North American Registry of Midwives (NARM) Practice Exam

What does bulging of the fontanels indicate?

1. Dehydration

2. Intra-cranial pressure

3. Normal brain development

4. Infection

The correct answer is: Intra-cranial pressure

Bulging of the fontanels in infants is primarily indicative of increased intracranial pressure. The fontanels, which are the soft spots on a baby's skull, allow the skull bones to flex during delivery and accommodate brain growth in the early stages of life. When there is an increase in cerebrospinal fluid (CSF) or swelling within the cranial cavity, it can cause the fontanels to bulge outward. This condition requires careful assessment since it can signal several serious health concerns, including hydrocephalus or brain injury. Observing bulging fontanels alongside other symptoms, such as irritability, vomiting, or a change in alertness, often prompts further investigation by healthcare professionals to determine the underlying cause of the increased pressure. Understanding this clinical sign is crucial for midwives and healthcare providers in monitoring the health and developmental progress of infants.