bump on head

I feel like i am reading a letter that was written by me... same problem, and lack of information about bump on baby's head...

http://www.askdrwarren.com/qa010319.htm#q4

Bump Near Fontanel

Dear Dr. Warren: I browsed your articles and did not find anything which specifically answered our question. I trust that I have not overlooked a relevant article. If so, please inform me that you already answered this question and I will search again.

Our three-month old daughter has a persistent bump on top of her anterior soft-spot. My wife noticed it early on and brought up her concern with our family doctor at our daughter's two-month checkup. Stating that he had not seen this before, he referred us to a pediatrician about an hour and a half away. This peditrician examined our daughter and found her to be in excellent health. He and his colleagues also performed an ultrasound and found the brain to be developing normally and also ascertained that the "bump" was not attached to the brain. None of these doctors had seen anything like this before, but did not feel that it was cause for any great alarm. They told us to watch this closely and to have an MRI performed if there was a significant change in the size of the bump.

We have read up on what this could possibly be in books like Dr. Spock's. He said that a sunken in anterior fontanel is often indicative of dehydration, while a persistently bulging fontanel may indicate pressure of some sort. Our daughter gives no indication that there is discomfort of any sort. She is breast-fed only, mom does not and has never smoked, drank, etc. She sleeps thru the night for 7-9 hours, feeds and normally goes back to sleep for another 2-3 hours. Afternoons are fine, evenings are a bit tougher, but nothing out of the ordinary. Touching the bump does not seem to cause her discomfort of any sort.

We are trying not to be overly-worried but, on the other hand, we do not wish to foolishly dismiss something that may be serious.

Any assistance you could provide would be greatly appreciated.

-Mr. & Mrs. H

Dear Mr. & Mrs. H: I am trying to visualize what you are describing when you talk about the bump in your daughter's fontanel, but from your description I cannot tell if you are talking about something attached to or part of the bone, a bulging of the fontanel, or something sticking out of the fontanel. If so many doctors have examined your daughter and can't tell you what it is, it is obviously not ordinary. I would consider consulting a pediatric neurosurgeon for an opinion or having the MRI done to see if the nature of the bump can be clearly delineated.

Sincerely,
Dr. Warren

Dr. Warren: Thank you for taking the time to respond to our question. My wife told me to describe the bump as being unattached to the bone (as far as the doctors could tell from the ultrasound), distinct from the fontanel (does not appear to be part of the fontanel) and somewhat soft in nature. It moves from front to back when palpated, moves laterally when palpated, but not as easily. It feels more fleshy to the touch than boney, almost like a blood vessel.

We have not had an abundance of doctors look at R, and are most concerned because we are in South Dakota. These doctors simply do not see the volume of babies which more urban doctors would. One doctor thought it to be a blood vessel, another thought it was a "crinkle" of the outer layer of the brain. Not sure what I think of these postulations. We asked another online doctor what they thought as well and they suggested it may be a cyst.

Do these clarifications help you to relate to something you may have seen in your years of practice? Your assistance is much appreciated.

-Mr. & Mrs. H

Dear Mr. & Mrs. H: If the lump is not part of the baby's skull and not connected to the brain or brain lining, it could be a cyst, hemangioma, lymphangioma, or lipoma. The small size (your subject line said pea-sized) is consistent with a cyst. The question is whether or not it has been established beyond a shadow of a doubt it is not connected to the brain or brain membranes since it is at the fontanel. If there is a connection to underlying tissue through the fontanel, it could also be an encephalocoele. I think, since the doctors who have seen it have been puzzled rather than giving you some definitive reassurance you need to find an answer. Therefore, I suggest my original advice which was to see a pediatric neurosurgeon and/or have an MRI of the head.

Sincerely,
Dr. Warren

Dr. Warren: Thank you, again, for taking the time to answer our question. We spoke with our family doctor after receiving your email and told him that we would be interested in pursuing this issue further for the very reasons you delineated in your most recent email. We will either be going to Rapid City or Sioux Falls in the coming weeks. This is the earliest we can get in around these parts. I am sure we could get in at Mayo right away if we need to. Is 2-3 weeks too long to wait to get in for something like this? We love our daughter but every indication has been that this is not a matter of great concern. I am inferring this from our family doctor's reactions when I asked him whether this might be a cyst. He replied that even if it was, nothing would probably be done about it until R was older. A person tries to trust their doctor and I am sure that doctors try to keep parents from undue alarm (especially first-time parents), but I am not entirely comfortable with his nonchalance -- especially in light of the uncertainty surrounding this bump.

We first-timers tend to try to steer clear of the "over-reaction" stereotype that seems to cling to new parents, even if you do not feel that you are that way. People seem to like to play to stereotypes. And yet, in such cases, it seems that one would prefer to err on the side of over-reacting and finding nothing rather than waiting for "image" sake and finding something too late which could have been treated if discovered earlier.

Thank you for letting me sound this out while writing to you. Having done so, I do not feel that I want to wait 2-3 weeks to find out what we are dealing with here. If you believe such a time frame to be acceptable for the possibilities you mentioned in your email, I would be more comfortable with this time frame. I do not know what the anomalies are which you mentioned. They probably sound worse than they are.

-Mr. & Mrs. H

Dear Mr. & Mrs. H: I can understand your being anxious, especially since your doctors appear to be puzzled; however, your daughter sounds healthy and her condition is stable, so I doubt there is any urgency to be seen before two to three weeks.

Sincerely,
Dr. Warren