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Sutures - ridged

Definition

Ridged sutures refer to an overlap of the bony plates of the skull in an infant, with or without early closure.

Considerations

The skull of an infant or young child is made up of bony plates that allow for growth of the skull. The borders where these plates intersect are called sutures or suture lines. In an infant only a few minutes old, the pressure from delivery compresses the head. This makes the bony plates overlap at the sutures and creates a small ridge.

This is normal in newborns. In the next few days, the head expands and the overlapping disappears. The edges of the bony plates meet edge-to-edge. This is the normal position.

Ridging of the suture line can also occur when the bony plates fuse together too early. When this happens, growth along that suture line stops. Premature closure generally leads to an unusually shaped skull.

Premature closing of the suture running the length of the skull (sagittal suture) produces a long, narrow head. Premature closing of the suture that runs from side-to-side on the skull (coronal suture) leads to a short, wide head.

Causes

Causes may include:

• Normal ridging due to overlap of bony plates after birth

• Congenital craniosynostosis

• Crouzon syndrome

• Apert syndrome

• Carpenter syndrome

• Pfeiffer syndrome

Home Care

Home care depends on the condition causing the premature closure of sutures.

When to Contact a Medical Professional

Contact your health care provider if:

• You notice a ridge along the suture line of your child's head.

• You think that your child has an abnormal head shape.

What to Expect at Your Office Visit

Your provider will get a medical history and will do a physical exam.

Medical history questions might include:

• When did you first notice that the skull seemed to have ridges in it?

• What do the soft spots (fontanelles) look like?

• Have the fontanelles closed? At what age did they close?

• What other symptoms are present?

• How has your child been developing?

Your provider will examine the skull to see if there is ridging. If there is ridging, your child might need x-rays or other types of scans of the skull to show whether the sutures have closed too early.

Although your provider keeps records from routine checkups, you may find it helpful to keep your own records of your child's development. Bring these records to your provider's attention if you notice anything unusual.

References

Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW. Head and neck. In: Ball JW, Dains JE, Flynn JA, Solomon BS, Stewart RW, eds. Seidel's Guide to Physical Examination. 10th ed. St Louis, MO: Elsevier; 2023:chap 11.

Goyal NK. The newborn infant. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 113.

Review Date: 1/24/2023

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.