Which finding most strongly suggests raised intracranial pressure in a child?

• A. Fever
• B. Gait disturbance
• C. Headache with morning vomiting
• D. Photophobia

Answer: (C)

Morning headaches with vomiting is a classic signal of raised intracranial pressure in a child. When a child lies down and sleep-related changes in CSF dynamics and venous drainage occur, ICP can rise, producing a headache that is often worst on waking. Vomiting happens because the elevated pressure stimulates the brainstem’s vomiting center or reflects global irritation from the pressure increase. By contrast, fever points toward infection rather than ICP, photophobia is more typical of meningitis or migraine, and gait disturbances can occur for various neurologic reasons but are less specifically linked to increased intracranial pressure. So, the combination of morning headache with vomiting most strongly suggests elevated ICP and should prompt urgent evaluation for causes like hydrocephalus or mass effect.