Sutures - separated

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Alternative names
Separation of the sutures

Definition
Separated sutures are defined as an abnormally wide separation of the bony sutures of the skull in an infant.

Considerations

The skull of an infant or young child is made up of bony plates that allow for growth. The borders at which these plates intersect 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 a normal finding of 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 increased intracranial pressure (pressure within the skull).

Separated sutures may be associated with bulging fontanelles and, if intracranial pressure is significantly increased, prominent veins over the scalp.

Common Causes

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

Home Care
Home care is based on the specific diagnosis associated with separated sutures.

Call your health care provider if

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

What to expect at your health care provider’s office

The medical history will be obtained and a physical examination performed. Your health care provider will palpate (feel) the sutures to determine the degree of separation. In addition, the fontanelles and scalp veins will be examined. If there are abnormal findings, the nervous system and vision will be evaluated in detail.

The help evaluate the problem, the doctor may ask:

• Have other abnormalities been present (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 also present?
  
• Is the child otherwise well? (e.g., normal eating, activity patterns)

The following diagnostic tests may be performed:

• MRI of the head
  
• CT scan of the head
  
• Ultrasound of the head
  
• Infectious disease workup (blood cultures, cultures from various other tissues possibly including a spinal tap)
  
• Metabolic workup (blood tests to look at electrolyte levels as well as tests for suspected causes)
  
• Standard ophthalmic exam

Although your health care provider keeps records from routine examinations, you may find it helpful to maintain 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.

If a diagnosis was made by your health care provider as to the cause of separated sutures, you may want to note that diagnosis in your personal medical record.

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