Is Your Baby’s Head Normal Or Should You Worry It Is Hydrocephaly?

Understanding Normal Baby Head Size and Risk of Hydrocephaly

From birth to 3 months of age the average increase in your baby’s head circumference is usually 2 cm or .78 inches each month. From 4 to 6 months of age, the head circumference or head growth slows to about 1 cm per month. The typical head circumference of a newborn falls between 13 and 14.5 inches (33–37 cm. A newborn with a big head on its own, within that range, is not automatically cause for concern. Now, these are just guidelines and every baby is different so do not become concerned if your baby’s head is growing a little faster than normal.

However, if the head circumference is rapidly growing and there are other neurological signs your child is exhibiting, the pediatrician should be questioning if there is an underlying pathology or hydrocephalus that could be causing the rapid increase in your newborn’s head size.

If you believe your child is suffering from hydrocephaly and that medical professionals might be involved in causing the injury or giving a delayed diagnosis, contact The Beasley Firm for a free consultation. We can discuss your situation and help you understand your legal options.

When Should You Be Concerned About Your Baby's Head Size?

Whether it is your first child or your third, any abnormalities in your infant’s development can be concerning. It is essential to know that an infant will not be diagnosed with macrocephaly or a large head unless their head circumference is larger than 97% of children the same age and sex.

Infants are notoriously fidgety during exams, so getting an accurate measurement can be difficult. Doctors and nurses should measure a child’s head circumference twice if it appears abnormal. It is crucial, however, that signs of rapid head growth are taken seriously. Early diagnosis and treatment of the underlying cause can be critical. Many newborn babies have a head that looks or measures slightly bigger than their body. That alone doesn't mean something is wrong. It's the combination of size and other signs, like the symptoms listed further down this page, that matters.

Can Head Circumference Indicate a Risk of Brain Damage or Cerebral Palsy?

Researchers have long known that damage to the brain's white matter is one of the leading risk factors for cerebral palsy. In recent years, some studies have looked at whether a newborn's head circumference might help identify which babies are more likely to have this kind of damage. In a 2018 study of 4,725 term-born infants, researchers found that 61 babies had white matter damage. The risk was highest among infants at both ends of the scale, those with unusually small heads and those with unusually large ones. Among babies with smaller heads, the damage tended to be linked to oxygen deprivation. Among those with larger heads, it tended to follow prolonged labor, particularly when the baby's head was too large to pass easily through the birth canal. A separate study of nearly 500,000 term-born children in Norway similarly found higher rates of cerebral palsy among infants with both small and large head measurements at birth.

It's important to keep this research in perspective. Head circumference alone does not cause or predict cerebral palsy, and most babies with larger or smaller heads develop normally. However, the research suggests that an abnormal head measurement, especially combined with a difficult or prolonged delivery, may warrant closer monitoring or brain imaging. The authors of the 2018 study noted that seemingly healthy newborns with large heads and long labors often aren't screened, which may explain why some brain injuries go undetected until developmental delays appear. If your child was later diagnosed with cerebral palsy and you're wondering whether warning signs were overlooked, our Philadelphia cerebral palsy lawyers can review your records.

What Is a Normal Head Circumference for a Newborn?

The normal head circumference of a newborn born at full term is about 13.5 inches (34 to 35 centimeters), with most healthy babies falling between 12.5 and 14.5 inches (32 to 37 centimeters). Because the normal size of a newborn head varies with sex, gestational age, and overall size, your pediatrician will compare your infant's head size to growth charts at each checkup.

How Does Head Circumference Grow By Age?

According to studies, head circumference increases by approximately 2 cm per month from 0 to 3 months of age and 1 cm per month from 3 to 6 months of age. During the next 6 months, head circumference typically increases by around 0.5 cm each month. 

After a child turns one year old, the circumference increase is around 1 cm per 6 months until the age of 3. Finally, between the ages of 3 to 5, a child’s head circumference grows an average of 1 cm per year.

Average Head Circumference by Age

Every baby grows at their own pace, and pediatricians expect some variation from these averages. What matters most is a steady, gradual pattern over time. A sudden jump, a growth rate noticeably faster than these ranges, or a large head circumference in an infant that keeps crossing percentile lines is worth flagging to your doctor.

When Does Head Circumference Stop Growing?

The head experiences rapid growth during the first year of life. On average, a child’s head circumference increases by 12 cm by age 1. After 12 months, the growth slows substantially, with routine measurements ending at around age 3.  

If you are concerned about the size of your child’s head, you need to speak to their pediatrician. While some causes of macrocephaly are harmless, others are severe. Conditions such as hydrocephalus can prove fatal if left untreated. A doctor should take any concerns about your child’s development seriously, conducting the necessary examinations to determine the cause of the larger-than-normal head circumference.

What Is Hydrocephaly?

