Quality standard

Quality statement 2: Head size and shape in children

Quality statement 2: Head size and shape in children

Quality statement

Children under 4 years with suspected abnormal head size or shape have their head circumference assessed using a standardised growth chart.

Rationale

In children aged under 4 years abnormalities of head shape or size are likely to indicate brain growth disorders or raised intracranial pressure. Measurement of head circumference is an important but simple method of identifying children with abnormalities of head shape or size who should be referred for specialist investigation. Using standardised methods of measurement, including plotting measurements on a standardised growth chart, ensures accuracy and consistency when making referral decisions.

Quality measures

Structure

a) Local arrangements and written protocols to ensure that children aged under 4 years with suspected abnormal head shape or size have their head circumference assessed using a standardised growth chart.

Data source: Local data collection, for example local protocols.

b) Local arrangements and written protocols to ensure that healthcare professionals have access to the necessary training needed to assess head shape and size in children aged under 4 years.

Data source: Local data collection, for example staff training records.

Process

Proportion of children aged under 4 years with suspected abnormal head shape or size who have the longest of 3 head measurements plotted on a standardised growth chart, corrected for gestational age.

Numerator – The number in the denominator who have the longest of 3 head measurements plotted on a standardised growth chart, corrected for gestational age.

Denominator – Children aged under 4 years with suspected abnormal head shape or size.

Data source: Local data collection, for example NHS personal child health records (red books).

Outcome

Referrals for specialist neurological assessment in children aged under 4 years with suspected abnormal head shape or size, who have the longest of 3 head measurements plotted on a standardised growth chart, corrected for gestational age.

Data source: Local data collection, for example local audit of patient records.

What the quality statement means for different audiences

Service providers (such as primary care services and community services) ensure that systems are in place for children aged under 4 years with suspected abnormal head shape or size to be assessed at GP appointments and routine health visits using a standardised growth chart corrected for their gestational age. They ensure that systems are in place for referral for specialist assessment when needed.

Healthcare professionals (such as GPs, nurses and health visitors) use a disposable, single-use, paper tape measure to take 3 consecutive measurements of head circumference at the same appointment for children aged under 4 years with suspected abnormal head shape or size. They plot the longest of the measurements on a standardised growth chart, corrected for gestational age, and refer for specialist assessment when needed.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which children aged under 4 years with suspected abnormal head shape or size are assessed, using a standardised growth chart corrected for their gestational age, at GP appointments and routine health visits.

Children aged under 4 years with an unusual head shape or size have their heads measured by a healthcare professional using a disposable, single-use paper tape measure. The measurement is done 3 times at the same appointment and the largest of the 3 measurements is checked against child growth charts. If the healthcare professional is concerned about the measurement, they refer the child to a specialist.

Definitions of terms used in this quality statement

Standardised growth chart

A chart allowing healthcare professionals to plot head circumference in children under 4 years, based on WHO child growth standards. [Royal College of Paediatrics and Child Health UK-WHO growth charts - 0–4 years]

Standardised methods of measurement

Three consecutive measurements of the child's head circumference at the same appointment, using a disposable, single-use paper tape measure, the longest of which is plotted on a standardised growth chart, corrected for gestational age. [NICE's guideline on suspected neurological conditions: recognition and referral]