assessing head shape and size Flashcards
normal infant skull
what is microcephaly
too small head
OFC 2SD or below the mean = mild
OFC 3SD below the mean = mod/severe
what is macrocephaly
too big head
OFC 2SD above the mean
how do the fontanelles close
posterior closes 2-3m/o
sutures gradually fuse
anterior closes 1-3y/o
measurements of the head
occipitofrontal circumference
repeat 2-3x for consistent reading/avg
- measure and plot parental head sizes to interpret - is the child’s in keeping with the rest of the family
- is it too big/small or odd shape
- sutures and fontanelles
- look at facial features, any asymmetry?
when is the head measured
- routine between birth-3yrs
- if any child with neurological symptoms or developmental complaints
what does microcephaly indicate
usually indicates small brain - micranencephaly
- is it prenatal/postnatal onset - is it crossing centiles downwards
- timing of onset may be clue to cause
causes of microcephaly
antenatal
postnatal
genetic
environmental
assessing macrocephaly
is it crossing centiles upwards - underlying brain/CSF is expanding abnormally
separation of sutures, large fontanelles - indicate very large head size
- familial
- hydrocephalus
- large brain
is development normal?
- consider other physical abnormalities - facial features, hepato splenomegaly, bony deformities etc
when do head shape problems generally occur
often in first year of life
assessing head shape probelms
- timing of onset
- is it getting better/worse with age
what is plagiocephaly
flat head
what is brachycephaly
short head or flat at back
what is scapocephaly
boat shaped skull
what is craniosynostosis
premature fusion of cranial sutures
brain doesn’t have enough space to grow
shape depends on which suture has closed too early
deformational plagiocephaly
often due to the position that the child is in - child often lies on that side of head
‘parallelogram’ type shape
may not be apparent at birth and becomes more prominent in 1st year of life
