I have seen bulging fontanels in kids who were not YET critically ill looking. With a 3 month old who has a fever and possible meningeal signs, ruling out meningitis is going to be necessary. However, as he is relatively good looking, an ultrasound through the fontanel before the spinal tap would be a good idea. David Tinkelman, MD ------------------ Reply Separator -------------------- Originally From: "G Hertz" <> Subject: bulging anterior fontanelle Date: 08/15/1999 08:51pm Today's case: I'm covering ER this weekend and at noon get called in to see a 3 month old with a 4 day hx of fever (99.5-102 otic), no vomiting, one "sort of loose" stool, and bulging fontanelle since 7pm previous evening. One day prior to onset of fever baby was exposed to neighbor child with "viral illness". Baby has decreased po intake [low Fe similac and has been on "baby cereal" for 3 weeks], and decreased urine output. Described by mom as "irritable" and not her "usual self", but still interactive and recognizes parents. PMH: Full term, SVD, only previous issue occasional diaper rash, imms up to date for 2 months. SH: Cared for by mom, first baby - lives with mom & dad, grandparents involved. PE: T=38.7 rectal [last tylenol 3am] other VS nl bulging ant. fontanelle - 5 cm x 4 cm x 2.5 cm high - firm PERRL, would track objects, interactive (smiled) but fussy rest of exam unremarkable - My question is this: The only kids I've seen before with a bulging ant. fontanelle have been VERY ill [status or comatose] - have you seen this level of presentation before? [I'll post labs, etc. in a later post] Gail Gail S. Hertz, MD, IBCLC Resident, Dept. of Pediatrics PSGHS Children's Hospital Hershey PA ---------------------------------------------------------------------- - group. "http://www.pcc.com/lists/";