The soft spot on the top of my baby’s head is one of my favorite places to run my hand.  I don’t know why exactly but it seems one of those places on him that truly represents his baby-hood.  One way I know that his infancy isn’t quite gone and my baby days aren’t over yet. O recently turned a year (so, yes, technically he’s no infant) and I have felt his baby-ness slipping through my fingers. I keep saying that to my patients when they ask about him. I am hoping it will somehow prolong this period and I won’t have to wake up and find myself with two grown boys in the house.

The emotional yo-yo between pure excitement about them growing up, with the simultaneous dread of losing these baby moments, remains real and palpable. The essence of parenthood I suppose is that stew of anxiety-thrill-dread-adoration-excitement as the days unfold and you hope for new things for your little baby while lamenting the loss of precious moments of who your baby is on a Monday in January.  So the soft spot is a good place to go to calm my inner anxiety about my toddlers walking out the door to college.

Lots of new parents ask me about caring for the soft spot. As the first year unfolds, it is the soft spot (aka “fontanelle”) in the front/top portion of a baby’s head that parents ask about, the anterior fontanelle. I think we all conjure up crazy worries about an errant flying pencil landing in it. Or pushing too hard and squishing something important. I’ve never experienced, read, or heard of this happening.

First, a little science to calm you about that soft spot:

  • Infants are born with about 6 soft spots in their heads to allow for the big squeeze through the birth canal. Ouch. Understatement of the century.
  • In general, pediatricians and parents can only feel 2 soft spots at birth.  Even then, we can usually only feel one spot after a baby is about a month of age.
  • 90 % of soft spots (the anterior fontanelle) close between about 7 and 19 months of age.
  • The soft spot is often a diamond shape. But it doesn’t always feel like that. It can be anywhere from a couple inches across to just finger tip in size.

soft spotI think we’re all curious (pediatricians, parents, relatives, neighbors, the lady at the grocery who touches your baby before you have time to stop her) about the soft spot as it reflects a tender spot on your baby. A reflection of all that growth and potential housed in one little head. You’re not alone if you find yourself thinking/worrying about the soft spot at 2am. When O was born, I asked his pediatrician at two separate visits to reassure me about his soft spot. It just felt big! I think she thought I was crazy. I remember feeling embarrassed to bring it up (thinking she would think I should know better) even though I was worried about it. She reassured me. He was growing well, his head was growing well, and he was doing what he was supposed to do. Dr Kelly Evans , a friend and pediatrician who is specializing in craniofacial pediatrics (head and face) said she, too, asked about her son’s soft spot after he was born, and worried like so many other moms.

Your pediatrician will always look at the baby’s head growth and the size of the soft spot at check ups. Only rarely do pediatricians send patients to see craniofacial experts. When Dr Evans sees patients in the craniofacial clinic for evaluation of the soft spot, the craniofacial team doesn’t just look at the soft spot, they feel and evaluate the spot in the context of the baby. “Our opinion of the soft spot all comes in context of their head shape, their developmental skills and OFC (measurement around the head).  I am never just looking at the fontanelle alone, but how the baby’s head is growing and how it looks and feels. And how they act when we examine them,” she adds. Although we talk a lot about this spot, it doesn’t often represent a health problem. More often, it’s a true reflection of health.

More Science to Calm You About That Soft Spot:

  • The fontanelle or “soft spot” at the front of a baby’s head is the intersection of 4 bones (2 frontal and 2 parietal) in the skull (see video below).
  • The anterior fontanelle is not fragile, but also not the spot you truly want to expose to the elements. It’s soft and vulnerable as there is no bone between your baby’s brain and the outside world. Good planning in the anatomy world afforded multiple layers of tough tissue protecting your baby at that spot.
  • The soft spot serves a dual purpose for your baby – it allows for your baby’s fast growing brain to expand and also provides an elastic-like cushion to the skull until it ultimately closes.
  • When a baby transitions from infant to toddler and starts walking (falling!), that fibrous area allows for the bones to shift and absorb impact upon a fall.
  • You’ll sometimes see the soft spot pulse a bit as you watch blood flow around your baby’s brain and skull when they are calm and resting.

When it comes to the soft spot, the reality is just to be gentle and smart and trust your instincts. And watch out for those flying pencils.

Take a peek at the video below, a 3-D reconstruction of a CT scan of a patient’s skull showing that diamond shaped fontanelle over the forehead area.