Professional Documents
Culture Documents
A CHILD WITH
LARGE HEAD
1. Introduction and proper exposure of patient
Interact with child, gain impression of development
2. General observations(for 30 sec at least)
Alertness
Respiratory pattern (raised ICP)
Dysmorphic features (e.g. Sotos, mucopolysaccharidoses)
Skeletal anomalies (e.g. achondroplasia, Osteogenesis imperfecta)
Growth Parameters
• Height: tall (e.g. Sotos); short (e.g. achondroplasia)
• Weight: failing to thrive (e.g. Tay–Sachs, subdural from non-
accidental injury, congenital toxoplasmosis)
Movement
• Quality (e.g. hypotonia, poor head control in Tay–Sachs)
• Symmetry (e.g. hemiplegia from subdural haematoma)
• Upper limb versus lower limb movements (e.g. spina bifida)
Skin
• Neurocutaneous stigmata (e.g. Tuberous sclerosis, NF1, Sturge-Weber
syndrome; Klippel-Trénauney-Weber syndrome)
• Bruising (Non-accidental injury)
3. HEAD
Initial inspection
• Size, shape
• Signs of hydrocephalus (scalp vein prominence, shiny skin, sun-setting
eyes)
• Eye signs, e.g. squint
• V-tap bandage/scars
• Weight
• Height
• Plot on centile charts
• Check gait
• Look for scoliosis
9.Chest
In case of IU infections for associated cardiac abnormalities
Normal Head circumfrence
It is easy to remember the following average figures:
• 35 cm at birth.
• 47 cm (another 12 cm) at 12 months.
• 49 cm (another 2 cm) at 2 years.
• 50 cm at 3 years.
• 52 cm at 6 years.
• 53 cm at 10 years.
• 56 cm as adult.
The term Macrocephaly refers to OFC of more than 2SD above the mean
The most important things to remember in this case:
1. Always measure the head yourself, until a constant result around the largest diameter
is obtained (usually three times is enough).
2. Always measure the parents’ heads (in a similar fashion).
3. Always request the progressive percentiles of the child (parents’ charts unavailable).
4. Always examine the back, to avoid missing spinal dysraphism.
5. Always examine the lower limbs before the upper limbs, as the lower limbs are
first affected in hydrocephalus, because the tracts supplying them run closer to the
ventricles.
6. Always examine the eye movements, in particular the upward gaze (for Parinaud
syndrome, from raised intracranial pressure [ICP] compressing the mesencephalic
tectum/superior colliculus) and lateral rectus function (for raised ICP compressing
the sixth nerve).