Myths about soft spots on infant’s head

Question: I am an engineer who has just been blessed with a baby boy. He’s just 16 days’ old as I write. My baby is suffering from an opening on the head – sunken soft spot, with attendant emaciation, fever, crying and sleeplessness, which have been giving us a lot of concern to. He has been taken to the hospital twice, where he has been treated only for malaria because the doctors believe that his sickness is malaria. Doctor, our experience is that my boy continues to emaciate and exhibit all the sicknesses I mentioned earlier after completing the dosage of the malaria drug.

Doctor’s response: Dear Engineer, Thanks for your enquiry. While I empathise with your baby during this neonatal period, I advise you to have a second opinion about the cause of your baby’s fever, crying, emaciation and sleeplessness, as this could not have emanated from the soft spot on his head.

In reality, the “opening” that was mentioned by the reader is called a fontanelle or, simply, “soft spot,” being the only soft part of the skull. It is a normal anatomical landmark and it is present in all newborns. The word ‘fontanelle’ comes from the French ‘fontaine’ for fountain.

It is perfectly normal for the diamond-shaped fontanelle to pulsate with each heartbeat. This pulsating action is how the soft spot got its name, fontanelle, which means “little fountain.” The spot on the head is soft precisely because the cartilage there has not yet hardened into bone between the skull bones.

There are normally two fontanelles, and they are both in the midline of the skull. The first is the anterior fontanelle and it is positioned in the front; while the second – the posterior fontanelle – is at the back of the head. The posterior fontanelle closes first, say, by the time the baby is two months old if he/she was born full-term. This is why most mothers don’t know that the fontanelle exists.

The anterior fontanelle closes at 18 months of age on the average, but it can also close normally as early as nine months. Indeed, the longer time it takes the anterior fontanelle to close is what makes it a thing of concern to mothers. Yet, if it closes too early or too late, it may be a sign of a problem.

The fontanelle allows for growth of the brain and skull during an infant’s first year. I will limit myself to the anterior fontanelle for the purpose of this discussion and it will be used interchangeably with soft spots.

At birth, the fontanelle should feel firm and very slightly curved inward to the touch. This slight depression, which is a normal landmark in infants, has been linked by traditions and customs with so many things like what the Yoruba call oka.

Infants with less hair on the head are often victims of this pseudo-diagnosis called oka because the spot is exposed, compared to those with plenty hair whose soft spots are fully covered. However, if the soft spots are depressed like a well (sunken) or bulging (swollen), seek medical help!

Causes of sunken soft spots

A sunken or depressed fontanelle is seen in infants with vomiting, diarrhoea or both (which could mean the baby is severely dehydrated). It is also seen among unwell or malnourished infants who may fail to thrive or those who have very low birth weight.

Causes of bulging soft spots

A tense or bulging fontanelle occurs when fluid builds up in the brain or when the brain swells, causing increased pressure inside the skull. When this happens, the soft spots become swollen and can present conditions such as hydrocephalus, which may be as a result of build-up of fluid inside the skull and increased intracranial pressure.

Encephalitis may be due to swelling (inflammation) of the brain, or meningitis (infection of the membranes covering the brain).

Immediate emergency care is needed for any infant who has a truly bulging fontanelle, especially if it occurs along with fever or drowsiness. Solutions will be offered, based on the parents’ responses.

In conclusion, the soft spot is not a cause of diarrhoea, vomiting, cold, sneezing, fever, reduced appetite or weight loss, as perceived and portrayed by traditions and customs! It is not associated with teething or failure of infants to suck breast. Since the soft spots are not a medical condition, it will be necessary to say no medication is required!

Nursing mothers are urged to avoid the use and application of herbal concoctions on the soft spots. Again, no scarification marks are needed on the soft spots. In addition, the use of olive oil, methylsalicylate and eucalyptus oil on the soft spots should be discouraged, as they are of no benefit to the infant.

COMMON FOOT PROBLEMS

In a lifetime, the average person takes about 9,000 steps in a day. A person with foot problems will not be able to achieve this act.

A middle aged man was brought from a rural settlement by his nephew to seek medical attention in Lagos for an injury which he sustained on the leg over a month ago. According to him, the injury defied treatment and he attributed this to the charm he stepped on in a neighbour’s farm.

He said he had gone to a neighbour’s farm to cut some leaves but sustained an injury when he stepped on a sharp object suspected to be charm meant for preventing intruders on the farm.

The victim, on getting home, felt the charm was in the leg. He had used razor blade to cut the edge of the wound, thereby enlarging it unknowingly.

He claimed the charm had dissolved in the wound, as nothing was seen. He therefore concluded it was spiritual.

He was later brought to the hospital. The nurses usually do a mandatory urinalysis for all patients before they go in to see the doctor.

The nurse had alerted the doctor by using a red ink to circle the result, she later pulled a call through to the doctor:

Nurse: Hello doctor, your patient’s urinalysis is 4+

Doctor: Kindly do an urgent sugar check

Nurse: I’ve done that sir

Doctor: What was the result?

Nurse: The meter read ‘High’

Doctor: This is a diabetic emergency. Get the patient to the observation room, and get drips, catheters and bottle for blood samples…

Patient: I feel thirsty and weak, my leg smells

The doctor explained to the patient that the blood sugar was extremely high and that he would need to be admitted to enable us to control the sugar.

He also explained to the patient that his high blood sugar (diabetes mellitus) was responsible for the legs not healing on time and not charms as wrongly thought.

After two weeks, the patient was strong and healthy; the leg still smelled and a part of it was already becoming gangrenous (dead tissue).

The patient was taken to the theatre and the smelling part was cut off to save the leg, a procedure called debridement.

