Login

Head Size & Shape

 

Head Size:

For all children with suspected abnormal head shape or size:

- Take 3 consecutive measurements of the child’s head circumference at the same appointment.

- Plot the largest of the 3 measurements on a standardised growth chart, corrected for gestational age.


Refer to Paediatric outpatients:

  • Any head size < 2nd centile
  • Any head circumference >99.6th centile

OR

  • If there is concerning trajectory (rapid increase/decrease) that differs by 2 or more centile lines from previous measurement (eg. increase from 25th to 75th centile, or decrease from 50th to 9th centile) and has crossed the 98th centile.

OR

  • has other concerning features such as dysmorphic features/developmental delay.

OR

  • If there is ridging of the suture lines and concern about Craniosynostosis (premature closure of the sutures causing an abnormal shaped head) on two separate occasions at least a month apart. 

 

NB. Contact Paediatric Admissions urgently via the Consultant Advice phoneline if concern regarding symptoms and signs of raised intracranial pressure (not required for well children with isolated macrocephaly).

 

Plagiocephaly

Mild flattening of the head usually corrects itself if you use simple measures to take pressure off the affected area of the skull during awake time eg tummy time, sloping chair, wearing in a sling. It may take 6-8 weeks of trying these measures before an y improvement is noticed.

Examine sutures in babies with Plagiocephaly as Craniosynostosis can present with flattening of the head on one side.

The Paediatric Orthopaedic Physiotherapy team accept any referral for plagiocephaly and/or restriction of cervical movement. The earlier the referral the better as this gives the most time for remodelling and increases the compliance of the baby. They do not accept referrals for brachycephaly (flattening of the back of the head).

There is currently no evidence for Helmet or skull band therapy and NICE do not recommend their use. Consideration of helmet therapy by the NHS requires referral to the paediatric neurosurgeons in Bristol and referral does not guarantee this therapy.

 

References: Plagiocephay and Brachycephaly RCHT Clinical Guideline V3.0 November 2020.

NICE guideline [NG127] Published May 2019 1.22 Head shape or size abnormalities

Author: Dr S Burns GP

Contributors: Chris Warren, Paediatric Consultant. Michelle Jackman, Paediatric Orthopaedic Physiotherapist.

Date: May 2021

Review date: May 2022

Version 1.1