Child head circumference in the ER

[jenturnrn]

Does anyone hane protocols on doing head circumference measurements in a pediatric ER? Apparantly, it is a new JCAHO recommendation, although I feel across the board head circumference measuring is absurd in an ER setting. I can understand if certain findings are present or hx of V-P shunt. Please help. Thanks!

[RainbowSkye]

I thought the same thing when I was told it was mandatory to do head circumferences in the ED. We were supposed to measure the kid's head, and that was that. I wondered where the normals were posted and what we were supposed to do if a child fell outside of normal. I contacted some nurses through the ENA website and most of them said that yes, they do measure head circumferences, but their policy only requires it in certain circumstances (like you mentioned). And these where all JCAHO accredited hospitals.

[2ndCareerRN]

My opinion is also that it is absurd to measure head circ. in the ER. We have no growth charts (easily remedied), and we do not have a trend on the kids we are measuring. I only do a very few, vp shunts and kids that look out of proportion.

I wonder if this has become a JCAHO reccomendation because of the high number of people who use the ER as their primary care provider? But, it still does not help us trend the kids because for the most part we will not pull charts for the kids prior visits, as they are usually for cough/colds/etc.

bob

[D J Rippl]

I spoke with a representative from JCAHO a couple of weeks ago, and he indicated that we should follow the recommendations of our professional organization for this. In Sheehy's book "Emergency Nursing Principles and Practice", 6th Edition, page 76, she indicates states, "The Joint Commission requires evaluation of head circumference on all patients less than 2 years of age as appropirate. Indications for measurement of head circumference in the ED include children who have obvious cranial abnormality and children presenting with suspected ventriculoperitoneal shunt malfunction."

These are the guideline we are going to use at our facilities.

[vivasmom]

We do it only for SCAN kiddos, SCAN=suspected child abuse/neglect

[NotReady4PrimeTime, RN]

It does seem to be superfluous to do head circumferences on totally normal kiddies with sniffles or diarrhea.

A recent report resulting from a fatalities inquiry into the death of a local foster child recommends screening skeletal surveys for ALL apprehended children. Admittedly there have been a number of fatally-abused foster kids in the last few years, but x-raying their whole bodies when they're taken into care? I don't know...