Hydrocephaly or hydrocephalus brain injury is a buildup of fluid inside the skull that leads to brain swelling. It is also referred to as “water on the brain.” The fluid, called cerebral spinal fluid (CSF), normally cushions the brain and spinal cord and drains on its own. When that drainage is blocked, or the body produces more than it can clear, the fluid builds up and increases pressure on the developing brain.

There are two main types:

Congenital hydrocephaly — present at birth, often linked to conditions like spina bifida or a birth defect affecting CSF flow

Acquired hydrocephaly — develops after birth, most often from bleeding, infection, or trauma during a difficult delivery

When there is a rapid increase in the size of a baby’s head or skull it may be hydrocephaly if one or more of the following symptoms are also seen:

• Bulging or tense fontanel or soft spot
• Bulging eyes
• Downward gaze or sunsetting eyes – eyes looking down
• Upward gaze – eyes looking up
• Constantly crossed-eyed
• Very large pupils
• Fussiness
• High pitched or shrill cry
• Persistent vomiting

What Causes Hydrocephaly?

The causes of hydrocephalus are not well understood. According to Stanford Medicine, the condition occurs in one out of 500 births. Hydrocephalus can be congenital (present at birth) or acquired. It may be genetic or linked to conditions such as spina bifida. 

Common causes of hydrocephaly include:

• Birth injury
• Infections
• Tumors
• Trauma during delivery
• Premature birth
• Bleeding inside the brain
• Abnormal blood vessel formation
• Congenital disease (usually developing during the third trimester of pregnancy)

Hydrocephalus does not resolve on its own. Early detection of the condition and proper treatment are key. If your child’s hydrocephalus was not detected or treated, you might be entitled to compensation. Contact our office to discuss your legal options. 

How Is Hydrocephaly Diagnosed?

If a pediatrician or nurse practitioner notices a rapid increase in your baby’s head circumference in addition to the above symptoms they may also check to see if the veins on your baby’s scalp are swollen or stretched.

They may also tap lightly on your baby’s skull to see if they hear a difference indicating there may be fluid under the skull. If the doctor or nurse practitioner suspects hydrocephaly they may order a CT scan of the brain, x-ray, ultrasound or other studies to detect if there is a problem.

If hydrocephaly is not diagnosed and treated as soon as possible, it could lead to several complications/injuries, including:

• Brain damage
• Seizures
• Stroke
• Brain herniation
• Hemiparesis
• Developmental delays

How Is Hydrocephaly Treated for Infants and Children?

If hydrocephaly is diagnosed, the primary treatment is aimed at reducing the amount of fluid or pressure in the skull or on the brain. Medications such as Diamox or Mannitol may be used until it is determined what is causing the hydrocephalus. The goal of treatment is to reduce or prevent brain damage by improving the flow of the cerebral spinal fluid (CSF).

Surgery may be performed to remove a cyst or mass that could be blocking the flow of the CSF. Other times, a shunt may be placed to redirect the CSF fluid to another area of the body such as the stomach where it can be absorbed.

How Can Medical Negligence Cause Hydrocephaly?

Sadly, sometimes medical error and doctor malpractice can lead to a child suffering from hydrocephaly. The most common cause of medical negligence leading to hydrocephaly is trauma to the head during delivery. The following examples of medical error might result in hydrocephaly:

• Incorrect use of forceps or vacuum during delivery
• Excessive mechanical force during delivery
• Failure to perform a C-section when needed
• Untreated respiratory distress syndrome
• Improper use of pitocin drug during labor

At The Beasley Firm our experienced birth injury lawyers are well-equipped with a team of nurses and doctors who can evaluate the circumstances of your child's birth and help determine if negligence might have taken place.

What Should You Do If You're Worried About a Delayed Diagnosis?

If you're wondering whether your child's symptoms were missed or dismissed, a few practical steps can help you get your footing before you decide anything. Start by writing down the timeline: when you first noticed symptoms, when you raised them with a doctor, and when (or if) hydrocephaly was diagnosed. Request a full copy of your child's medical records, including prenatal, delivery, and NICU records. Hospitals are required to provide them. Then ask your pediatrician to walk you through what is hydrocephaly in your child's case, what likely caused it, and whether anything in the timeline stands out to them. Finally, consider talking to a birth injury attorney, who can tell you at no cost whether what happened warrants a closer look.

None of this means you've decided to pursue a claim. It just gives you the information to make that decision from a place of clarity instead of guesswork.

Do You Suspect A Delay in Diagnosis of Hydrocephaly for Your Child?

If you believe there was a delay in diagnosing your child’s hydrocephalus you may be eligible for compensation. Since 1958, the experienced medical malpractice team at The Beasley Firm has been successfully representing victims of medical negligence. To date, we have had over $2 billion awarded on behalf of our injured clients.

We currently have on staff a nurse attorney and nurse who have worked in neonatal intensive care units (NICU) and pediatric intensive care units (PICU) caring for infants and children who developed hydrocephaly and required surgery or shunt placement.

Please feel free to contact one of our experienced lawyers, doctors, or nurses at The Beasley Firm for a strictly confidential and free consultation.