Diabetic foot

Chronically high blood sugar (glucose) levels can be associated with serious complications in people who have diabetes. The feet are especially at risk. Two conditions called diabetic neuropathy and peripheral vascular disease can damage the feet (and other areas of the body) in people who have diabetes.

Diabetic neuropathy

Chronically high sugar levels associated with uncontrolled diabetes can cause nerve damage that interferes with the ability to sense pain and temperature. This so-called “sensory diabetic neuropathy” increases the risk of injury for a person with diabetes, as he will not notice if he has problems with his/her feet.

Nearly 10 per cent of people with diabetes develop foot ulcers due to peripheral vascular disease and nerve damage. People with diabetes may not notice sores or cuts on the feet, which in turn can lead to an infection.

Nerve damage can also affect the function of foot muscles, leading to numbness, tingling sensation, improper alignment and injury.

Peripheral vascular disease

Diabetes is associated with poor circulation (blood flow). Inadequate blood flow increases the healing time for cuts and sores. Peripheral vascular disease refers to compromised blood flow in the arms and legs.

Poor blood flow increases the risk that infections will not heal. This, in turn, increases the risk of ulcers and gangrene, which is tissue death that occurs in a localised area when there is inadequate blood supply.

Foot ulcers

Foot ulcers are dangerous wounds that can affect people with diabetes. When a minor scrape, skin break, or sore on the foot becomes infected, a sore can result. In people who have diabetes, sores heal slowly or fail to heal. Early diagnosis and treatment are necessary to reduce the risk of complications.

Medical advice

Living with diabetes requires people to pay special attention to their health and condition. Follow the doctor’s instructions regarding diet, exercise and medication.

Keeping the blood sugar (glucose) levels within the recommended range is one of the best things that can be done to control the condition and protect the feet.

Diabetic foot presents with nerve damage numbness, tingling sensation, leg pain, improper alignment, injury and poor circulation (blood flow). Inadequate blood flow increases the healing time for cuts and sores. When a minor skin bruises or scrape occurs, it can result in ulcers or sores.

Other common foot problems which affect a lot of people with one medical condition or the others are explained below.  Some don’t have any underlying medical condition.                         

Athlete's foot

Fungal infection of the feet is called athlete's foot. Cracked skin, itching, and redness are associated with the condition. Fungus enters cracks in the skin causing an infection that must be treated with antifungal medications. Oral medications or topical creams may be used to treat athlete foot

Fungal nail infection

Thick, brittle, yellow-brown, or opaque nails are common with fungal nail infections. The infected area may crumble or seem to pull away from the rest of the nail. Fungus thrives in the warm, moist, dark environment created by wearing closed-toed shoes.

Nail injury also increases the risk of fungal nail infection. These infections are difficult, but not impossible, to treat. Oral medications work best to treat fungal nail infections.Sometimes, surgery is necessary to remove infected areas of the nail.

Calluses and Corns

Calluses are hard areas of thickened skin that build up on the bottom of the feet. Uneven weight distribution, a skin abnormality, or ill-fitting shoes may cause calluses while a corn is a thickened, button-like area of skin that builds up between the toes or near a bony area of a toe. Pressure and friction cause corns.

Care of calluses and corns includes: Rubbing the area with pumice stone after a shower or bath, Placing cushioned insoles or pads in shoes, using some medication to soften calluses.

It's normal to have some calluses. It's important to never try to cut a callus using a sharp object. Doing so can cause serious injury. 

Bunions

A bunion is a sore, red, callused area that forms on the outside of the joint of the big toe. Bunions make the big toe angle inward. They may appear on both feet and tend to run in families.

Wearing high-heeled shoes with inadequate toe room increases the risk of bunions by pushing the big toes into an unnatural position. Covering the bunion with padding or a foam cushion helps protect it. Special toe separators and other devices may be used to keep the toes in proper alignment. If the bunion is very painful or unsightly, surgery may be used to alleviate the symptoms.

Hammertoes

Weakened muscles in the toes contribute to the curled appearance known as "hammertoes." This weakness shortens the tendons in the toes, causing them to contract. Hammertoes can be hereditary.

They can also be caused by wearing shoes that are too small and provide inadequate toe room. Hammertoes can cause foot problems such as calluses, sores, blisters, and difficulty walking.

 Corrective footwear and splints can help reposition and treat hammertoes. Sometimes surgery may be needed to straighten the affected toes.

Ingrown toenail

Ingrown toenails derive their name from growing into the skin along the edges of the nail. An ingrown toenail may cause pain, pressure, and even cut into the skin leading to an infection.

 Wearing tight or ill-fitting shoes increases the risk of ingrown toenails. High-impact activities such as running and aerobics may contribute to the problem.

Walking, toe crowding, and inadequately trimmed toe nails may also cause ingrown toenails. The best way to prevent ingrown toenails is to keep the nails trimmed.

Professional medical treatment is necessary if an ingrown toenail is severe or if there is an infection. Sometimes surgery is necessary to remove the affected part of the nail and the growth plate from which the nail grows.

In conclusion, wash out for this common foot symptoms or signs which may be a pointer to serious feet disorders: Foot or ankle swelling, the appearance of corns, calluses, ingrown toenails.

Others are infected toenails, dry cracked skin, leg pain, foul-smelling, persistent, or unusual foot odour, ingrown toenails or toenails infected with fungus, oozing, open sores that appear to be draining and/or are slow to heal.

Generally, People who have diabetic foot or other foot disorders should have a regular foot exam done by a foot doctor (podiatrist) every 3-6 months, at each check-up, the doctor will thoroughly examine the feet.