontanelles
A bulging fontanelle is an outward curving of an infant's soft spot (fontanelle).
Read Article Now Book Mark ArticleCauses
The problem may be caused by:
- Arnold-Chiari malformation
- Battered child syndrome
Battered child syndrome
Child physical abuse is a serious problem. Here are some facts:Most children are abused at home or by someone they know. They often love this perso...
Read Article Now Book Mark Article - Bleeding inside the brain (intraventricular hemorrhage)
- Brain tumor
Brain tumor
A brain tumor is a group (mass) of abnormal cells that grow in the brain. This article focuses on primary brain tumors in children.
Read Article Now Book Mark Article - Certain vitamin deficiencies
- Dandy-Walker malformation
- Down syndrome
- Hydrocephalus
Hydrocephalus
Hydrocephalus is a buildup of fluid inside the skull that leads to the brain pushing against the skull. Hydrocephalus means "water on the brain. "...
Read Article Now Book Mark Article - Infections that are present at birth (congenital infections)
- Lead poisoning
Lead poisoning
Lead is a very strong poison. When a person swallows an object that has lead in it or breathes in lead dust, some of the poison can stay in the body...
Read Article Now Book Mark Article - Meningitis
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
Read Article Now Book Mark Article - Subdural hematoma or subdural effusion
Subdural hematoma
A subdural hematoma is a collection of blood between the covering of the brain (dura) and the surface of the brain.
Read Article Now Book Mark ArticleSubdural effusion
A subdural effusion is a collection of cerebrospinal fluid (CSF) trapped between the surface of the brain and the outer lining of the brain (the dura...
Read Article Now Book Mark Article - Underactive thyroid gland (hypothyroidism)
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
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When to Contact a Medical Professional
Contact your health care provider if your child has:
- Separated sutures, bulging fontanelles, or very obvious scalp veins
Bulging fontanelles
A bulging fontanelle is an outward curving of an infant's soft spot (fontanelle).
Read Article Now Book Mark Article - Redness, swelling, or discharge from the area of the sutures
What to Expect at Your Office Visit
The provider will perform a physical exam. This will include examining the fontanelles and scalp veins and feeling (palpating) the sutures to find out how far they are separated.
The provider will ask questions about the child's medical history and symptoms, including:
- Does the child have other symptoms (such as abnormal head circumference)?
Head circumference
Head circumference is a measurement of a child's head around its largest area. It measures the distance from above the eyebrows and ears and around ...
Read Article Now Book Mark Article - When did you first notice the separated sutures?
- Does it seem to be getting worse?
- Is the child otherwise well? (For example, are eating and activity patterns normal?)
The following tests may be performed:
- MRI of the head
MRI of the head
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark Article - CT scan of the head
CT scan of the head
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark Article - Ultrasound of the head
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
Read Article Now Book Mark Article - Infectious disease work-up, including blood cultures and possible spinal tap
Blood cultures
A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.
Read Article Now Book Mark ArticleSpinal tap
Cerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...
Read Article Now Book Mark Article - Metabolic work-up, such as blood tests to look at electrolyte levels
Electrolyte
Electrolytes are minerals in your blood and other body fluids that carry an electric charge. Electrolytes affect how your body functions in many ways...
Read Article Now Book Mark Article - Standard eye exam
Standard eye exam
A standard eye exam is a series of tests done to check your vision and the health of your eyes.
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Although your provider keeps records from routine checkups, you might find it helpful to keep your own records of your child's development. Bring these records to your provider's attention if you notice anything unusual.
References
Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Head and neck. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Seidel's Guide to Physical Examination. 10th ed. St Louis, MO: Elsevier; 2023:chap 11.
Goyal NK. The newborn infant. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 113.
Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 88.
Skull of a newborn - illustration
The sutures or anatomical lines where the bony plates of the skull join together can be easily felt in the newborn infant. The diamond shaped space on the top of the skull and the smaller space further to the back are often referred to as the soft spot in young infants.
Skull of a newborn
illustration
Skull of a newborn - illustration
The sutures or anatomical lines where the bony plates of the skull join together can be easily felt in the newborn infant. The diamond shaped space on the top of the skull and the smaller space further to the back are often referred to as the soft spot in young infants.
Skull of a newborn
illustration
Review Date: 1/24/2023
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.