Related Experiment Video
Updated: May 10, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Fifteen-minute consultation on the infant with a large head
1Correspondence to Dr Arnab Seal, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospitals NHS Trust, Children's Services, Wortley Beck Health Centre, Ring Road, Lower Wortley, Leeds, West Yorkshire LS12 5SG, UK. arnab.seal@nhs.net
Insights
An infant presenting with a large head, or macrocephaly, is common. While often benign, clinicians must investigate potential serious underlying causes like developmental disorders or increased intracranial pressure (ICP).
Area of Science:
- Pediatrics
- Neurology
- Clinical Genetics
Background:
- Macrocephaly, defined as a large head circumference, is a frequent clinical finding in infants.
- Most cases are benign, attributed to isolated or familial macrocephaly (FM), requiring no intervention.
- However, certain underlying conditions necessitate careful evaluation.
Purpose of the Study:
- To highlight the importance of distinguishing benign macrocephaly from significant underlying pathologies.
- To guide clinicians in investigating infants with large heads for specific red flags.
Main Methods:
- Clinical assessment of infants presenting with macrocephaly.
- Review of differential diagnoses for large head size in neonates and infants.
- Consideration of associated symptoms and family history.
Main Results:
- Benign macrocephaly and familial macrocephaly (FM) are common and typically require no further management.
- Key concerns include associated developmental disorders, syndromic associations, and signs of increased intracranial pressure (ICP).
Conclusions:
- While most large heads in infants are benign, active clinical consideration of serious underlying causes is crucial.
- Prompt investigation for developmental issues, syndromes, or raised intracranial pressure (ICP) is essential before reassuring parents.
Abstract:
An infant with a large head (2.5 SDs above normal for weight and gender or above 99.6th centile for age) is a common clinical presentation. Usually, it is due to benign isolated macrocephaly or familial macrocephaly (FM) where some close family members are similarly affected(1); neither condition requires any further intervention. However, there are a few important underlying causes the clinician needs to actively consider and investigate when indicated before reassuring parents. These considerations include whether there is any associated developmental disorder or suggestion of a syndromic association or evidence of raised intracranial pressure (ICP).
