The Grand Canyon
What should you do when you suspect craniosynostosis?
Referral is the gold standard, however if care is limited, X-ray or HUS are the next best options. The ultimate correction will be surgical.
With a head circumference less than 5% and length/weight greater than 5% what is the next step?
Send CMV, consider other genetic/TORCH infection evaluation if physical exam or history warrants
By what age does 75% of head growth occur? (+/- 2 months)
2 years of age.
What age does colic typically begin and end?
2-4 weeks, 4 months
This 2007 movie stars "Auggie", a 10yo boy who has Treacher-Collins Syndrome
Wonder
At what age should you refer to physical therapy for positional plagiocephaly? (+/- 2 weeks)
7 weeks of age. Torticollis can be present in 15-20% of positional plagiocephaly
What is the preferred imaging modality for severe microcephaly?
MRI
How should head circumference be measured?
From the most prominent diameter of the occiput to the midforehead
Is colic positional? Is it based off of frequency of feedings?
No, the Kung San hunter-gatherer population utilizes constant carrying, direct body contact, upright positioning, and continuous feedings for infants with no difference in colic rates
Who is Dustin from Stranger Things
If conservative treatment (i.e physical therapy, repositioning) fails, what is the next step in treatment of plagiocephaly?
Helmet therapy.
What endocrine abnormality can present with microcephaly?
Hypothyroidism
What are the 6 major cranial sutures?
1 metopic, 2 coronal, 1 sagittal, 2 lambdoid
Milk protein intolerance, GERD, infant abuse, infantile migraine, isolated fructose intolerance, parental medications in breast milk (fluoxetine), hair tourniquet, occult infection, and corneal abrasion.
This macrocephalic baby from an animated movie has superpowers which represent the undifferentiated potential of children
Who is "Jack-Jack" from the Incredibles
If you suspect concerning macrocephaly (i.e. non-familial, abnormalities on PE, rapid growth out of proportion from body), what is the next step?
HUS, some neurosurgeons recommend just doing an MRI however there are retrospective studies that show you don't miss much, however the cause of hydrocephalus and some extracranial things (bleeds) can be missed
What syndrome that can present with reversal of development is associated with microcephaly?
Rett syndrome (Also associated with microcephaly is Cornelia de Lange, Smith-Lemli-Opitz, Trisomy 13, 18, 21)
What is the normal rate of head growth throughout the first year? (3 different answers from 0-2months, 3-6, and 6+)
The normal rate of head growth is 2cm/month for month 0-2, 1cm/month for months 3-5, 0.5cm/month for months 6-12
Does the AAP recommend any treatments for colic? Name 3 things people try but make no difference.
No, there is a whole bunch of things that parents can try, but realistically this just sucks and resolves by itself. Simethicone does not work. Some preliminary data shows probiotics in mom during pregnancy might reduce the risk of colic but it isn't enough yet. Dicyclomine actually does work but causes apnea. A soy diet does not work. Changing to a hypoallergenic diet from mom has very loose evidence supporting it. Protein-hydrolyzed formulas also have very loose evidence supporting it (inconsistent in trials). Gripe water exists and is not recommended. Sometimes made up of cardamom, chamomile, cinnamon, clove, dill, fennel, ginger, lemon balm, licorice, peppermint, yarrow, sugar, alcohol, activated charcoal. Anecdotal reports say positioning sometimes can help.
This facially disfigured character invites you to "Listen to the music of the night" in this 1986 musical
The Phantom (Erik) from the Phantom of the Opera
How do you differentiate positional plagiocephaly from lambdoid craniosynostosis? (4)
Lambdoid Craniosynostosis has a palpable ridge over the suture line, posterior displacement of the ipsilateral ear, contralateral frontal bossing, and a trapezoid shape when viewed from above
Surprise! The Grand Canyon pt. 2. What is a differential for macrocephaly? (article lists 8 different categories)
Hydrocephalus, Benign Subdural Hygromas of Infancy, Subdural effusion or hematoma, familial macrocephaly, primary megalencephaly, genetic and metabolic diseases (leukodystrophies, lipidoses, mucopolysaccharidosis), neurocutaneous syndromes (Tuberous sclerosis, NF, Sturge-Weber, Klippel-Trenaunay-Weber syndrome), primary diseases of bone (achondroplasia, bone dysplasia's, hyperphosphatemia, osteogenesis imperfecta, osteopetrosis, rickets, Soto's syndrome, Riley-Smith syndrome)
What sutures come together to make the anterior fontanelle?
metopic, coronal, and saggital
What diseases are babies with colic more likely to develop later in life? (4)
Childhood migraines, ADHD, allergic disorders, functional gastrointestinal disorders.
In the U.S. 1800 election, these two candidates ran opposed to each other and this led to changing how elections for the Vice President work
Who are Thomas Jefferson and Aaron Burr