The neonatal skull is fragile and easily damaged during delivery and in the days and months following birth.
Understanding the Neonatal Skull
The skull is an aggregation of five bones that doesn’t fully form until after birth. The sagittal suture, posterior fontanelle, anterior fontanelle, occipital bone, and frontal bone are connected by fibrous seams. These seams give the bones flexibility to grow as the child’s brain expands during early childhood. It is only after the brain stops growing that these sutures fully close and the skull becomes a solid bone structure.
Types of Fractures
Infants and children can suffer a number of different types of fractures. These include diastatic fractures which cause the bones to push apart from one another. There are also depressed fractures which cause the bony plates to push inwards. These are among the most dangerous as they cause pressure on the brain. As such, they often require immediate surgery to correct.
Linear fractures occur when the bone is split apart. The fracture does not cause the bones to shift position. Finally, there are basilar fractures which occur below the cranium. These include damage to the eye sockets, bones within the nasal cavity, the ears, or those between the bottom of the skull and the neck.
Potential for Long-Term Injuries
Whether through vaginal delivery or c-section, the birth process can easily inflict skull fractures and brain injuries in infants. Repeated contractions, contact with the mother’s pubic bone, and contact with instruments including vacuums and forceps used in delivery can damage the fragile bones within the skull as the baby enters the world.
Signs and symptoms of brain fractures include persistent vomiting, seizures, loss of tension within muscle groups, and problems with coordination. When these symptoms are present, parents should take precautions to closely monitor their child and seek immediate treatment of the injury to prevent further damage.
While many skull fractures heal without long-term injury, there exists the very real potential for serious long-term damage caused by traumatic brain injury. Skull fractures that cause bleeding or pressure on the brain can cause neurological damage which can lead to developmental delays, diminished cognitive ability, nerve damage, and paralysis. Even with prompt treatment, severe traumatic brain injury to an infant can lead to permanent long-term injuries and the need for extensive care and treatment.
