Large Head Circumference in Infants: When to Seek Further Evaluation

Issues with increased head circumference in infants?

Hello Doctor: My child was born in Taoyuan, Taiwan, but we are currently living in South Korea and are unable to return to Taiwan for follow-up.
Since the prenatal check-ups until birth, my child's head circumference has been consistently large (35 cm).
At birth, we paid for a brain ultrasound and other examinations at your hospital.
Now, my baby is 6 months old with a head circumference of 46 cm.
The doctor in Korea mentioned that the growth curve for head circumference exceeds the 97th percentile, and the weight is 7.6 kg, which is on the smaller side.
From 4 to 6 months, the head circumference increased by 3.5 cm.
I would like to know if it is necessary to continue monitoring with brain ultrasounds.
Can hydrocephalus develop suddenly? At the time of the ultrasound at your hospital, we were not given an explanation of the report.
When I asked the nurse in the neonatal unit why there was no physician to interpret the report, she said that if there were no abnormalities, there would be no special arrangement for a follow-up appointment to discuss the report.

Ms. Li, 30~39 year old female. Ask Date: 2018/01/24

Dr. Pei Rensheng reply Pediatrics

Hello! The standard for head circumference can be referenced from the Child Health Handbook.
If it is greater than the 97th percentile, it is important to be cautious and rule out conditions such as hydrocephalus, brain tumors, and chondrodysplasia.
The out-of-pocket ultrasound after birth comes with a written report.
If you still have questions, you can discuss them with the pediatrician during your baby's vaccination appointments.
Wishing you health and happiness! Best regards, Rensheng.

Reply Date: 2018/01/24

More Info

When it comes to infants with a large head circumference, it is essential to understand the potential implications and when further evaluation may be necessary. A head circumference that exceeds the 97th percentile, as in your child's case, can be a cause for concern, but it is not always indicative of a serious underlying condition.

Firstly, it is important to note that a larger head circumference can be a normal variant, especially if there is a family history of larger head sizes. Genetics plays a significant role in determining head size, and if one or both parents have larger heads, it is likely that the child will too. However, it is crucial to monitor the growth pattern over time to ensure that it remains proportional and does not increase at an alarming rate.

In your situation, your child was born with a head circumference of 35 cm, which is already above average, and has since grown to 46 cm at six months. The increase of 3.5 cm in just two months is noteworthy. Rapid increases in head size can sometimes indicate conditions such as hydrocephalus (water on the brain), brain tumors, or other neurological issues. Hydrocephalus, in particular, can develop gradually but may also present suddenly, depending on the underlying cause.

Given that your child has already undergone a cranial ultrasound, it is essential to review the findings of that examination. If the ultrasound indicated no abnormalities, that is reassuring. However, if there were any signs of increased ventricular size or other concerns, it would warrant closer monitoring. The absence of a detailed discussion regarding the ultrasound results is concerning, as parents should be informed about their child's health status. It is advisable to follow up with the pediatrician to clarify the findings and express your concerns about the lack of communication.

As for whether you should continue with regular ultrasound evaluations, this decision should be based on the growth pattern of the head circumference and any accompanying symptoms. Regular monitoring of head circumference is crucial; if you notice a significant increase or if the head circumference continues to rise disproportionately compared to the rest of the body, further evaluation may be warranted.
In terms of developmental milestones, it is also important to assess whether your child is meeting other developmental markers. If there are any delays in motor skills, cognitive development, or social interaction, these could be additional indicators that further evaluation is necessary.

In conclusion, while a larger head circumference can be a normal variant, it is essential to monitor the growth pattern and any associated symptoms. If you have concerns about hydrocephalus or other neurological issues, it is advisable to seek further evaluation from a pediatric neurologist or a specialist who can provide a comprehensive assessment. Regular follow-ups and open communication with healthcare providers are key to ensuring your child's health and development.

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