The paper by Chu et al is helpful and delineates the more common symptoms occurring in each age group, and underlines the importance of rethinking and reinvestigating persisting and escalating symptoms, especially when associated with cognitive and behavioural decline. The paper allows us to conclude that raised ICP symptoms occur late in presentation and their absence should not prevent clinicians from investigating symptoms further. However, the paper findings have to be taken within context of what is considered reasonable management of symptoms that are common across paediatrics. Elucidating red flag signs and symptoms as well as close review of the child's progress over time should therefore inform the need for neuroimaging and further management.