Aims Craniotabes describes softness of the infant’s cranial bones, causing a ‘ping pong ball’ effect after minimal pressure is applied. Exact causes of this phenomenon are not clear. This paper aimed to outline the nature and causation of craniotabes from published clinical series, and to identify its relevance to modern clinical practise.
Methods A literature review was performed to identify relevant publications. Historical series were identified from Embase and Medline, with the search criteria “craniotabes”.
Results Craniotabes was first described by Elsässeur of Neuenstadt in 1843. Early case series from the 19th century recorded a high rate of congenital syphilis in infants with craniotabes. No specific prognostic implication as to the outcome of the infants was derived from this finding. A proportion of cases however always appeared to recover with no underlying cause. We therefore suggest that at this time, craniotabes may have been a sensitive, but not specific, test for syphilis. More recent series of larger numbers of infants show rates of up to 30% in normal births. Some authors described a close correlation between the physical sign and biochemical evidence of maternal vitamin D deficiency. Treatment with vitamin D has been reported to result in rapid resolution of soft skull bones. We suggest that despite not being a sensitive test for the rickets, craniotabes may now be more specific to the condition due to the extremely low prevalence of congenital syphilis. The various case series examined did not allow comparisons with data on head circumference or the size of the anterior fontanelle. No case series has information on neruodevelopmental outcomes or head growth.
Conclusion Craniotables can be identified in those infants in whom skull ossification is slower towards the end of pregnancy. The finding may in some indicate an underlying disorder such as infection or vitamin D deficiency. The role of membranous ossification to an infant’s life-course may permit novel insights into relative growth of brain and bone.