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Newborn and Infant Care

Head circumference

05/14/2007

Question:

My son was born on the small-average size but all of his measurements were proportionate--head, weight and length were between 15-25th %ile. At his 2 month check up, his weight and length now are at the 50% ile, while his head circumference still hovers at 15th %ile. He seems to be hitting his developmental milestones in timely fashion. Should I be concerned and follow up?

Answer:

It appears that most growth parameters for your baby are intact, that is increasing in a proportional manner, with the exception of his head circumference. The measurement of head circumference can be affected by the infant’s cooperation with the procedure. Has the measurement been re-checked by different care providers? Also, some families have a predisposition to either larger or smaller than average head size. This is a familiar trait which has no detrimental effect on the child.

You point out that your son has been reaching his developmental milestones, this is the key indicator of brain/neurologic growth and health. Head circumference is less worrisome if milestones are occurring on time. If you or your care provider have any questions regarding this, a developmental evaluation could be requested from an experienced pediatric physical/occupational therapist.

Finally, has your care provider checked and reassured you that your baby’s fontanelles (soft spots) are still appropriately opened? If not, you can request this. A condition called cranial synostosis involves the premature closing of the fontanelles and can be managed by a pediatric neurosurgeon. Diagnosis of this condition is based on physical exam, and if there is any question after this, a skull x-ray or CAT scan may be ordered to confirm that the skull bones have not grown together prematurely. In doing a web search for this condition I did not find any family friendly sites. I would suggest you discuss this possibility with your son’s health care practitioner rather than making any assumptions.

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Response by:

Sarah Sauntry, RN, MS, CPNP-PC
Assistant Professor of Clinical Nursing
College of Nursing
University of Cincinnati