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Newborn and Infant Care

Head Circum, Torticoli, pupil size



Two questions about an 9 week old female newborn. On my most recent visit to the pediatrican, he told me that the baby`s weight & height are in the 75th percentile up from the 25th last visit (I`m nursing if that matters); however, the baby`s head circumference is still at the 25 percentile level but slowing growing. The infant was vacuumed out at delivery (does that make a difference?). Now that i`ve had a chance to think about it, should I be concerned at this point or when should I be concerned, developmentally?

Secondly, one of the baby`s pupils is larger than the other. The Pediatrician noticed and said he would check with an opthalmologist and if it was felt to be a problem, would let me know. Does pupil differences occur for awhile in NBs? The baby also has torticoli`s syndrome on the same side as the pupil enlargement, is there a relationship here anywhere? The baby is alert to books already and otherwise happy and healthy.

Thanks for your kind review and thoughts in this perhaps (perhaps not) intertwining matter. I appreciate any and all input!


I have not read anything that associates decreased head growth with vacuum extraction deliveries. It is certainly important that the head growth be followed and plotted to see if it is going to increase. I am sure the Pediatrician will follow it closely. Breastfeeding should be what is best for the baby and I would encourage you to continue to do this. Make sure your diet is well balanced so that you can provide adequate nutrition for the baby. In terms of development, it is something that should be watched from the time the baby is born regardless of whether or not concerns have been raised. I would recommend close follow up with the pediatrician. If you are concerned you should be able to obtain ongoing Developmental Screening though programs that are available in the community. Your Pediatrician may be able to help refer you to someone close to your home and many are available either free of charge or for only minimal cost. They will do a complete assessment of the baby and see if there are any deficits that are present. If they don`t find any deficits, great, and they will probably recommend continued follow-up especially if the head growth does not improve. If they do find deficits they can give you additional education that will help you to help your baby to progress.

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Response by:

Tina   Weitkamp, RNC, MSN Tina Weitkamp, RNC, MSN
Associate Professor of Clinical Nursing
College of Nursing
University of Cincinnati