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Children's Health

Baby`s Head Measurement Percentage Decreasing

09/07/2011

Question:

I am concerned about my 4 month old granddaughter. Her weight/heighth has been in the 50% and at her 2 month checkup her head circumference measured in the 10%. She just had her 4 month checkup and her head measurement had dropped to 7% while the other measurements remained the same. She has always had very jerky movements in all four limbs, and is almost always in constant motion. My daughter says this constant motion was true even in utero. I am very concerned about these differences - should we take her to a specialist for a thorough evaluation?

Answer:

I can appreciate your worry for the baby. It seems as though her head circumference has not increased hardly at all over a two month period. Since the first 6 months of life are the most rapid part of the brain growth spurt after birth, the lack of growth is concerning. It possibly might be due to error in head circumference measurement. If the doctor rechecked the measurement carefully to assure it's accuracy, then the concern is supported. It is also possible that she has inherited a smaller than average head size, however, even then, steady upward growth would be the expected norm.

Developmental milestones are another window into the baby's brain wellness. Is the baby able to hold her head up steadily looking straight ahead when on her tummy? Is she reaching for toys or other objects with her hands and bringing them to her mouth? Is she awake and alert at least 8-hours per day in longer chunks than 2-months ago? Does she roll over on her own from her back to her tummy? Does she laugh, squeal, smile, and make throaty sounds? If she can do all or almost all of these things, then she is developing normally and the likelihood of restricted brain growth is less.

However, if she is not doing most of these things, then I think it is critical to discuss her mother's concerns with the baby's doctor. If the doctor is not concerned, but her mother remains concerned, then evaluation by a Child Behavior and Development Specialist is a great idea. Ultimately her doctor may be correct, that she is doing just fine. However, her mother and grandmother will feel a lot better knowing that the possibility of a problem is definitely ruled out. If there is a problem, it will be identified before 6 months of age. Research shows that intervention before 6 months of age, in the case of something such as prematurely fused cranial sutures that physically restrict brain growth, is critical for preserving brain function. Early intervention, in general, is much more effective than intervention after two years of age for just about any and every developmental delay. 

If both you and your daughter see the baby's activity level as much more active than other babies her age, you may well be right. Parents are right 85% of the time when they are worried about some aspect of their child's behavior or development. Parents see the child constantly whereas doctors see the child for only a brief time period in the office. Doctors and nurse practitioners may perceive unusual levels of activity as due to the strange environment or need for a nap and not be concerned unless the parent questions it and the doctor delves further into the child's behavior level.

So to wrap this up, my first recommendation is to meet with the baby's doctor and discuss your concerns. This may result in a more thorough review of the baby's history or additional evaluation that does raise suspicion of a problem. If the doctor is not concerned or cannot allay your worries, then seeing a pediatric neurologist or a behavioral and developmental pediatrician is a good second step. I would not delay the visits because you need an answer before the baby is 6 months of age if possible.

The good news is that your grandchild's body is showing consistent, proportionate growth, which means that she is getting good nutrition. So if there is an underlying problem, it is not one of inadequate nutrition. 

I hope this response proves helpful to you and that indeed all is well with your grandchild.

Dixon, S.D., & Stein, M.T. (2006) Encounters with children (4th ed.). Philadelphia, PA: Elsevier-Mosby.

Legido, A., & Piatt, J.H. (2009). Clinical pediatric neurosciences for primary care. Elk Grove village: American Academy of Pediatrics.

 

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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