Hydrocephalus, head circumference and health visitor negligence

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Last year we wrote about the importance of head circumference and what to look out for as your baby develops. A recent case showed why it’s so crucial for healthcare workers to pay attention to a baby’s head measurements, as when something went wrong, the hospital Trust was found to be responsible for the health visitors in charge of assessing a baby’s weight and head circumference.


XM v Leicestershire Partnership Trust [2020]


Baby Connor (not his real name) suffered a brain injury when his hydrocephalus wasn’t diagnosed, which caused the pressure in his skull to rise far above the level that is safe. This case is important as it is the first clinical negligence claim to deal with the standard of care expected of health visitors.

The facts

Connor was born in June 2012, and by December his parents began to feel that something wasn’t right. He was taken to an emergency walk in centre on 20 December 2012, which led to him being diagnosed with a rare, benign brain tumour.

The tumour caused an over-production of cerebro-spinal fluid (the fluid that protects your brain and spine) which built up around his brain. This caused his head to grow abnormally fast.

Connor’s tumour was successfully removed on 3 January 2013 but, sadly, by that time, he had suffered permanent catastrophic brain damage. By the time the injuries occurred, his head was so large that it was off the centile chart.

Why were the health visitors found to be negligent?

The hospital Trust was the responsible agency for the health visitor service. Several health visitors had visited Connor’s home to check on his progress. Some health visitors had measured his weight, but not all had measured his head.

What had the health visitors done that was negligent?

One of the health visitors who had measured Connor’s head during a visit in August 2012 should have noticed discrepancies between his weight gain and the increase in his head circumference and should have either:

  1. Referred him to a GP or paediatrician for assessment; or
  2. Monitored the pattern and rate of growth of his head circumference and arranged for a further measurement to be taken 1-2 weeks later

Connor’s head circumference at age 2 weeks was on the 25th centile and at age 6 weeks was on the 50th centile. This should have been a warning sign to be noted by the health visitor, but they either didn’t notice, or didn’t make a note of what was happening to Connor.

The health visitor also neglected to tell Connor’s parents about the discrepancy between his weight increase and his head circumference, or to ask them to monitor it in case it got worse. They had also failed to note the discrepancy in Connor’s medical records, or to let his GP know to ask for Connor to be monitored when he was seen next.

The hospital Trust accepted that if a referral had been made following Connor’s August visit, the outcome would have been a re-measurement of his head, which would have led to diagnosis and successful treatment.

There were further allegations that the health professionals who had visited after August 2012 should have identified that Connor had not seen a GP for his 6–8-week check and encouraged his parents to book him in. He should have also been advised to see a GP because of the increase in head circumference and discrepancy in weight gain noted after the August visit.

In considering the standard of care for health visitors, the Judge considered that the role being carried out by a professional is more important than their qualifications. Sadly, Connor’s injuries could have been avoided if his care had been better.

Are you worried about the care provided to your baby?

If your baby’s head circumference is measuring small or big, it can be a sign of an underlying health condition. Your baby’s length or height should be measured whenever there are any worries about weight gain, growth or general health.

If you have any worries and concerns about whether your child has an injury because something went wrong in the care either you or they received, we can help you to find answers using the claims process. If their claim is successful, it also will provide your child with care, aids and equipment and therapy for life and, if necessary, a suitably adapted property purchased for them to live in with you.

We will work with you to determine what happened, whether the care provided was substandard  and, if it was, the specific care, therapy and equipment needs your child is likely to have to make it possible for them to achieve their maximum potential during their life.

Hats On for Hydrocephalus

Hydrocephalus week runs from 7th – 13th March 2022. We are supporting Shine by getting involved in Hats On For Hydrocephalus and helping to raise awareness of their crucial work.

Shine are a national charity who dedicate their time to seek to improve the lives of people with spina bifida and/or hydrocephalus. Anyone living with these conditions or their family and friends can become a Shine member for free. Membership includes the provision of specialist support to help people make sense of the conditions and increase their knowledge.

For information on how you can support Shine by getting involved, visit their website or join in the conversation online using the hashtag #HatsOnForHydrocephalus and by tagging @ShineUKCharity on Facebook or Twitter.

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