GET-A-HEAD: Midwives agree more awareness needed around baby head circumference measurements

Midwives agree there should be more open conversations with parents about why a baby's head circumference should be measured and documented at routine check-ups throughout the first year of life.

It's after we addressed a Maternity and Midwifery Forum event in London about the GET-A-HEAD campaign, alongside Harry's Hydrocephalus Awareness Trust. Together, we're calling for an improved set of national guidelines to standardise baby health care across England to help prevent life threatening conditions from being missed.

Hydrocephalus affects 1 in every 770 babies

The NICE guidelines state: "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."

A rapidly growing head can indicate a dangerous build-up of fluid on the brain, also known as hydrocephalus, but speaking to midwives at the Maternity and Midwifery Forum earlier this month, they admitted that the reasons behind their checks are not always clearly explained to parents.

This midwife chose to remain anonymous: "As a practising midwife, sometimes we don’t always give the right information at the right time. For example, when we measure a head; we take for granted that we have the knowledge and information about why we do it, but the mums and families involved don't have that.

"One of the key things that midwives should really look at is the information that they have and how they share that with parents. That's the only way that we can get on top of this.

"In the immediate postnatal phase we do a lot of checks and we need to be telling the mums 'this is what we look for when we measure the head'. We probably talk about the length or weight, but the head is also very important and parents need to know about any worrying signs or symptoms to look out for.

"Hydrocephalus is something we need to talk more about and I think, as midwives, we don't give the women enough information, if at all. If you have the information then at least you're aware and you're more alert to certain symptoms. Information is key in things like this."

Harry's HAT hopes a simple conversation between health professionals and parents would explain the relevance of head circumference measurements, as well as the signs and symptoms to be aware of. It's hoped that would then equip parents with a greater understanding of why tracking the measurements over time is important, and allow them to better advocate for their baby in the event of a health scare.

Caroline Coates is the charity's CEO: " New parents often tell us that they were totally unaware of the significance of measuring their baby’s head. From my own personal experience, Harry is baby number four. I have also spent much of my working life, working for charities which provide support to families, yet I still had no idea why you measure a baby’s head.

"If I am honest, I just thought it was something you did, not that it could reveal a potentially life-threatening condition. On reflection you don’t know what you don’t know.

"I believe most parents would be horrified to think back and realise that their child hadn’t had their head measured once they knew what doing so could reveal. To me education is key. Parents need to know why head measurement is important so that they can take control and ensure their baby’s head is measured, but without knowing its significance the process is just something which risks being lost in whirlwind of life as new parent."

The GET-A-HEAD campaign was initially launched by Harry's HAT to raise awareness of the importance of head circumference measurement in the diagnosis of hydrocephalus, and to educate parents on why it should be recorded at each routine health check. Now, the charity is going further with its ambition to improve baby health care by calling for improvements in three areas:

CONTACT:

A minimum number of face to face contacts with health professionals who are trained to measure head circumference and interpret the result in the first year of a child's life. This has recently been adopted in Scotland, where health visiting teams are now committed to 8 visits with a family in the first 12 months.

COMMUNICATION:

Midwives, GPs, Health Visitors etc to briefly explain why they perform each one of their checks. For example - does the parent know why head circumference measurement is important and do they know when to expect this measurement to be taken again?

CONCERN:

A review of the current NICE guidelines which discuss when and how a health professional should refer a child with concerning symptoms to a specialist team.

GET-A-HEAD has already gained high profile support from the Minister for Women's Health Strategy, Maria Caulfield, who described it as an 'absolutely crucial' awareness raising campaign, as well as the Chief Executive of the Institute of Health Visiting, Alison Morton who said: "Rapidly increasing or slowing of head growth can be a sign of an important underlying condition – spotting these problems as early as possible is therefore important as it ensures that children receive treatment quickly, with the greatest chance of success.

"Regardless of where families live, all children aged under 4 years with suspected abnormal head shape or size should be assessed by professionals like health visitors with the skills to measure and interpret head growth, with rapid referral for specialist assessment and treatment when needed”.

Signs of hydrocephalus may include:

• A rapidly growing or unusually large head
• A thin and shiny scalp with easily visible veins
• A bulging or tense fontanelle (the soft spot on top of a baby's head)
• Downward looking eyes
• Poor feeding
• Irritability
• Vomiting
• Sleepiness
• Muscle stiffness and spasms in your baby's lower limbs

• midwives