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Macrocephalic BabyEvaluation of a baby’s “big head” is one of the most common referrals made to pediatric neurosurgeons.

Macrocephaly refers to a head circumference (the measurement around the widest part of the head) that is greater than the 98th percentile on the growth chart.

Primary care physicians may refer to the pediatric neurosurgeon based on your child’s increasing head circumference

Causes of macrocephaly include:

  • Benign familial macrocephaly – other family members with big heads (inherited)
  • Excess fluid in the brain – benign extra-axial fluid of infancy or hydrocephalus

If your child is not showing signs or symptoms of increasing intracranial pressure such as a tense, bulging anterior fontanelle (soft spot), unusual eye movements, projectile vomiting, increasing irritability or a high-pitched cry, then a follow-up appointment in three months with the pediatric neurosurgeon may be recommended.

If needed, imaging studies such as a head ultrasound, head CT scan or quick brain MRI may show:

  • Benign extra-axial fluid of infancy – a thin layer of cerebral spinal fluid between the brain & skull. This condition usually resolves over time.
  • Hydrocephalus – increased cerebral spinal fluid within the ventricle spaces in the brain. This condition may require surgical intervention.

To schedule an appointment with UNC Pediatric Neurosurgery, please call (919) 445-2410.

Melody Watral, CPNP-PC, CPON
Melody Watral, CPNP-PC, CPON