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Newborn and Infant Care

Small head circumference



we are considering a referal for adoption and were given the following information. the mother was an everyday user of cocaine ($10 per day habit). the mother has 2 children one of whom is autistic but this child is from a different birth father than the baby we are considering. his apgar is 8-9, negative hep-b and hiv, 5lbs 8 oz, 18 3/4" long, head circumference of 31cm. with this small head circumference should we be more concerned with higher than usual developmental issues, a higher chance of autism as well as the potential for fetal alchohol syndrome even though the mother did not disclose drinking during her pregnancy? thank you for your response.


You have many reasons to be concerned about the developmental outcome for this child, although there is no accurate way to know a child's developmental outcomes with any great degree of certainty. This child was born small-for-gestational-age (SGA). This means that throughout the prenatal period he received poor quality nutrition and oxygenation as a fetus. This is clearly not providing him with the best environment for the growth and development of his brain and nervous system. 

We do not know all of the consequences of cocaine exposure, but what is best known at this time includes that learning disabilities are likely, although, these often are not clear until about the second or third grade. Behavior difficulties such as hyperactivity, inattention, and problems in self-control are more frequent, as well as a difficult infant temperament and more fussiness.

In terms of autism, he is at significantly higher risk for autism both because he has a sibling with autism and he is a male. Recent research also points to multiple genetic factors as well as environmental exposures as the bases for this disorder.

It is also true that many drug users are polydrug abusers, so the risk for fetal alcohol syndrome is also high. Like autism, there is a spectrum of fetal alcohol disorders, so even the absence of external signs of the disorder is not reassuring and does not preclude damage to the central nervous system.

Finally, if you know in your heart that a developmentally normal child is very important to you and your partner, then passing on this child is a good idea. On the other hand, a loving and nurturing home is protective of a child's development and may prohibit the emergence of developmental problems. Many of us in pediatrics know "miracle children' we would never have guessed would do so well given their very rocky beginnings. If you and your partner have the resources and patience for a possibly very challenging child, then you move forward knowing that you will need to monitor his development closely and enroll him in early intervention at the first signs of problems. Early intervention is key because the young child's brain is most flexible between birth and 3 years of age.

I hope this is helpful information.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University