Sutures - separated

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

The skull of an infant or young child is made up of bony plates that allow for growth. The borders at which 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, making the bony plates overlap at the sutures and creating a small ridge. This is normal in newborns. In the next few days the head expands, the overlapping 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.

• Dandy-Walker malformation
• Arnold-Chiari malformation
• Battered child syndrome
• Hydrocephalus
• Congenital infections
• Meningitis
• Brain tumor
• Bleeding inside the brain (intraventricular hemorrhage)
• Subdural hematoma or subdural effusion
• Lead poisoning
• Down syndrome
• Hypothyroidism
• Some types of vitamin deficiency

Home care is based on the diagnosis of what caused the separated sutures.

Contact your health care provider if:

• Your child has noticeably separated sutures, bulging fontanelles, or very obvious scalp veins
• There is redness, swelling, or discharge from the area of the sutures

The health care provider will get a medical history and will do a physical examination. During the exam, the health care provider will feel (palpate) the sutures to find out how far they are separated. Also, the fontanelles and scalp veins will be examined. If there are abnormal findings, the child will have nervous system and vision tests.

The help determine the problem, the doctor may ask:

• Does the child have other problems (such as abnormal head circumference)?
• When did you first notice that the sutures were separated?
• Does it seem to be getting worse?
• What other symptoms are present?
• Is the child otherwise well? (for example, are there normal eating and activity patterns?)

The following tests may be performed:

• MRI of the head
• CT scan of the head
• Ultrasound of the head
• Infectious disease work-up, including blood cultures and possible spinal tap
• Metabolic work-up, such as blood tests to look at electrolyte levels
• Standard eye exam

Although your health care provider keeps records from routine examinations, you might find it helpful to keep your own records of your child's development. You will want to bring these records to your health care provider's attention if you notice anything unusual.