RHC for Health Professionals
Red Flag Features suggestive of raised intracranial pressure include: drowsy or irritable child, vomiting, bulging fontanelle - refer urgently for assessment at the hospital.
Infant with a Large Head: Advice for Referrers
Warning
Macrocephaly is defined as an occipito-frontal circumference (OFC) more than 2 standard deviations above the mean. Large heads may be familial.
Please do not refer:
A child who has always had a large head, with an OFC tracking appropriately without deviating upwards away from previous measurements.
A well child with normal development, and a large OFC that is tracking appropriately, +/- a family history of macrocephaly, does not need further investigations.
- Is the child well and is development appropriate?
- Are the parents concerned about the child or has this been an incidental finding?
- Are there any signs of raised intracranial pressure – e.g. a child who is more irritable or drowsy than normal, who has poor feeding or vomiting?
- Do other members of the family have large heads?
- Has the child a past history of any serious illnesses, e.g. meningitis?
- OFC measurements (present and past)
- Weight and length (i.e. has the child’s weight and length also increased over the same time period)
- If possible include parents’ OFC measurements (Refer to head circumference chart – plot adult head circumference at age 18 years on the female/male chart as appropriate)
- Assessment of child’s development and whether this is appropriate
- Approximate size of anterior and posterior fontanelles. The anterior fontanelle usually closes by 12-18 months and the posterior fontanelle by 2 months
- Is the anterior fontanelle tense suggesting raised intracranial pressure?
Nil specific
Nil specific
Seal A. Fifteen-minute consultation on the infant with a large head Arch Dis Child Educ Pract Ed 2013;98:122–125.