Increasing head circumference
Reassure
- Normal growth of head circumference along centile expected
- No symptoms of raised intracranial pressure
- No risk factors
- Normal neurological examination
Review/refer
- Growth rate of head circumference faster than normal (crossing centiles on a growth chart) especially in relation to height and weight
- Early review (within two weeks) if well child with isolated one off increased measurement to measure head circumference again and plot on growth chart
Scan
- Growth rate of head circumference faster than normal (crossing two or more centiles)
- Abnormal neurological examination
- Increasing head circumference with 1 or more other symptoms attributable to a brain tumour
Diagnostic pitfalls
- Failure to measure and monitor head circumference in a baby with persistent vomiting
Examination/assessment
- Determine duration and rate of increase in head circumference
- Plot height, weight and head circumference on a growth chart and compare to previous
- Ask specifically about associated symptoms and risk factors:
- Personal or family history of a brain tumour
- Leukaemia
- Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
- Neurofibromatosis types 1 and 2
- Tuberous Sclerosis
- Li Fraumeni Syndrome
- Family history of colorectal polyposis
- Gorlins Syndrome
- Other familial genetic syndromes
- Feel anterior fontanelle
- Neurological examination (include assessment of vision (including acuity), gait and coordination)
- Full visual assessment – in particular looking for roving eye movements