Help! there is a hole in my baby’s head (Oka).

Does my baby have “oka”?
A lot of Nigerian Mums ask me countless number of times if their babies have “Oka”. In fact, most do not ask “if” as they have been handed the standard diagnosis of “Oka” by the Grannies stat. Their own 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 do I 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”.

So what is this “Oka”?
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”.

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 loosing weight, the space is very prominent and can even be sunken. Such babies are easily labelled 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 “Oka”?
Some years ago, during my residency training to become a Paediatrician, I 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 that day was when I saw the baby rushed in. He was about 2 – 3 months old. For the first time in my life, I was seeing the brain live and direct in a living person who was not being operated. 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 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 us the doctors.

That is why I talk and educate 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 serious infection of the brain even before and after surgery. Though he did not die, but there are long-term complications he will face all because of someone’s ignorance. No wonder, ignorance is more expensive than education.



1. 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.

2. 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.

3. The fact that in some babies, very hairy or chubby especially, that you can not see it pulsating or “breathing” in local naija parlance does not mean it is not there. Some mums have actually said their babies do not anterior fontanelle! That is not true….every baby is born with one!

4. The size and shape of the AF varies from one baby to another normally. In some conditions, it can be too big. Also the anterior fontannelle 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.

Please note that in these conditions, it is not the AF causing the disease symptoms (for example diarrhoea and dehydration with sunken AF). Rather, the AF is just reflecting the fact that something is wrong in the body systems.

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 use d have dangerous side effects and consequences especially on the immature liver and kidneys of the babies causing further damage….”fry pan to fire” scenario!!!

5. 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 delay in closure of the AF. See your paediatrician if you can still feel the AF in your baby after age 2 years.

6. 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!!!

7. 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!


Shared with permission from :

Author: Dr Gbemisola Boyede

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