Evaluation of head size and shape is a routine part of the infant and toddler health supervision visit. Maximal occipitofrontal circumference is the best correlate for brain growth and is plotted on a Centers for Disease Control and Prevention growth chart normalized for age and gender up to 36 months of age. Microcephaly and macrocephaly are defined as a head circumference less than two standard deviations and greater than two standard deviations from the norm, respectively. For both micro- and macrocephaly, it is important to document parental head size because the size may represent a trait that can be hereditary. If the child’s head size is not congruent with familial sizes, a full history (including prenatal, birth, past medical, and family) in addition to a physical examination focused on identifying dysmorphic features and a neurologic examination are warranted. Microcephaly may be due to cessation of brain growth or abnormal brain...

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