Assessment and Management of Premature Anterior Fontanelle Closure

Initial Evaluation

The American Academy of Pediatrics recommends immediate measurement of head circumference and plotting it on a growth chart to assess for microcephaly or abnormal head growth, and performing a complete neurological examination to assess for signs of increased intracranial pressure in infants with premature anterior fontanelle closure 1
A neurological examination should be conducted to assess for signs of increased intracranial pressure, including altered mental status, vomiting, lethargy, scalp bruising or bogginess, and large or rapidly enlarging head circumference 2, 1
Developmental assessment should be implemented to identify any delays that may accompany craniosynostosis 1

The diagnosis of craniosynostosis and skull malformations is strictly clinical and does not require routine radiographic imaging, according to the American College of Radiology 3
Ultrasound examination is often sufficient for suspected anomalies of the cranial sutures and anterior fontanelle 3
CT imaging is indicated only for treatment planning in selected cases, not as a routine diagnostic tool, as recommended by the American College of Radiology 3
MRI consideration is recommended if there are concerns about brain development or other neurological symptoms 1

Close monitoring of head growth and neurological development over time is recommended for infants with premature anterior fontanelle closure 1
Early intervention services should be provided if developmental delays are identified 1
Serial head circumference measurements at regular intervals and ongoing developmental surveillance are recommended for isolated premature fontanelle closure without other abnormalities 1
Ultrasound imaging to assess suture status and CT imaging for surgical planning if intervention is needed are recommended for premature closure with abnormal head growth or neurological signs 3