Head Flashcards
Physical Assessment of the Head (6)
- Look for torticollis (inability to turn the head in both directions)
- Examine the head from above and side
- Examine the entire head using fingertips
- Feel for ridge over sutures
- Face
- - Forehead and upper orbit
- - Orbitonasal zygomatic area
- - Maxillomandibular area
- - Posterior cranial vault - Examine the extremities and back of child with deformation of head since congenital dislocation, scoliosis and deformed feet are more common. **
When performing the physical assessment…(3)
- When you examine head, you want to look above, from both sides, at general shape, and at the eyes
- Look at head from face on
- Look at extremities, because deformation of head could indicate problems with the spine
LOOK AT YOUR SLIDE OF THE SUTURES YOU NEED TO MEMORIZE THEM! (5)
- Metopic: frontal suture in the middle (vertical)
- Coronal: frontal horizontal suture
- Saggital suture down the middle of the head
- Lamboidal suture is in the back
- Squamosal: suture above the ears
Looking at head circumference
Check where child (
When do you measure the head?
Measure the head at 2,4,6,9,12,15,18 months,2.5,3 year old well child visits
Transilluminating the skull
can tell you how much brain is there; if there is a lot of transilluminating then there is low brain volume
*Arteriovenous malformation of brain can be indicated by bruit
Macrocephaly Head Assessment (7)
- Serial head measures
- Measure parents head
- Developmental history
- Transilluminate skull
- Look for skeletal dysplasia !
- Listen for bruit (can indicate arteriovenous malformation)
- Look for sunset eyes
- Signs of neurocutaneous disorder
Sunset eyes
when you can see sclera above the iris; can see top of the sclera; consider thyroid disease or hydrocephalus
Cafe au lait spots
Cafe au lait spots or flat round macules may indicate neurofibromitosis
Causes of microcephaly (6)
- Genetic defect
- Karyotype or axon sequencing can tell u
- Intrauterine infections
- Antenatal radiation
- Exposure to drugs and chemicals
* Certain anti-epileptics - Perinatal insult (can be due to in utero virus)
Scaphocephaly or dolichocephaly
Scaphocephaly: long, narrow head in an infant
Dolichocephaly: longer head than normal
Can be caused by positional problems in the premature infant
- Saggital Craniosynostosis
- If saggital suture closes too soon, it causes the head to grow longwise instead of outward/circular (will be a long-narrow head)
Plagiocephaly
Common with back head sleep position, torticollis;
Due to position, not premature closure; due to back-to-back sleep campaign
Craniosynostosis (5)
- Rare condition in which the skull sutures close and the bony plates of the skull become fused too early in life.
- Develops while the fetus is still in the mother’s womb
- 1 in every 2,500 births
- Sagittal suture closes prematurely
- Can occur as a part of a larger pattern of abnormalities
- Two main categories:
- - Simple or isolated craniosynostosis
- - Complex or syndromal craniosynostosis
Looking for craniosynostosis
Palpate over all sutures and feel for any overriding bones; will be normal right after birth but then they should open up
Craniosynostosis: not necessarily genetic; normal variation that occurs to cause narrow head
*But complex type could be due to one of the sutures being completely shut leading to differences in head shape
Scaphocephaly (4)
- No growth perpendicular to sagittal suture; can cause promminent occiput that is long and narrow
- Bitemporal narrowing
- Cranial elongation in anterior-posterior direction
- Characteristic: Frontal bossing and prominent occiput
Need to know what an open vs. closed suture looks like on X-ray; When a suture is open you can see a line through it