Head Sizes and Shapes

Question 1

Assessing the child with the unusual head:

• Accurate measurements and interpretation as part of a _________ physical examination
• Head size problems: __________ (too large) and __________ (too small)
• Head _____ problems: what not to miss
• Refer early for a _________ opinion

Answer 1

childhood

Macrocephaly

microcephaly

shape

specialist

Question 2

Infant skull made up of a number of different bones that haven’t fused together to form the cranium

Held together by sutures

These bones form vault of skull

what bones, sutures and fontanelle make up an infants skull?

Answer 2

Question 3

why are sutures open?

Answer 3

Sutures open to allow brain to grow

Question 4

How do fontanelles close, what closes first?

Answer 4

Order in how sutures and fontanelles close

Posterior fontanelle first to close and anterior last

Question 5

when taking a childs head circumfrance measurement, whats importnat to do with it?

Answer 5

See if it falls in what is expected for child’s height and weight

plot it

Question 6

Measurements - how do you measure head circumfrance?

Answer 6

• Occipitofrontal circumference
• As routine: Between birth- 3 years
• In any child with neurological symptoms or developmental complaints
• Measure and plot parental head sizes
• Too big, too small or odd shape?
• Sutures & Fontanelles?
• Look at the facial features - any asymetry?

Should measure both parents head size to see if it is in keeping with the rest of the family

Question 7

Microcephaly - what is it?

Answer 7

•Definition: OFC <2 SD: mild

OFC <3 SD: moderate/ severe

• Microcephaly usually indicates small brain: ‘micranencephaly’
• Prenatal or postnatal onset: is it crossing centiles downwards? (this is where the red book of child becomes important as head size is taken at birth)

Question 8

What causes microcephaly?

Answer 8

• Timing of onset may be a clue
• Multiple causes: antenatal, postnatal, genetic and environmental

Question 9

what is Macrocephaly?

Answer 9

• Definition: OFC > 2SD
• Is it crossing centiles upwards?
• Sutures?
• Fontanelles?
• Familial?
• Hydrocephalus?
• Large brain?
• Development normal?
• Other physical abnormalities – facial features, hepatosplenomegaly, bony deformities etc

Indicated either underlying brain or CSF is expanding in a way it shouldn’t

Question 10

Head shape problems often occir in the first year of life (as brain growing rapidly)

in relation to head shape problems you need to think about:

• Timing of onset?
• Is it getting better or worse? (as they get older)

what are some head shape problems?

Answer 10

• Plagiocephaly ‘flat-head’ (usually on one side)
• Brachycephaly ‘short head or flat at back’
• Scaphocephaly ‘boat shaped skull’ (flattened form side to side)
• Craniosynostosis (premature fusion of cranial sutures meaning brain has no space to grow)

Question 11

what is Deformational plagiocephaly?

Answer 11

Due to the position that the child is in

Polarogram shape when looking form above

Deformational, or positional, plagiocephaly is when a baby develops a flat spot on one side of the head or the whole back of the head. It happens when a baby sleeps in the same position most of the time or because of problems with the neck muscles that result in a head-turning preference

Question 12

what is Craniosynostosis?

Answer 12

Deformational plagiocephaly can be confused with this

Sutures fused to early

Depending on what suture has closed to early you can get some characteristic skull shapes

Craniosynostosis is a condition in which one or more of the sutures close too early, causing problems with normal brain and skull growth. Premature closure of the sutures may also cause the pressure inside of the head to increase and the skull or facial bones to change from a normal, symmetrical appearance