Prevalence of sub-clinical vitamin-D deficiency and hypothyroidism in children aged 18- 36 months with open anterior fontanelle: a cross-sectional study

Vigneshwaran Rajendiran, Dhandapany Gunasekaran, Soma Venkatesh, Indumathi Dhayalan, Rangan Srinivasaraghavan


Background: The range of normal closure time of the anterior fontanelle (AF) is generally regarded to be 4 to 26 months. The objectives of this study was to find out the prevalence of subclinical vitamin D deficiency and hypothyroidism in children aged 18-36 months with open AF.

Methods: This is a hospital based, cross-sectional study done over a period of 24 months, in which thyroid function tests and 25-hydroxy-vitamin D levels were done for healthy children aged 18-36 months with open AF; the latter was also done for equal numbers (n=30) of age and sex matched children with closed AF for control values. The mean vitamin D levels and proportion of children of various categories based on vitamin D levels among both the groups were compared.

Results: Open AF was seen in 37 children. Seven of them had obvious causes of delayed AF closure and were excluded. In the remaining 30 children, none of the children had abnormal thyroid function tests. 23.3% of the study group had low vitamin D levels; but, the levels were low even in 37% of control group. The mean vitamin D level of the study group (39.05±17.11 ng/ml) was similar to the control group (37.3±14.74 ng/ml).

Conclusions: Neither subclinical vitamin D deficiency nor subclinical hypothyroidism accounted for delayed AF closure in this study. 


Anterior fontanelle, Children, Hypothyroidism, Vitamin D deficiency

Full Text:



Tunnessen WW Jr. Persistent open anterior fontanelle. JAMA 1990;264:2450

Aisenson HR. Closing of the anterior fontanelle. Pediatrics. 1950;6:223.

Kiesler J, Ricer R. The abnormal fontanel. Am Fam Physician. 2003;67:2547-52.

Acheson RM, Jefferson E. Some observations on the closure of the anterior fontanelle. Arch Dis Child. 1954;29:196-8.

Tunnessen WW, Roberts KB. Signs and symptoms in pediatrics. 3rd ed. Philadelphia: Lippincott Williams & Wilkins;1999.

Popich GA, Smith DW. Fontanels: range of normal size. J Pediatr. 1972;80:749-52.

Mathur S, Kumar R, Mathur GP, Singh VK, Gupta V, Tripathi VN. Anterior fontanel size. Indian Pediatr. 1994;31:161-4.

Esmaeili M, Esmaeili M, Ghane Sharbaf F, Bokharaie S. Fontanel size from birth to 24 months of age in Iranian Children. Iran J Child Neurol. 2015;9:15-23.

Ekbote VH, Khadilkar AV, Mughal MZ, Hanumante N, Sanwalka N, Khadilkar VV, et al. Sunlight exposure and development of rickets in Indian toddlers. Indian J Pediatr. 2010;77:61-5.

De Gaetano HM, De Gaetano JS. Persistent open anterior fontanelle in a healthy 32-month-old boy. J Am Osteopath Assoc. 2002 Sep;102(9):500-1.