Bulging Fontanelle: Causes, Treatment, and When to See a Doctor

Finding a bulging fontanelle — the soft spot on your baby’s head — can be frightening for any parent. While it’s normal for your baby’s soft spot to pulse slightly or appear a bit raised when they’re coughing, crying, or straining, a fontanelle that remains bulging could signal a medical issue that needs immediate medical attention. 

Understanding what’s normal versus what requires medical care can help you protect your child’s health. Here’s what you need to know about a bulging fontanelle:

• Common causes: Infections like meningitis, ear infections, and upper respiratory illnesses that can affect fontanelle appearance
• Serious causes: Increased pressure in the brain, head injuries, brain tumors, and fluid buildup in the skull
• Emergency warning signs: When the fontanelle stays bulged while baby is calm, feels very firm or hard, or occurs with fever, vomiting, or unusual behavior
• Treatment options: Antibiotics for infections, medications to reduce brain pressure, surgical procedures when necessary, and supportive care

If you notice your baby’s soft spot appears swollen, feels firm to the touch, or remains bulging — especially when your baby is calm, not crying, and not straining — seek medical care immediately. Complete Care’s freestanding ER locations have emergency-trained staff and specialized equipment to provide the appropriate care your baby needs.

For life-threatening situations, please call 911.

What does a bulging fontanelle look like?

As a parent, it’s natural to worry about your baby, and that sometimes can lead to falsely identifying medical conditions. Here is what is normal and what is not:

Normal

A normal fontanelle sits relatively flat with the surrounding skull bones and may pulse gently with your baby’s heartbeat. It’s also normal for the soft spot to appear slightly sunken when your baby is sitting upright and calm, or to rise slightly when they’re crying, coughing, or lying down.

Not normal

Key bulging soft spot symptoms to watch for include when the fontanelle appears noticeably raised above the level of the surrounding skull bones and feels firm or tense to gentle touch. When your baby’s soft spot is swollen, this bulging typically persists even when your baby is calm, quiet, and in an upright position. The area may feel tight rather than soft, and the normal pulsing might be more pronounced or completely absent. 

If you’re unsure whether what you’re seeing is normal variation or concerning bulging, trust your instincts — it’s always better to have a medical professional evaluate your baby’s condition than to wait and worry.

What does it mean if a soft spot is bulging?

When a baby’s soft spot appears bulging or raised, it indicates that extra fluid, swelling, or other factors are taking up more space than usual inside their skull. When you notice this in your baby, the first thing you should do is take them to the doctor. 

Knowing the exact cause will determine how your baby will be treated, whether it’s with simple antibiotics for infections or emergency surgery for serious brain conditions. Regardless, early intervention can prevent permanent damage or life-threatening complications.

If your baby’s soft spot is swollen, here are the main conditions that could be causing this concerning change:

Possible causes

• Head injuries: Trauma from falls or accidents can cause bleeding or swelling inside the skull, creating dangerous pressure that pushes outward against the soft spot.
• Fluid buildup in the skull: Known as hydrocephalus, this condition occurs when cerebrospinal fluid can’t drain properly, causing dangerous accumulation and pressure.
• Meningitis: This serious infection affects the protective membranes around the brain and spinal cord, causing dangerous inflammation and swelling that pushes against the fontanelle.
• Ear infections: While typical ear infections don’t directly cause a bulging soft spot, in rare cases, a severe infection that spreads to the brain — such as meningitis or encephalitis — can lead to this symptom and requires emergency medical attention.
• Upper respiratory illnesses: Severe colds, flu, whooping cough, or other respiratory infections and common childhood illnesses can lead to increased pressure from coughing, congestion, and the body’s inflammatory response.
• Increased pressure in the brain: This can happen when normal fluid circulation is blocked or when the brain swells due to injury, infection, or other medical conditions.
• Brain tumors: Though rare in infants, growths in the brain take up space and create pressure that has nowhere else to go except against the fontanelle.

Other medical conditions

• Lyme disease: This bacterial infection from infected ticks can cause brain inflammation and increased intracranial pressure.
• Addison’s disease: When adrenal glands don’t produce enough hormones, it can affect fluid balance and brain pressure.
• Congestive heart failure: Poor heart function leads to fluid buildup throughout the body, including potentially around the brain.
• Leukemia: This blood cancer can affect circulation and pressure systems throughout the body, including the brain.
• Electrolyte imbalances: When blood levels of sodium, potassium, or other essential chemicals are disrupted, brain function and pressure can be affected.
• Hyperthyroidism: Overactive thyroid hormone production can increase heart rate and fluid pressure throughout the body.
• Maple syrup urine disease: This rare genetic condition prevents proper protein breakdown, leading to toxic buildup that can affect brain pressure.
• Anemia: When blood doesn’t carry enough oxygen, the body may compensate in ways that affect brain circulation and pressure.

