Increasing head circumference

Increasing head circumference

Reassure

  • Normal growth of head circumference along centile expected
  • No symptoms of raised intracranial pressure
  • No risk factors
  • Normal neurological examination

Action

Reassure

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

Action

Refer to paediatrician for assessment if confirmed accelerating head growth independent of any other features

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

Action

Scan

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