Head Sizes and Shapes COPY Flashcards
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
childhood
Macrocephaly
microcephaly
shape
specialist
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?
why are sutures open?
Sutures open to allow brain to grow
How do fontanelles close, what closes first?
Order in how sutures and fontanelles close
Posterior fontanelle first to close and anterior last
when taking a childs head circumfrance measurement, whats importnat to do with it?
See if it falls in what is expected for child’s height and weight
plot it
Measurements - how do you measure head circumfrance?
- 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
Microcephaly - what is it?
•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)
What causes microcephaly?
- Timing of onset may be a clue
- Multiple causes: antenatal, postnatal, genetic and environmental
what is Macrocephaly?
- 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
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?
- 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)
what is Deformational plagiocephaly?
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
what is Craniosynostosis?
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
