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.
- Arnold-Chiari malformation
- Battered child syndrome
- Bleeding inside the brain (intraventricular hemorrhage)
- Brain tumor
- Certain vitamin deficiencies
- Dandy-Walker malformation
- Down syndrome
- Infections that are present at birth (congenital infections)
- Lead poisoning
- Subdural hematoma or subdural effusion
- Underactive thyroid gland (hypothyroidism)
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 health care provider will perform a physical exam. This will including examining the fontanelles and scalp veins and feeling (palpating) the sutures to find out how far they are separated.
The health care 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:
- 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.
Separation of the sutures
Carlo WA. Physical Examination of the Newborn Infant. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.N elson Textbook of Pediatrics.
Update Date 2/21/2013
Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.