A 15 Month Old with a Very Big Head

2/7/2008

A fifteen month old boy came to my office for a routine visit. As part of his normal examination, his height, weight and head circumference were measured. The weight was 25-50th percentile, the height was 50th percentile and the head circumference was 95th percentile for age. This simply means that while his height and weight are average for age, his head is large as compared to his other growth parameters.

His development is meticulous. He says approximately 10 words, he walked at one year of age, he climbs and feeds himself. I asked the mom if either she or dad has a large head. She smiled and confirmed that dad had a very large head proportional to his body.

This child very likely has a normal variant of growth called Familial Macrocephaly or a big head that he inherited from one or both of his parents. I measured mom’s head in the office and it was average size at 50th percentile. It is critical to confirm dad’s large head as this condition is completely benign and needs no work up. Other conditions of large head size in young children could be serious such as hydrocephalus or excess fluid in the deep ventricular system of the brain.

I provided the mom with a disposable tape measure and showed her how to measure her husbands head. She called me later in the day and indeed dad has a head size in the 95th percentile as well. I reassured the mom of the benign diagnosis and that no further investigation would be needed.  A happy ending to a big head.

      

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