Growth charts of sutures and fontanelles for the first year of infancy

Understanding the morphological development of infant sutures and fontanelles is essential for evaluating normal cranial growth, detecting developmental anomalies and aiding forensic evaluations. Yet, age-specific quantitative data and standardized growth charts for these structures have not been systematically established. Here, we present comprehensive normative growth charts for cranial sutures and fontanelles and quantify the prevalence and morphology of accessory sutures during the first year of infancy. A total of 194 head computed tomography (CT) scans from the New Mexico Decedent Image Database (NMDID) were analysed using an automated morphometric framework, measuring suture width, length, sinuosity and fontanelle area. Growth trajectories were modelled using Generalized Additive Models for Location, Scale, and Shape (GAMLSS), and suture closure was quantified via the suture closure ratio (SCR). Results show that suture length increases and width decreases with age; the metopic suture closes earliest, where other major cranial sutures remain open throughout the first year. The anterior fontanelle peaks in area around three months before gradually decreasing. Accessory sutures, particularly the mendosal suture and superior median fissure, are prevalent in early infancy but diminish rapidly with age. These results provide a comprehensive morphometric reference for infant cranial sutures and fontanelles, supporting objective clinical assessment and forensic interpretation.