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

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