Question: My 13-month-old daughter has a large head circumference, and her soft spot is very large. She is normal developmentally, even advanced in some areas but has "episodes" occasionally where she stares through you and is not responsive for 20-60 seconds. What could these episodes be, and why is her head so large?

Answer: This question brings up a few different issues. The first is the issue of head circumference. During the first year or two of life, the doctor will measure head size at every visit. Until the fontanels close (sometime between 1 and 2 years) the head circumference is directly influenced by brain growth. As the brain grows, the head grows. This holds true unless there is a problem with the bones of the skull, the brain itself or the fluid that surrounds the brain. If we see a head size that is “off the charts” or growing too fast or too slow, we will usually start with some imaging studies to see what’s going on in there and may refer to a specialist like a neurosurgeon for help.

The second issue is the staring spells. These are concerning for a certain type of seizure and should be evaluated. Lots of children will stare off into space every once in a while, but if your child doesn’t respond when you call her name or stimulate her, then it’s something that needs to be looked at. She may need an EEG (to measure brain waves) or an appointment with a pediatric neurologist.

A lot of kid behaviors can make us scratch our heads, perplexed. It’s important to have a good relationship with your child’s doctor, so that you don’t feel silly asking these sorts of questions. If you still feel that something isn’t right, keep asking. Trust your mother’s intuition.

Dr. Melissa St. Germain is a pediatrician at Children's Physican's. She has a son.