Head Growth in Children

• The growth of the head circumference takes for the most part place during the first two years of life.
• Congenital and neonatal problems are usually reflected on the growth of the head circumference during the first year, when the follow-up is thus especially important.
• The size of a child's head should increase in parallel with the length of the child.
• A child with an abnormal head size should be referred to a paediatric outpatient clinic for further investigations in the following situations:
  • acceleration of head growth > 1 SD as compared with the growth in length / acceleration of length growth
  • slowing down of head growth > 1 SD as compared with the growth in length / slowing down of length growth.
  • head growth deviates > 2 SD from the length growth, even if a clear acceleration or slowing down of head growth, as describe above, would not be observable AND
    • there are abnormal features in the child's appearance or
    • there is delayed or abnormal development
  • head growth is > +3 SD (macrocephaly)
  • head growth is < -3 SD (microcephaly).

Acceleration of head growth

• Acceleration of head growth may be caused by an obstruction to the circulation of the cerebrospinal fluid (tumour, aqueduct occlusion/stenosis) or an interruption to its reabsorption (subdural bleed/effusion; consider trauma and abuse). Neurometabolic illnesses may also cause acceleration of head growth.
  • If, in addition to accelerated head growth, the child has a squint, an urgent referral for further investigations should be made without delay.
  • If the child is lethargic, has difficulty feeding or is vomiting, or if the anterior fontanelle is bulging and distended, or if he/she has lid retraction with impaired upgaze (”sunsetting”), he/she must be referred as an emergency case to the paediatric emergency department for investigations and treatment.

Slowing down of head growth

• Slowing down of head growth may be due to premature ossification of cranial sutures or some neurometabolic disease or syndrome.

Head shape deformity

• The growth of the head is determined by the growth of the brain.
• There are different types of anomalies in the cranial shape of infants. These are in most cases mild and do not require treatment.
• These self-correcting deformities include different depressions in the skull as a consequence of, e.g., the position of the foetus in the uterus or of the mode of delivery.
  • Deformational posterior plagiocephaly denotes unilateral flat area at the back of the head, which is caused by moulding of the head, rarely by an actual synostosis.
• Premature fusion of the cranial sutures, i.e. craniosynostosis, causes anomalous cranial shapes.
• Different types of ridges (e.g. a ridge formed by the metopic frontal suture) or eminences in the cranial bones do not require surgical treatment.
• A progressive deformity of the cranial shape associated with craniosynostosis of the coronal, sagittal or lambdoid sutures warrants consultation with a plastic surgeon.