In this post, I link to four podcasts on “Approach to Abnormalities in Head Shape and Size” from PedsCases:
With Related Content:
- Podcast: Approach to Abnormalities in Head Shape and Size Part 1: Head Circumference and Head Growth
- Script
- by Lindsey Logan, Jan 31, 2022
This podcast is part 1 of a 4 part series discussing the Abnormalities in Head Shape and Size in pediatrics. This part will describe how to measure head circumference and head growth. This was developed by Lindsey Logan, Pediatric Neurology resident, and Claire McNiven, Pediatrics Resident, with Dr. Melanie Lewis, Dr. Lauren Redgate, and Dr. Peter Gill for PedsCases.com.- Review
- Head circumference is defined as the greatest occipito-frontal circumference and is routinely tracked until a patient is about 3 years old.
- For children born prematurely, we use corrected age until 2 years old.
- Remember to use specific charts if a child has a known syndrome, such as Down syndrome (trisomy 21) or achondroplasia.
- An abnormal head circumference is anything outside of 2-standard deviations away from the mean – or the 95% normal range. It is helpful to track over time with multiple measurements.
- To fit through the birth canal and to allow for rapid head growth, children’s skull bones have gaps (sutures) and holes (fontanelles).
- The anterior fontanelle usually closes between 12-24 months of age, but it can close earlier, too! The anterior fontanelle can also be quite variable in size. It is helpful to use as a marker of hydration status, or raised intracranial pressure.
- The differential diagnosis for an enlarged anterior fontanelle includes conditions of bone growth such as rickets, genetic conditions like down syndrome, and also conditions that prevent the closure, such as anything causing raised intracranial pressure.
- Podcast: Approach to Abnormalities in Head Shape and Size Part 2: Abnormalities in Head Shape
- Script
- by Lindsey Logan, Feb 20, 2022
In this podcast on abnormal head shape, the listener will learn the differential diagnosis for children with an abnormal head shape, the key points on history and physical exam to refine your differential diagnosis, and the relevant investigations and management options for children with abnormal head shape. The podcast was created by Dr. Lindsey Logan, a pediatric neurology resident in Toronto, and Dr. Claire McNiven, a pediatrics resident at the University of Alberta. The podcast’s development and editing were supported by Dr. Melanie Lewis, a pediatrician at the Stollery Children’s Hospital, Dr. Lauren Redgate, a pediatrician in Calgary, and Dr. Peter Gill, a pediatrician at SickKids.- Review
- After birth, children may have abnormal head shapes associated with birth trauma or moulding, as well as any instrumented deliveries.
- Caput succedaneum is superficial moulding of the skull and will resolve quite quickly.
- Cephalhematoma is under the periosteum so does not cross suture lines, and can harden into the bone before going away.
- Subgaleal hematoma is a boggy collection under the skin of the scalp and must be closely monitored.
- After birth, it is important to track head circumference and head shape at regular pediatric visits.
- If the sutures between bones close too early it leads to a condition called
craniosynostosis, which can result in abnormal head growth and abnormal head shape. This often requires neurosurgical surgical referral.- Plagiocephaly is another term for abnormal head shape. It essentially means flattening of one side of the head!
- The most common cause of plagiocephaly is positional – when babies spend too much time on their backs or with their head to one side.
- Depending on the severity of positional plagiocephaly, it is possible to initiate environmental modifications and exercises like tummy time. The CPS
- recommends three times per day for 10-15 minutes. If these do not work, there are often head shape programs at pediatric centres to determine whether further intervention such as physiotherapy and/or custom helmets are indicated.
- Okay, that is it for our overview of head growth, head shape, and measuring head circumference.
- Be sure to stay tuned for parts 3 and 4 of our podcast, which discuss an
approach to big and small heads – macro and microcephaly- Podcast: Approach to Abnormalities in Head Shape and Size Part 3: Macrocephaly
- Script
- by Lindsey Logan, Mar 06, 2022
This podcast is part 3 of a 4-part series discussing an approach to abnormalities in head shape and size. This third part reviews the differential diagnosis for children presenting with large heads (macrocephaly). Key points on history and physical exam and the relevant investigations and management options for children with macrocephaly will be discussed. The podcast was created by Dr. Lindsey Logan, a pediatric neurology resident in Toronto, and Dr. Claire McNiven, a pediatrics resident at the University of Alberta. The podcast’s development and editing were supported by Dr. Melanie Lewis, a pediatrician at the Stollery Children’s Hospital, Dr. Lauren Redgate, a pediatrician in Calgary, and Dr. Peter Gill, a pediatrician at SickKids.- Review
- Macrocephaly is defined as a head that is bigger than the 97th percentile.
- There are many causes of macrocephaly, and the easiest way to approach this is to run through the multiple things that you find inside the head: the skull, the brain, cerebrospinal fluid, blood, and then of course the possibility of other
masses.- Having an idea of the growth trajectory is important to see if a child’s head has always been on the large side or if it is progressively getting larger.
- One of the most important things to rule out in cases of macrocephaly is a
space-occupying mass, inside the head.- Hydrocephalus is when cerebrospinal fluid accumulates in the closed space of the skull. If a baby’s sutures and fontanelle have not fused yet, it can cause the skull to enlarge and the fontanelle to “bulge”.
- It may also cause the eyes to look down, a term called “sun setting”.
- Other symptoms of raised intracranial pressure are morning vomiting and headache.
- A sign of elevated ICP is papilledema on fundoscopy! (or swelling of the optic disc!)
- Raised ICP can also cause a 6th cranial nerve, or abducens nerve palsy.
- Other causes of macrocephaly are a large brain (which can sometimes be seen in children with autism), or enlargement of the bony areas of the skull, which can be secondary to extramedullary hematopoiesis in things like thalassemia.
- If there are concerns about macrocephaly, head imaging like an ultrasound or MRI can be useful, as well as referrals to other specialists, like neurosurgery or ophthalmology.
- Podcast: Approach to Abnormalities in Head Shape and Size Part 4: Microcephaly
- Script
- by Lindsey Logan, Apr 17, 2022 0 comments
This podcast covers an approach to children presenting with microcephaly including the definition of microcephaly, the differential diagnosis, the key points on history and physical exam to refine your differential diagnosis, and the relevant investigations and management options. It was developed by Dr. Lindsey Logan, a pediatric neurology resident in Toronto, and Dr. Claire McNiven, a pediatrics resident at the University of Alberta. The podcast’s development and editing were supported by Dr. Melanie Lewis, a pediatrician at the Stollery Children’s Hospital, Dr. Lauren Redgate, a pediatrician in Calgary, and Dr. Peter Gill, a pediatrician at SickKids.- Review
- Causes of microcephaly are often split up into primary and secondary.
- Primary microcephaly usually pertains to something genetic, such that the brain, and therefore the head, were never destined to be normal size.
- Secondary microcephaly refers to microcephaly where the brain and head were forming normally and then an insult, or infection, occurred, causing the growth to slow down.
- Again, with microcephaly, it is important to measure the child’s head, compare it to the size of the rest of their body, and plot the growth over time.
- Also, pay attention to other factors such as dysmorphism or developmental delay.
- Imaging microcephaly can also be done by a US, CT, or MRI depending on what is most appropriate for the child.
- Referrals may also be required to ophthalmology to evaluate the eyes,
development for an assessment and identification of appropriate developmental services, or neurology, especially if there are suspected seizures.
