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Children's Health

Head circumference

05/11/2009

Question:

My Son was born at 34 weeks and 5 days and he has completed 1mnth . His wt is 7 lb and ht is 51 cm and head circumference is 34 cm. I`m woeeird if his head circumference is within the normal range.

Answer:

Growth is so worrisome for preterm babies! I have plotted his growth measures on an IHDP (Infant Growth and Development Program) growth chart for preterm baby boys weighing more than 1500 grams at birth. Plotting his growth on a standard CDC 2000 growth chart for boys would underestimate his growth. On that chart, presuming that he is now 39 weeks post conceptional age (34.5 weeks + 4 weeks of life after birth = 38.5 weeks), his length is at the 50th percentile, meaning that half of preterm boys similar to him in age and weight are shorter than he is and half are longer than he is. His weight is at the 25th percentile, so he weighs more than 25% of little boys his age and weighs less than 75% of little boys his age. His head circumference is at the 25th percentile as well, with 25% of preterm little boys his age having smaller head circumferences and 75% having larger head circumferences.

So consider this his taking off place for head growth. Ideally, his head circumference will start to accelerate towards the 50th percentile making up for lost time in the protective world of the uterus. It is not unusual for head circumference percentiles to exceed growth percentiles in weight and length in the first 5-6 months. In fact an increase of up to 1.5 cm per week in head circumference is considered good for a preterm infant and even desirable. 

The best things you can do for your son to promote his growth include respecting his behavioral cues indicating the need for a break or rest (yawning, closing his eyes, looking away from you or turning his head away, holding up his hand like a policeman for stop, hiccuping, spitting up or vomiting, turning bright red or white, fidgeting his feet and flailing his arms, grabbing onto his clothing, ear or head), giving him gentle loving care when he is awake, feeding him when he is hungry at least 6 times per day,  and comforting him promptly when he cries or fusses. All babies need help to calm down when they are upset, but preterm babies often need it more help to calm down. 

Infant massage using firm but gentle strokes promotes infant growth and high quality sleep. Look for videos or picture books with step by step instructions. Just remember to use firm strokes. Light stroking irritates many babies. If massage provokes crying, back arching or fussing, that is a sign to stop and it is best to respect his response. Many babies enjoy massage and it is a wonderful way to spend time being close to your new son. It also helps new dads get over any fear of hurting the baby and involves them in care. 

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