It is important for the clinician to examine head circumference in infants/children up to age:
A. 1 year
B. 2 years
C. 3 years
D. 4 years
ANS: B
The head circumference should be measured at all well visits up to 2 years of age to assess for macro- or microcephaly. Assess the head symmetry and look for plagiocephaly. For the fontanel to be accurately assessed, the child should be sitting upright and not crying. Some variants that might be noted in newborns include the following:
• Caput succedaneum—Seen at birth, usually following a traumatic vaginal delivery or vacuum-assisted delivery; edema of the soft tissue of the scalp that usually crosses the suture lines; no specific treatment; should resolve in a few days.
• Cephalohematoma—Often appears several hours after birth and may increase for the first 24 hours; subperiosteal collection of blood that does not cross the suture lines; may take weeks to months to resolve; watch for hyperbilirubinemia.
Red Flags for the Head Examination
• No growth in head circumference between well visits.
• Enlarged head size or excessive growth between well visits.
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