A medical doctor shared his experience with New mums and Facts about Baby’s soft spot “OKA ORI”  I was a fresh medical graduate when one of my aunts told me about her neighbour’s new born child that died of what Yoruba call ‘oka ori’,  (BABY’S SOFT SPOT) someone told me it is called “ndawa isi” in Ibo. Someone should tell me the Hausa name.

 BABY’S SOFT SPOT (OKA ORI):  Mothers Myth Versus Doctor’s Reality
    Since I started practicing, I came across few mothers that don’t bother asking for the meaning of ‘oka ori’, they have been handed the standard diagnosis of “Oka” by the grannies or neighbours.
 Their constant question is whether they should give “agbo oka” that is native concoction or herbal remedies for the “Oka”.
Another category of mums have gone beyond that and have started the treatment for “Oka”; how will you know?
Once you see a new baby with clean shaven head and sticky blackish substance applied to the scalp toward the front, you are seeing a child undergoing treatment for “Oka”.
Therefore majority don’t even know what or where the ‘oka ori’ is, but I could deduce from their history to likely referring to either the soft spot (sunken or bulging) on their baby’s head or cranial sutures.
     Fast forward to when I gave birth, I was told my child has “oka ori” after the hair was shaved;  I was told I will  need concoction; I just laughed and told them politely that my baby has nothing like ‘oka ori’, although it’s hard to correct a widespread shared myth, but my child never took any concoction.  My curiosity made me asked what exactly is
‘oka ori” it was the obvious cranial suture that was pointed at…
   I, therefore, concluded in my mind that, for me to correct the shared myth about ‘oka ori’, I need to discuss both the ‘soft spot(anterior fontanelle) and the cranial sutures’.
    If you are not from Nigeria, you may be lost from the title alone. The typical Naija Mum knows what I am talking about, especially if you are from the South-Western part of the country, specifically the Yoruba tribe.
So what is this “Oka ori”  BABY’S SOFT SPOT?
 Nigerian way of bathing newborn baby
The Grannies and some mums believe that there is a “hole” or “space” which is “breathing” or pulsating in the head of the new baby which is abnormal. That this soft space is not right and should not be there. Any baby that has this “abnormal space or hole” is diagnosed with “Oka”.  Some also believe obvious cranial sutures in associated with the hole or space breathing is a serious case of ‘oka’.
     For fat, hairy babies, the “hole” is not so apparent and often ignored. However, in smaller babies who are also not gaining weight or perhaps losing weight especially in the 1st ten days of life, the space is very prominent and can even be sunken; such babies are easily labeled as having “Oka” and commenced on all forms of treatment ranging from application of substances on the scalp to drinking herbal remedies. There are lots of myths and beliefs surrounding this “Oka”.
So why am I talking about it?
    In addition to my encounter with ‘oka ori’, there was a story shared by a paediatrician. She said during her residency training to become a Paediatrician, she was working at the Children Emergency Room (CHER) at the Lagos University Teaching Hospital when two women rushed in with a baby crying. That is not unusual in CHER.  What was terrifying about the day was when she saw the baby rushed in, he was about 2 – 3 months old and for the first time, she was seeing the brain live and direct in a living person who was not being operated.
 Yummy Homemade Baby Foods Puree
This was not a movie scene! The brain of this baby was completely visible to everyone. What happened?
 In the usual fashion, the grandma who came for “omugwo” had made a diagnosis of “Oka” and has prescribed the traditional treatment which was coating the surface with a black material. Unfortunately, in this scenario, whatever substance was applied was so caustic, it eroded (burnt) away from the membrane of the anterior fontanelle and you can see the baby’s brain live and direct!!! Of course, this was disastrous….for baby, mother and grandma and even the doctors.
    That is why I feel like educating people around me especially mums about this traditional myths and beliefs that are dangerous to children’s health. Of course, granny did not mean to harm her precious grandson but she did anyway.
That baby had to undergo brain surgery. Of course, he had a serious infection of the brain even before and after surgery. Though he did not die, there are long-term complications he will face, all because of someone’s ignorance. No wonder, ignorance is more expensive than education.
1.     An infant’s skull is made up of six separate cranial (skull) bones:
    –    Frontal bone
    –    Occipital bone
    –    Two parietal bones
    –    Two temporal bones
    These bones are held together by strong, fibrous, elastic tissues called SUTURES.
    Two fontanelles usually are present on a newborn’s skull:
–    On the top of the middle head, just forward of center (ANTERIOR FONTANELLE) – usually, closes between 18 & 24 months. During childbirth, it let the skull changes its shape so that the fetus can easily pass through the birth canal.
–    In the back of the middle of the head (POSTERIOR FONTANELLE) – usually closes earlier than the fontanelle
2.    Therefore, the “soft hole or space” often erroneously believed to be an abnormality is A NORMAL PART of the baby’s head. It is called ANTERIOR FONTANELLE (AF).  Every baby has it. It is there to allow along with the small spaces (sutures) between the different bones of the skull to accommodate the baby’s brain growth. So it is not “OKA” or any other thing….It is a normal part of the baby’s head.
3.     The anterior fontanelle (AF) is covered by a membrane, and this membrane is what actually separates the baby’s brain from the environment. It is that important! So any application of substances that can damage this membrane will lead to exposure of the brain to the environment with serious consequences like in the story above.
4.     The fact that in some babies, very hairy or chubby especially, that you can not see it pulsating or “breathe” in local Naija parlance does not mean it is not there. Some mums have actually said their babies do not have anterior fontanelle! That is not true….every baby is born with one!
5.       Clinically, AF is very important, it usually gives a clue of what is going on in the baby’s system, therefore, treatment should be towards the cause of distortion of the AF not aiming to close or treat Oka ori(AF).
6.     The size and shape of the AF vary from one baby to another normally. In some conditions, it can be too big. Also, the anterior fontanelle can be elevated “bulging” in some conditions especially if the baby has infections in the brain. It can be depressed “sunken” in other conditions like in babies that are very dehydrated or malnourished.
It is important to say this because this is one of the reasons some mums believe in “OKA”. Such babies are sick and may either have prominent or sunken AF in addition to other symptoms. The “OKA doctors” will now say it is the “oka” causing the symptoms.
The danger of this belief is all treatments will be directed to the AF and the underlying disease causing the change in AF will be ignored. Also, some of the native medications often used have dangerous side effects and consequences especially on the immature liver and kidneys of the babies causing further damage….” fry pan to fire” scenario!!!
7.    The AF closes on its own by age of 18 – 24 months. This is because more than 90% of brain growth and development has occurred by the age of 2 years. You did not need to do anything about it. It happens on its own. Just to note that some diseases can cause a delay in closure of the AF. See your pediatrician if you can still feel the AF in your baby after age 2 years.
8.     You did not need to apply oil to the AF hourly or daily….highly unnecessary and the dripping oil will cause rashes on the baby’s face. The AF is not “drying up” like many Naija mums believe. You also do not need to put thread from cloth. You also do not need to mop AF with hot water or apply any substances local or herbal on it. JUST LEAVE THE AF ALONE!!!
9.     Finally, if your baby is sick with or without observed changes in the AF, please go to the Hospital immediately. Don’t assume and don’t accept the “OKA” diagnosis. Please see your doctor for proper diagnosis and treatment. A stitch in time saves nine!
If you find this piece useful, feel free to share and educate people around you. Together we can make our environment better.
“Before you put that oil in that soft spot on the head of your newborn”
From Dr. Yusuf Abolude