Pediatric emergency medicine trisk 623

immediately identified on the scalp. Figure 96.18 shows a scalp electrode site
that has been infected with HSV.
Size. The measured occipitofrontal head circumference should be plotted on
the standard CDC full-term growth curve (Link to CDC website for all growth
curves: ). For preterm
infants (<37 weeks), the corrected gestational age (CGA = gestational age at birth
+ postnatal age) should be used to adjust head circumference when using CDC
standard curves. Adjustment is continued until 24 to 36 months of chronologic
age. Alternatively, preterm growth curves such as the Fenton curve may be used
(Link
to
the
Fenton
Preterm
Growth
Chart
). Head circumference measurement at
birth and at initial hospital discharge may vary considerably after 1 week due to
subsidence of edema, water loss from the intracranial structures and unmolding of
sutures. Accurate measures can be obtained after 1 week and should be followed
serially by the pediatrician. Increase in head circumference is normal after 14
days.


FIGURE 96.15 Severe seborrheic dermatitis (yellow, greasy-appearing plaques). (Reprinted
with permission from Kyle T, Carman S. Essentials of Pediatric Nursing . 2nd ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2012.)

Fontanelles. The anterior fontanelle, situated at the junction of the coronal and
sagittal sutures, usually measures about 2 cm × 2 cm (can be up to 5 to 6 cm in its
long axis) and normally closes between 9 and 18 months (range 6 to 24 months).

The posterior fontanelle, situated at the junction of the lambdoidal and sagittal
sutures, generally measures between 0.5 and 1 cm (may be closed at birth in some
cases) and usually closes to palpation by 3 to 4 months of age. Enlarged
fontanelles may be associated with a variety of conditions, including prematurity,


hypothyroidism, rickets, or hydrocephalus. Increased intracranial pressure from
infection or hemorrhage produces a full or bulging fontanelle, whereas
dehydration produces a depressed fontanelle. A fontanelle that appears full while
the infant is supine or crying should be reassessed while the infant is held upright
and sleeping or feeding before it is determined to be full or bulging.

FIGURE 96.16 Caput succedaneum in a newborn infant. Large soft swelling over the vertex,
not confined to suture lines. (Courtesy of the late Peter Sol. In: Chung EK, Atkinson-McEvoy
LR, Boom JA, et al., eds. Visual Diagnosis and Treatment in Pediatrics . 2nd ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2010. With permission.)


FIGURE 96.17 Unilateral cephalohematoma. Cephalohematoma is a subperiosteal collection
of blood and therefore does not cross suture lines. (Reprinted with permission from O’Doherty
N. Atlas of the Newborn . Philadelphia, PA: JB Lippincott; 1979: 136–143.)