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Newborn and Infant Care

Large head

03/06/2007

Question:

We are adopting a child from China and her head is larger than the rest of her body. We only have one set of measurements taken at 10.5 months. Her height is 26.4 inches, her weight is 15.84 pounds, and her head size is 17.34 inches. As you can see, her weight and height are below the 3% while her head is in the 25%. Is this a problem? Everything else about her is listed as healthy.

Answer:

Actually her head circumference is closer to the 50th percentile than the 25th percentile, her weight is below the 3rd percentile, and her length is at the 10th percentile according to the 2000 CDC Growth Chart. There are one of two interpretations that will be true.

In the best case, these measurements represent sparing of her brain growth relative to her body growth in length and weight. She is for sure experiencing inadequate calorie intake with her weight two standard deviations lower than her length and four standard deviations lower than her head circumference. This is a significant disparity, but potentially good news for her developmental potential.

In the worst case, this large head size may signal hydrocephalus, or an excessive amount of fluid in the brain's ventricles. this results in compression of the normal brain tissue and impairs it's function and growth.

It comes down to what they mean by a "healthy child." Does this mean she has no overt physical illness or does this mean entirely normal physically and developmentally? If you are able to obtain pictures or videos for a pediatrician to review, this would help to determine if the little girl is likely normal or not.

I am sorry that I can't be more precise than this. It's a big commitment to bring a child from China into your home and life. I am certain you have much love to give. It will likely be a very challenging experience as she is now a toddler or soon will be. If you move forward with the adoption, be sure to work with a behavioral and developmental pediatrician when you run into difficult behaviors. Your new child will not understand English for some time and the cultural change is enormous, even if it is to far better circumstances. Any adult would be stressed out if he or she were suddenly transplanted into a new country with no one speaking his language. This child will have far fewer coping resources than an adult to help her and will only have behavior in which to release her distress and frustration. The first year can be especially challenging. Happily things usually improve with time and loving care. I wish you the best in making this important decision. 

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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