What is measured at each visit of a pediatric patient from birth to 36 months?

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In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

2022 Jul 25.

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  • PMID: 32809621
  • Bookshelf ID: NBK560786

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Macrocephaly

Stephen G. Jones et al.

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Excerpt

Measurement of head circumference, or OFC (occipital frontal circumference), is a reflection of head growth and is a useful tool in tracking and monitoring childhood growth and development. On average, head circumference increases by 2 cm per month in 0 to 3 months of age and 1 cm/month in 3 to 6 months of age. During the last six months of infancy, head circumference increases by 0.5 cm/month. During the first year of life, there is a 12 cm average increase in head circumference. After one year of age, only 1 cm gain occurs per 6 months in head circumference until three years of age and only 1 cm every year between 3 to 5 years of age (average 5 cm total gain in head circumference occurs during 1 to 5 years of age).

Accurate measurement of head circumference can be challenging in restless young infants, especially in the presence of thick hair, and particular attention needs to be paid for correct placement of the tape on the anatomical landmarks. Serial measurement of head circumference during every health supervision visit is necessary up to 24 to 36 months of age to assess head growth velocity. It is also critical to monitor head size frequently in high-risk cases such as preterm infants and those in the active phase of bacterial meningitis, subdural hematoma, and hydrocephalus. Abnormal readings should always be double-checked.

Macrocephaly is described as a head circumference more than two standard deviations above the mean for gestational age and sex, which falls above the 97th percentile. Although erroneously used interchangeably with macrocephaly, megalencephaly is a distinct term to suggest increased growth of cerebral structure. Macrocephaly is a broader term to encompass megalencephaly and other causes of increased head size without cerebral overgrowths, such as subdural fluid collection.

It is important to understand that there are different etiologies of macrocephaly. This understanding is needed to differentiate benign macrocephaly from conditions that require acute investigation and intervention to prevent long term neurological deficits and developmental delays.

Copyright © 2022, StatPearls Publishing LLC.

Sections

  • Continuing Education Activity
  • Introduction
  • Etiology
  • Epidemiology
  • Pathophysiology
  • History and Physical
  • Evaluation
  • Treatment / Management
  • Differential Diagnosis
  • Prognosis
  • Complications
  • Deterrence and Patient Education
  • Enhancing Healthcare Team Outcomes
  • Review Questions
  • References

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References

    1. Day RE, Schutt WH. Normal children with large heads--benign familial megalencephaly. Arch Dis Child. 1979 Jul;54(7):512-7. - PMC - PubMed
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    1. Winden KD, Yuskaitis CJ, Poduri A. Megalencephaly and Macrocephaly. Semin Neurol. 2015 Jun;35(3):277-87. - PubMed
    1. Strassburg HM. Macrocephaly is not always due to hydrocephalus. J Child Neurol. 1989;4 Suppl:S32-40. - PubMed
    1. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC) Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States. MMWR Recomm Rep. 2010 Sep 10;59(RR-9):1-15. - PubMed

Publication types

What are pediatric measurements?

In pediatrics, the essential growth measurements in infants and toddlers to age 2 years are length, weight, head circumference, and weight-for-length. For children ages 3 years and up, the essential measurements are height, weight, and body mass index (BMI).

What position should a child from infancy to age 36 months be in when measuring the child's height?

Length, measured in the recumbent position, is the correct linear measurement for infants younger than 24 months of age or children aged 24 to 36 months who cannot stand unassisted.

What is the correct about measuring the length of a pediatric patient?

Children under two years of age and those who are unable to stand stably enough to be measured in the standing position should be measured in the supine position on a measuring board. If the child is >2 years old and able to stand, standing height should be measured instead, using a stadiometer.

What is the most common measure used to assess growth in infants?

What is a percentile? Percentiles are the most commonly used clinical indicator to assess the size and growth patterns of individual children in the United States.