What is considered a big head?
As with a small head, centile tables decide everything: head circumference is compared with the norm for age, gender and date of birth. Macrocephaly is said to occur when the value is significantly higher than the average level. But it is much more informative not just one point, but a line: if the head grows quickly, but parallel to the upper corridor of the graph, and the child is developing well, there is usually no anxiety. You should be wary of going through several upward corridors in a short time. The pediatrician also necessarily measures the heads of the parents: often a large head turns out to be a family trait.
- Score using centile tables for age and gender
- Regular measurements at every scheduled examination
- The key feature is the growth rate, not just one number
- Measuring parents' head circumference
- Taking into account the height and weight of the child as a whole
Common benign causes
The most common is benign familial macrocephaly: the child has a large head, like one of the parents, and development is completely age-appropriate. The second most common reason is benign expansion of the subarachnoid spaces: the baby has a little more fluid between the brain and skull, the head grows faster in the first months, and then the indicators stabilize and by two or three years everything returns to normal. Such children require only observation, not treatment. That is why it is important not to prescribe unnecessary drugs in case of an accidental finding on ultrasound.
- Benign familial macrocephaly
- Benign expansion of subarachnoid spaces
- Normal child development in both forms
- Requires observation, not treatment
- Indicators usually level out by two to three years
When there is a disease behind a big head
Alarming causes are associated with either excess fluid or additional volume inside the skull. With hydrocephalus, the outflow or absorption of cerebrospinal fluid is impaired, the ventricles of the brain expand, and intracranial pressure increases. Accumulations of blood or fluid under the dura mater occur after injury or due to clotting disorders. Less commonly, the cause is tumors, vascular malformations, as well as hereditary metabolic diseases and neurofibromatosis, in which the brain tissue itself is enlarged. All of these conditions are accompanied by additional symptoms, not just head size.
- Hydrocephalus, congenital or after hemorrhage and meningitis
- Subdural collection of fluid or blood
- Brain tumor or cyst
- Vascular malformations
- Hereditary metabolic diseases
- Neurofibromatosis and other syndromes
Survey
The first and most informative step in a baby with an open fontanel is neurosonography: it is safe, does not require anesthesia and immediately shows the size of the ventricles and spaces around the brain. A complete neurological examination and developmental assessment based on age are required, as well as an examination of the fundus, where signs of increased intracranial pressure can be seen. MRI of the brain is prescribed for rapid head growth, neurological disorders, or an unclear picture on ultrasound; in infants it is performed according to special protocols. Additional tests are needed if metabolic diseases are suspected.
- Head circumference chart for several months
- Neurological examination and skills assessment
- Neurosonography through the large fontanel
- Fundus examination by an ophthalmologist
- MRI of the brain for warning signs
- MSCT of the brain in emergency situations
- Metabolism and genetic tests according to indications
What do they do next?
For familial and benign forms, observation is sufficient: regular head measurements, development monitoring and repeated examination by a neurologist. Diuretics and vascular drugs in such cases are not needed and do not affect the size of the head. If hydrocephalus is confirmed, treatment is neurosurgical: a shunt is installed to drain the fluid, or an endoscopic operation is performed to restore its outflow. In case of large formations and fluid accumulations, the tactics are determined by the neurosurgeon. In all cases, the child’s development is supported in parallel with classes and physical therapy.
- Observation and repeated measurements for benign forms
- Avoidance of unnecessary diuretics and vascular drugs
- Shunt surgery for hydrocephalus
- Endoscopic restoration of fluid outflow
- Neurosurgical treatment of space-occupying processes
- Developmental activities and physical therapy for delays