Normal growth of head circumference along centile expected
No symptoms of raised intracranial pressure
No risk factors
Normal neurological examination
Action
Reassure
Review/refer
Growth rate of head circumference faster than normal (crossing centiles on a growth chart) especially in relation to height and weight
Early review (within two weeks) if well child with isolated one off increased measurement to measure head circumference again and plot on growth chart
Action
Refer to paediatrician for assessment if confirmed accelerating head growth independent of any other features
Scan
Growth rate of head circumference faster than normal (crossing two or more centiles)
Abnormal neurological examination
Increasing head circumference with 1 or more other symptoms attributable to a brain tumour
Action
Refer for an MRI scan
Diagnostic pitfalls
• Failure to measure and monitor head circumference in a baby with persistent vomiting.
Examination/assessment
• Determine duration and rate of increase in head circumference.
• Plot height, weight and head circumference on a growth chart and compare to previous
• Assess motor skills including:
• Sitting/crawling in infants.
• Walking/running in older children
• Co-ordination e.g. heel-toe walking, finger-nose testing
• Fine motor skills, e.g. handling of a small toy / cup in young children.
• Handwriting in school age children and young people
• Touching tip of thumb with tip of each finger of the same hand in turn in school age children and young people
• Ask specifically about associated symptoms and risk factors:
• Neurological examination (include assessment of vision (including acuity), gait and coordination)
• Full visual assessment – in particular looking for roving eye movements
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