American Academy of Pediatrics – Section on Neurological Surgery

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March 15, 2021

Do not routinely obtain a CT or MRI scan for developmentally normal, clinically asymptomatic infants with macrocephaly.

Most infants with macrocephaly do not have abnormalities that require neuroimaging or neurosurgical evaluation. Imaging should generally be reserved for infants with clinical concerns such as abnormal neurological examination findings, significant developmental delay, or rapidly increasing head circumference measurements (such as those crossing growth curves). When imaging is indicated, head ultrasonography should typically be considered as the first-line test for infants with an open fontanelle.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The pediatric neurosurgery Choosing Wisely topics were chosen after discussion among the Section on Neurological Surgery (SONS) Executive Committee members regarding the most common pediatric neurosurgery issues and treatments general pediatricians see in their practices. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee then granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Haws ME, Linscott L, Thomas C, Orscheln E, Radhakrishnan R, Kline-Fath B. A retrospective analysis of the utility of head computed tomography and/or magnetic resonance imaging in the management of benign macrocrania. J Pediatr. 2017;182:283-289.e1

Sampson MA, Berg AD, Huber JN, Olgun G. Necessity of intracranial imaging in infants and children with macrocephaly. Pediatr Neurol. 2019;93:21-26