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Newborn and Infant Care

Small head circumference



I read your reply regarding the Guatemala baby and I have a similar situation. My baby is from China. She weighed 6.12 pounds at birth, was 18.12 inches long, and head a head circumference of 31.52 cm. Her measurements for the folowing 7 months were as follows: Height - 20.09 inches, 21.28, 22.46, 23.25, 24.03, 24.82, 25.61. Her weight for the same months was: 7.48 pounds, 9.46, 11.22, 12.32, 13.64, 14.74, 15.84. Her head circumference for the same months was 32.5cm, 35.0, 37.5, 38.5, 39.2, 40.0, 41.0. As you can see, she dips in and out of the 3%. How much of a risk is there with her having developmental problems or mental retardation? How old will she be when she starts getting problems? Should we adopt her? We asked for a healthy baby. Thanks


There is no simple, straightforward answer for any particular child. Your baby started out around the 5th percentile for weight and length meaning that only 5% of little girls at birth weighted less than she did and 95% weighed more) with her head circumference well below the 3rd percentile (meaning virtually no little girls had head circumferences smaller than hers). Over the 7 months since her birth, her weight and length have both moved to the 25th percentile and her head circumference is nearing the 10th percentile. So thre is not a huge disparity among her growth measures. It is very encouraging that her head circumference has moved up steadily. However, there is no denying that her brain received poor oxygen and nutrition during the critical period of it's development. No one can at this time tell you what exactly will be her outcomes. In addition, our developmental measures for the first 2 years of life do not predict academic achievement in later life at all.

What is more critical, is whether or not she has been in an orphanage vs a foster home. Usually children in orphanages do more poorly. It is also important that if you decide to adopt her that you move quickly to do so in order to minimize her exposure to a poorly stimulating environment. It is also important from an attachment point of view as well as. Young infants need to develop a strong attachment relationship with consistent caregivers both for the sake of their mental health as well as their ability to learn. We do know from many research studies that the longer children live in unfavorable environments, the more difficult it is to make up for this poor start in terms of child behavior, development and academic achievement. Adoption before 4-6 months has the best outcomes. Adoption after 12-18 months almost certainly means significant difficulties.

Do be prepared for a challenging period of adaptation for any child coming to a new country. It is impossible to truly appreciate the overwhelming impact of this change on a young child. Even though they do not speak yet, they have been learning the language around them, tasting the flavors of their native culture, and forming at least some type of relationship with caregivers. In one fell swoop, their familiar caregivers change, they hear words that have no meaning to them, and they are likely fed foods they have never tasted before. Nothing is the same! It is overwhelming to the young child and leads to much crying, irritability, clinginess, and all types of challenging behaviors as they try to make sense of this experience. It may take up to two years for the older infant or young toddler to adapt to different caregivers, a new culture and a different lifestyle than they have known. These are far more difficult issues than health issues in general. All of this has absolutely nothing to do with the fact that you are offering the child a wonderful opportunity for a better life in every way imaginable and that you are a loving and generous parent. You must be or you would not be considering adoption.

If you decide to adopt internationally, I highly recommend finding a pediatrician with a strong developmental and behavioral background as well as an early childhood mental health specialist, both of whom can be knowledgeable supporters as you begin your journey as parents. I hope this information helps!

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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