A three-month-old boy born full term without complications is brought in by his grandmother for “something wrong with his head”.  She has been caring for him during the day since his mother returned to work, and today noticed a deformity in the back of his head. The child has been gaining weight, eating, sleeping, and eliminating well.  There has been no change in behavior, and after a thorough history there do not appear to be any red flags for abuse.  On exam, you see a well appearing boy.  Total body check is normal, except for an asymmetric occiput: he has flattening of the right occiput and his right ear seems to be displaced slightly anteriorly.  There is no ecchymosis and bilateral tympanic membranes are normal.

Regarding his presentation and management, which of the following is the BEST answer:

    A. Obtain CT of the head non-contrast to evaluate extent of calvarial deformity
    B. Admit the child for MRI and genetic work up
    C. Proceed with medical work up and involve child protective services
    D. Discharge home with possible deferred work up
In the meantime, a quote --   "Symptoms are the body's mother tongue; signs are in a foreign language."   --John Brown, MD (1810-1882)


12/12/2012 12:42am

D. This sounds like plagiocephaly rather than craniosynostosis or nonaccidental trauma. I think that since the child is very well appearing and has no change in behavior or PO intake, he can follow up with a plastic surgeon for possible orthotics.


Leave a Reply