{"id":24308,"date":"2025-06-16T19:11:27","date_gmt":"2025-06-16T18:11:27","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=24308"},"modified":"2025-08-14T16:02:38","modified_gmt":"2025-08-14T15:02:38","slug":"head-size-shape-abnormalities","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/medical-paediatrics\/head-size-shape-abnormalities\/","title":{"rendered":"Head size &amp; shape abnormalities"},"content":{"rendered":"\n<p><strong>Introduction<\/strong><\/p>\n\n\n\n<p>Families often have concerns about the size and shape of their babies\u2019 heads.<\/p>\n\n\n\n<p>Please see the flowchart below to determine whether to reassure families, monitor babies or refer to secondary care.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"829\" height=\"1024\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-shape-size-829x1024.png\" alt=\"Head shape &amp; size\" class=\"wp-image-24520\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-shape-size-829x1024.png 829w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-shape-size-243x300.png 243w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-shape-size-768x949.png 768w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-shape-size-1243x1536.png 1243w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-shape-size-922x1140.png 922w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-shape-size.png 1535w\" sizes=\"auto, (max-width: 829px) 100vw, 829px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><strong>D.R.M &amp; C.H. 16-6-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer:<\/strong><\/h4>\n\n\n\n<p>All Primary Care clinicians<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<p><strong>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.<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Children with suspected Familial Macrocephaly;<\/li>\n<\/ul>\n\n\n\n<p>For babies with large heads, it can be helpful to measure parents\u2019 head circumferences (OFC \u2013 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\u2019s OFC is greater than 57cm and \/ or Dad\u2019s 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.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Children with positional moulding of their head.&nbsp; See flow chart above for details.&nbsp; Refer if any doubt.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p>If suspected raised ICP (see flow chart above): Emergency \/ immediate review required \u2013 please send child and family to the emergency department at RHCYP or St John\u2019s hospital, Livingston.<\/p>\n\n\n\n<p>Suspected Craniosynostosis, dysmorphic features, or developmental delay (see flow chart above) &#8211; please refer <strong>urgently<\/strong> via Sci-Gateway to medical paediatrics at RHCYP or paediatrics at SJH <\/p>\n\n\n\n<p>Other concerns\/features suggestive of underlying problems on examination (see flow chart above) \u2013 please refer routinely to medical paediatrics via Sci-Gateway at RHCYP or paediatrics at SJH <\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p style=\"text-decoration:underline\"><strong>For families:<\/strong><\/p>\n\n\n\n<p>Information leaflet from the Association of Paediatric Chartered Physiotherapists: <a href=\"https:\/\/apcp.csp.org.uk\/system\/files\/documents\/2024-08\/UPLOADED%20Head%20Turning%20and%20Plagiocephaly%20sent%20awaiting%20%28790%29.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Head turning preference and plagiocephaly.pdf<\/a><\/p>\n\n\n\n<p>NHS information:<\/p>\n\n\n\n<p><a href=\"https:\/\/www.nhs.uk\/conditions\/plagiocephaly-brachycephaly\/\" target=\"_blank\" rel=\"noreferrer noopener\">Plagiocephaly and brachycephaly (flat head syndrome) &#8211; NHS<\/a><\/p>\n\n\n\n<p style=\"text-decoration:underline\"><strong>For professionals:<\/strong><\/p>\n\n\n\n<p>NICE guideline: suspected neurological conditions: recognition and referral, 0-16 years<\/p>\n\n\n\n<p>Section 1.22: head size or shape abnormalities:<\/p>\n\n\n\n<p><a href=\"https:\/\/www.nice.org.uk\/guidance\/ng127\/chapter\/Recommendations-for-children-aged-under-16#head-shape-or-size-abnormalities\" target=\"_blank\" rel=\"noreferrer noopener\">Recommendations for children aged under&nbsp;16 | Suspected neurological conditions: recognition and referral | Guidance | NICE<\/a><\/p>\n\n\n\n<p>Scottish National Centre for Craniofacial surgery referral pathway (Glasgow):<\/p>\n\n\n\n<p><a href=\"https:\/\/clinicalguidelines.scot.nhs.uk\/rhc-for-health-professionals\/referring-a-patient\/outpatient-referrals\/scottish-national-centre-for-craniofacial-surgery-for-children-young-people-referral-pathway\/\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish National Centre for Craniofacial Surgery for children &amp; young people : referral pathway | NHSGGC<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-Circumference-for-age-Boys.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-Circumference-for-age-Boys.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-circumference-for-age-Girls.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Head-circumference-for-age-Girls.pdf<\/a><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Families often have concerns about the size and shape of their babies&rsquo; heads. Please see the flowchart below to determine whether to reassure families, monitor babies or refer to secondary care. D.R.M &amp; C.H. 16-6-25<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":21301,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1253],"class_list":["post-24308","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-head-size-shape-abnormalities"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/https-apps-nhslothian-scot-refhelp-head-size-shape-abnormalities\/\" rel=\"tag\">Head size &amp; shape abnormalities<\/a>","rttpg_excerpt":"Introduction Families often have concerns about the size and shape of their babies&rsquo; heads. Please see the flowchart below to determine whether to reassure families, monitor babies or refer to secondary care. D.R.M &amp; C.H. 16-6-25","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24308","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=24308"}],"version-history":[{"count":8,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24308\/revisions"}],"predecessor-version":[{"id":25172,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24308\/revisions\/25172"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21301"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=24308"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=24308"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}