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Newborn and Infant Care

Low head circumference and weight



We are in the process of adopting a five month old baby from an orphanage in India. Both her head circumfeence and her weight are below 5th percentile. We don`t have the information if she was a pre term baby. Her weight has increased from 4lbs at birth to 7lbs at 5 months. We don`t have any data on her head circumfence. We are concerned about developmental problems later in life. Is she a healthy baby?


It is wonderful that you are considering opening your home to this child. I truly cannot tell you if she will be a healthy, normal child as she grows older. I can say that on a World Health Organization (WHO) growth chart for girls, her birthweight was very low. The fact that her head circumference was also low might suggest that she was overall a small baby due to her mother's poor nutrition or because her mother's placenta was not functioning well during pregnancy and, therefore, the developing baby was unable to grow properly.  At five months of age, she is actually moving upward on the WHO growth chart in terms of her weight. This is a positive sign indicating that she is a vigorous eater who is able to grow and it is less likely that she has a chronic condition that results in continued poor energy levels and weak growth.

There is no guarantee that all will be well with any child whose mother's health and care are unknown and whose own birth history is unknown. Love and attention can work wonders and it is great that she is coming to you before 7 months of age. This will give her the opportunity to know you and your partner well before she masters the big gain in mental development that is tied to the achievement of object permanence, knowing that things are not gone when they are out of sight. This is so important in the development of a healthy attachment to fuel her learning and development.

I hope this information proves helpful to you. If you wish to use WHO growth charts as she grows, there is a link to them on the website at http://www.adoptmed.org/topics/growth-charts.html as well as charts for children born in India. As you might guess, Indian children are smaller and lighter as they grow compared to children in the US or to many children used in developing the WHO growth charts.

Mcinerny, et al. (Eds.). (2009). Textbook of Pediatric Care. Elk Grove Village, IL: American Academy of Pediatrics.

Proos LA., 2009, Growth and development of Indian children adopted in Sweden. Indian J Med Res. Nov;130(5):646-50.

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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