Regardless of the underlying cause, a persistently bulging soft spot on your baby’s head signals that your baby’s brain may be under stress. A quick medical evaluation is key to figuring out what’s wrong and starting the right treatment before things get worse.

When to worry about a bulging fontanelle

While it can be challenging to determine what’s normal versus alarming, especially with a newborn, there are specific red flag symptoms that should never be ignored. Seek immediate medical care if your baby shows any of these emergency symptoms:

• Persistent bulging when calm: The soft spot on the head of a newborn remains raised even when baby is quiet, upright, and not crying
• Fever: Temperature of 100.4°F (38°C) or higher, especially when combined with fontanelle bulging
• Vomiting: Repeated or projectile vomiting that doesn’t seem related to feeding
• Extreme fussiness or lethargy: Baby is either inconsolable or unusually sleepy and difficult to wake
• Seizures: Any unusual jerking movements, stiffening, or loss of consciousness
• Changes in eating or sleeping: Refusing to feed, excessive sleepiness, or dramatic changes in normal patterns
• Swollen lymph nodes in infants: Enlarged, tender nodes in the neck, behind ears, or under arms combined with fontanelle changes
• Skin changes: Unusual rash, especially one that doesn’t fade when pressed, or pale/bluish skin color
• Breathing problems: Rapid, labored, or irregular breathing patterns

If you notice any of these warning signs, don’t hesitate to contact pediatric emergency services immediately. Complete Care’s freestanding ERs are equipped to handle these urgent situations and can provide the specialized care your baby needs right away. Quick treatment for fontanelle issues is important because delays can cause serious or even permanent brain damage.

What happens if a bulging soft spot isn’t treated?

When a bulging fontanelle goes untreated, the underlying condition causing the increased pressure can lead to serious and potentially irreversible complications. 

This is because the brain is extremely sensitive to pressure changes, and a prolonged increase in pressure can damage delicate brain tissue, affecting your child’s development and quality of life permanently. The severity of complications depends on the underlying cause, but delays in treatment generally lead to worse outcomes.

Potential complications from untreated bulging fontanelles include:

• Brain damage: Sustained pressure can compress brain tissue, leading to permanent cognitive impairment, learning disabilities, or developmental delays.
• Seizure disorders: Increased intracranial pressure can trigger ongoing seizure activity that may become difficult to control even with medication.
• Vision and hearing problems: Pressure on the optic and auditory nerves can result in partial or complete loss of sight or hearing.
• Motor skill impairment: Damage to areas controlling movement can cause weakness, paralysis, or coordination problems that persist throughout life.
• Hydrocephalus progression: If fluid buildup is the cause, continued accumulation can lead to severe brain compression and require emergency surgical intervention.
• Infection spread: Untreated infections like meningitis can progress rapidly, potentially causing sepsis, coma, or death.
• Increased risk of death: Some conditions causing fontanelle bulging, particularly infections and severe pressure increases, can be fatal without prompt treatment.

The good news is that most conditions causing bulging soft spots on babies’ heads respond well to treatment when caught early. However, the window for preventing permanent damage can be narrow, especially with serious infections or rapidly increasing pressure. This is why immediate medical evaluation is so important when you notice changes in your baby’s soft spot.

Experience the Complete Care difference for bulging soft spot treatment

A bulging fontanelle in your infant requires immediate medical attention from healthcare professionals who understand the urgency and complexity of pediatric emergencies. The experienced team at Complete Care combines advanced diagnostic capabilities with compassionate, family-centered care to quickly identify the cause of your baby’s soft spot concerns and implement the right treatment plan.

Complete Care’s freestanding emergency rooms are strategically located throughout Texas and Colorado to serve families when emergencies strike. Whether you’re in Austin, Corpus Christi, Dallas/Fort Worth, East Texas, Lubbock, San Antonio, or Colorado Springs, our pediatric-trained medical staff and state-of-the-art equipment are ready to provide the expert care your baby needs — without the long waits and overwhelming environment of traditional hospital emergency rooms.

Don’t let fontanelle concerns keep you awake at night wondering if your baby is okay. Trust Complete Care to deliver the immediate, expert evaluation and treatment that can protect your child’s developing brain and give your family the peace of mind you deserve.

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