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Children's Health

Soft spot and head circumference

05/11/2009

Question:

Hi, My baby is five months old now. She does not have a soft spot in her head. When I told that to the doctor he said its already been fused. Also her head circumference at birth was 34cm and now at the 5th month its 39 cm. She seems to be very healthy and normal. Her activities are very normal. But I`m worried since I feel that there will be some effect of this to the development of the brain. Should I be concerned or s this normal.

regards

Answer:

You are asking really good questions. In responding I am making the assumption that she was a full term newborn. Your daughter's head circumference at birth plots at the 25th percentile, which means that out of 100 newborn baby girls born at term, her head circumference was larger than 25 other baby girls but smaller than 75 other term baby girls. If her length and eight were also near the 25th percentile at birth, she would be considered proportional in her growth measures.

Now at 5 months, her head circumference is below the 5th percentile for little girls her age. I don't know how her growth in length and weight have been, nor do I know how tall you and your husband are in terms of predicting what her expected growth curve pattern would be. What I can tell you is that her head growth has slowed significantly since her birth, dropping from the 25th to below the 5th percentile and crossing two major growth centiles. Early fusion of her cranial bones would account for the slowing of head growth.

Because the first 2 years of life are the brain growth spurt, early closure would have a very negative impact on her brain and its function if left untreated. The best thing to do is to see a child neurologist and have the issue of slowed head growth explored.

If her cranial bones have fused early, the condition is called craniosynostosis. The bones will need to be released from one another by a neurosurgeon to allow for normal growth. Many times this is a singular problem, other times it indicates the presence of an inherited disorder where craniosynostosis is only one feature. Since you have been taking your child for wellness care, larger problems are likely to have already been noted if they are there, so the chances are good that this is only a single problem that can be treated successfully. 

I wish you and your daughter well as you pursue this important issue.

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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