Sutures - separated

  • Definition
    • Separated sutures are abnormally wide spaces in the bony joints of the skull in an infant.

  • Alternative Names
    • Separation of the sutures

  • 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 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).

      Separated sutures may be associated with bulging fontanelles. If intracranial pressure is increased a lot, there may be large veins over the scalp.

  • Causes
  • When to Contact a Medical Professional
    • Contact your health care provider if your child has:

      • Separated sutures, bulging fontanelles, or very obvious scalp veins
      • 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)?
      • 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:

      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
    • Carlo WA. The newborn infant. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 88