In a 10-year-old child, which is most consistent with increased intracranial pressure?

• A. Bulging fontanel
• B. Tachypnea
• C. Increase in head circumference
• D. Headache

Answer: (D)

In school-age children, the most consistent sign of increased intracranial pressure is a headache. This age group typically presents with headaches (often with associated nausea or vomiting and sometimes visual symptoms) when ICP is elevated, reflecting stretching of pain-sensitive meninges and pressure changes within the skull.

Bulging fontanel is a sign seen in infants because their fontanelles are still open; a 10-year-old’s fontanelles are closed, so this is not expected. Increase in head circumference similarly points to problems in infancy (where skull sutures can widen) and is not a typical sign in a child of this age. Tachypnea alone is not a characteristic feature of raised ICP in children; respiratory changes are usually irregular or part of broader brainstem involvement rather than simple rapid breathing.