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Newborn and Infant Care

Small head circumference

06/06/2007

Question:

During my pregnacy my now six month old daughter was diagnosed with increasing mild ventriculomegally, Diagnosed at 19 weeks gestation, the ventriculomegally continued to increase until about 26 weeks and then slowly returned to normal by the time I was 34 weeks pregnet. There was no intervention I was just closley monitored until delivery. My baby was born with 8 days late with a birth weight of 3170g, a head circumference of 34cm and a length of 50cm. There were no abnormalaties detected at birth. At every check up her head circumference and wieght have continued to decline on the growth charts, Her weight at 6months and one week was 6450g, ht 63.5cm and her HC 40cm, her head circumference is now just off the chart. She appears to be developing normally meeting all milestones except for rolling over, she can sit supported, put her dummy in her mouth and all other relevant milestones. I am waiting to see her paediatrician but in the mean time I would like to know what if anything it could indicate. Thank you.

Answer:

I can understand your concern. It's difficult to say exactly how worried you should be. Both your daughter's weight and length have trended from above the 25 percentile down towards the 10th percentile. She has, however, doubled her birthweight on schedule. I don't know if you are breastfeeding or not. Breastfed infants tend to be more slender babies. I also don't know if you and the baby's father are smaller as well or if you both have smaller head sizes. Although most healthy term babies are about 7 pounds at birth regardless of parent size, babies tend to trend toward their genetically driven growth curve after birth. Growth rate also slows normally at 6 months of age to about half that in the first 6 months of life. So judging the normalcy of growth patterns has to take a lot of information into account.

The fact that she had hydrocephalus in utero that has apparently resolved is also worrisome. While it's great that she appears to be developing normally in terms of gross motor or large muscle function, gross motor function is not related to intellectual function and development, which I am sure is of concern to you. In fact, it takes a lot of damage to derail the normal unfolding of a young child's development.

In general, it is worrisome to see a baby's head circumference decreasing to the being below the growth curves. There is always the possibility that her head circumference has been inaccurately measured as well. It is the body measurement most subject to error. I think it is very important to ask for the doctor to recheck her head size and frankly discuss your concerns.

I strongly recommend that if a careful remeasurement of her head circumference and plotting on the growth chart at your next visit shows the same evidence of poor growth that you request referral to a pediatric neurologist or at least an MRI of her brain. MRI does not expose her to radiation and will provide detailed images of all of the brain structures and accurate measurements of tissue density. This would at least identify if there are differences of concern and, if all is well, provide considerable reassurance to her worried mother. Because early intervention is so much more effective in the first three years of life, it is critical to identify children who will benefit from therapies as early as possible when the brain is most adaptable. Early Intervention services are an entitlement program, free to all citizens regardless of income. You can refer your daughter yourself if problems are discovered. In Ohio, you can find your closest program by checking the www.ohiohelpmegrow.org website.

I hope this information is helpful. Parents are their children's best advocates. Your daughter is lucky to have a mother who asks good questions and is concerned for her well being.

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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