Macrocephaly in infants
Macrocephaly is a malformation in the baby that causes its head to grow above normal, what can parents do?
Macrocephaly is the growth of the cranial perimeter in babies , more specifically of the upper area of the skull. As the growth speed is very relative in babies, we say that this disorder presents when the perimeter of their head exceeds two standard deviations with respect to the size of the rest of the head or is above the 98th percentile . Symptoms can appear from birth in some cases or develop after the first years of life. It also tends to affect males more.
Parents who go to the pediatrician usually come very alarmed because they see that their child’s head is growing disproportionately and that something bad could be happening to the little one. Actually, there is no need to be alarmed at first because there are different types of macrocephaly, and of course, not all of them are malignant.
Index
THEY ARE NOT ALWAYS DANGEROUS
The growth of the head in children is very fast in their first year of life, let’s think that their brain is growing and therefore pushes the skull bone to stretch, which is very elastic, during the first years of life. If this growth is not proportional to the growth of your body, we can speak of microcephaly (when it is too small a skull) or macrocephaly (if it is large).
On the other hand, within macrocephaly we have to distinguish which may or may not be dangerous, since having one does not necessarily have to be a tragedy. They may be:
1) Benign macro-headache. It is the most common of all and usually appears between 2 and 7 months after delivery. The child would be above a 95th percentile but it is not worrisome. After an examination, the doctor would confirm that there are no neurodevelopmental problems, that is, there are no abnormalities or delays. In those cases we can say that it is benign and that it does not pose dangers for the baby because from 2 years of age this growth tends to stabilize and again anchors within normal measures of development.
2) Malignant macrocephaly. When, in addition to accelerated growth, there are other symptoms such as increased intracranial pressure, vomiting, headaches, drowsiness, or irritability, it is necessary to take the child to a pediatric neurologist in order to verify the diagnosis. The problem is serious because if the cranial structures increase very quickly, so does the intracranial pressure and as a consequence damage to the brain can occur. Sometimes it can be confused with hydrocephalus , (increased pressure within the skull due to large production of cerebrospinal fluid). To know the true cause, neuroimaging techniques must be used.
Another cause of malignant macrocephaly is a bone malformation , for example, when the cranial structures close too quickly, a bulge appears because the nervous system does not have enough space and therefore cannot expand.
SYMPTOMS OF MACROCEPHALY
Hopefully, macrocephaly can be diagnosed already from gestation by ultrasound, this would only be possible with congenital macrocephaly, not with acquired ones that appear later and are diagnosed in pediatrics. The associated symptoms are:
– vomiting
– Headaches.
– Delays in development.
– Seizures .
– Increased cranial pressure.
– Cognitive damage.
– Appearance of white spots or “café au lait” color on the skin.
– Gait disturbances, muscular dystonia and other motor disorders such as gait disturbances.
– Irritability.
Doctors will compare the measurement of the child’s head with tables of percentiles of the population , they are tables with the normative values of growth that children have. It is observed if this size falls within normality or deviates from its normative group. Children who have it have skull measurements significantly higher than their age group. Then more specific neuroimaging tests will be done to find out the cause.
CAUSES OF MACROCEPHALY
1) The most common cause is a disproportionate increase in cerebrospinal fluid (fluid that protects the inside of the brain) that increases the pressure inside the skull and can damage the brain.
2) Appearance due to bone problems .
3) Other causes why the child may experience this disproportionate increase in the skull are NDE (Inborn Errors of Metabolism) , more specifically:
– Alexander disease.
– Canavan disease.
– Krabbe disease.
– Basement Syndrome.
– Síndrome de Beckwith.
– Gangliosidosis.
– Leucodistrofia.
TREATMENT FOR MACROCEPHALY
There is no treatment that “cures” macrocephaly (that makes it disappear), since it is a malformation and not a disease. However, there are multiple treatments that are aimed at alleviating the symptoms derived from the disorder. For example, it is common for these children to have some delay due to the pressure exerted at the time inside the skull.
– Drainage of cerebrospinal fluid. When macrocephaly is due to this reason, the excess fluid that is producing the cognitive damage is extracted.
– Dietary treatment. When macrocephaly is caused by a metabolic disease, a low protein diet and an enzyme substitute will be followed.
– Bone marrow transplant. In cases where microcephaly is a consequence of a degenerative disease, a bone marrow transplant (BMT) can be considered.
– Pharmacological. If there are seizures associated with the disorder, antiepileptic drugs will be prescribed. In these cases the pediatrician will recommend rehabilitation, stimulation and orthopedic measures for the baby. As well as a special education and family and social support from the beginning.
WHAT CAN WE PARENTS DO?
We can try to be prepared in advance so that we are not caught off guard. In many cases it can be detected from the first ultrasound scans during pregnancy. Ultrasonic ultrasound can detect pathologies in the growth of the skull from the first stages of gestation if the macrocephaly is caused by congenital causes.
When macrocephaly is acquired, the first thing is not to be alarmed before the baby has been evaluated by a doctor, in most of these cases macrocephaly is benign and the risks are lower, assessing in these cases the severity of the associated symptoms, if they are not very disabling babies can have correct neural development for their age.
Take him to the pediatrician to do the relevant tests, he will be able to advise you depending on your case.
Dr. Tabriella Perivolaris, Sara's mother and fan of fashion, beauty, motherhood, among others, about the female universe. Since 2018 she has been working as a copywriter, always bringing to her articles a little of her experience and experience as a mother and woman.