Introduction
Families often have concerns about the size and shape of their babies’ heads.
Please see the flowchart below to determine whether to reassure families, monitor babies or refer to secondary care.
Who can refer:
All Primary Care clinicians
Who to refer:
If there is suspicion of craniosynostosis, then urgent referral to neurosurgery should be made as corrective endoscopic repair may be possible under 3 months of age.
Who not to refer:
- Children with suspected Familial Macrocephaly;
For babies with large heads, it can be helpful to measure parents’ head circumferences (OFC – occipito-frontal circumference) to determine whether familial macrocephaly is a likely diagnosis, or if other diagnoses should be considered. Two standard deviations above the mean head circumference for women is 56.1cm and for men is 58.9cm. We have agreed that if mum’s OFC is greater than 57cm and / or Dad’s OFC is greater than 60cm, then familial macrocephaly is a possible diagnosis. Please see flowchart for more information / red flag signs and symptoms that would preclude this diagnosis.
- Children with positional moulding of their head. See flow chart above for details. Refer if any doubt.
How to refer:
If suspected raised ICP (see flow chart above): Emergency / immediate review required – please send child and family to the emergency department at RHCYP or St John’s hospital, Livingston.
Suspected Craniosynostosis, dysmorphic features, or developmental delay (see flow chart above) – please refer urgently via Sci-Gateway to medical paediatrics.
Other concerns/features suggestive of underlying problems on examination (see flow chart above) – please refer routinely to medical paediatrics via Sci-Gateway.
For families:
Information leaflet from the Association of Paediatric Chartered Physiotherapists: UPLOADED Head Turning and Plagiocephaly sent awaiting (790).pdf
NHS information:
Plagiocephaly and brachycephaly (flat head syndrome) – NHS
For professionals:
NICE guideline: suspected neurological conditions: recognition and referral, 0-16 years
Section 1.22: head size or shape abnormalities:
Scottish National Centre for Craniofacial surgery referral pathway (Glasgow):
https://apps.nhslothian.scot/files/sites/2/Head-Size-Shape.png
https://apps.nhslothian.scot/files/sites/2/Head-Shape-Size-chart.png
