HEAD EXAMINATION OF INFANT OR CHILD

HEAD EXAMINATION OF INFANT OR CHILD

It is important to measure its circumference at mid forehead anteriorly and the most prominent part of the occiput posteriorly. At birth, it measures 34-35 cm. Then a gain of 2cm/month for first 3 months (total gain 6 cm), 1 cm/ mouth in next 3 months (total gain 3 cm)and 0.5 cm in the subsequent 6 months (total gain 3 cm) occurs. Thus there is a total gain 12 cm by the end of the first year. During second and third years, when it measures 47 cm increase is 2 cm and 1.5 cm, respectively. During 3-14 years, it is 2.5 cm. At 14 years, head circumference is 53 cm.

We should note its shape as well-whether scaphocephaly, oxycephaly (acrocephaly), brachycephaly or plagiocephaly. Palpation of the sutures may reveal evidence of craniosynostosis. In hydrocephalus, sutures may be separated. Craniotabes may be demonstrated in occipitoparietal region and should arouse search for other signs of rickets, prematurity, osteogenesis imperfecta or syphilis. In suspected hydrocephalus, it is desirable to do transillumination of the head in dark room. Positive “crack-pot” or Macewen sign on percussing the skull with a finger does not always suggest hydrocephalus. It may well be positive normally as long as the fontanels are open. Since posterior and lateral fontanels close very early in infancy, it is the anterior fontanel that has clinical value. It usually closes between the ages of 9 to 18 months. Early-closure suggests craniosynostosis and late closure rickets, congenital hypothyroidism, malnutrition, hydrocephalus, syphilis, etc.  A truly bulging anterior fontanel suggests raised intracranial tension or Pseudotumor cerebri. A depressed fontanel is a sign of significant dehydration. An intracranial built on auscultation, particularly in temporal region, may well be a normal finding or evidence of an aneurysm, or facial haemangioma.

While examining the head, you should inspect hair for color, texture, sparseness and easy pluckability. Light-colored, sparse, silky or coarse, easily pluckable hair is usually seen in kwashiorkor or infantile tremor syndrome. Localized alopecia without any sign of infection is seen in trichotillomania. With presence of infection and pruritic lesions, it should suggest ringworm.