Baby's Growth Rate

I wouldn't be concerned at all. My son has been in the 50-90 percentile for weight and height at various times and has always been in the 5th percentile for head circumference. My ped said as long as he's following his own projectile and it isn't falling or growing dramatically, there's no cause for concern. She also asked if there were any small heads in the family (I've got a big one) and both my husband and mother have smaller heads. Also, my son is right on target for walking, talking (maybe even a little early), etc. So don't sweat it!

Hi J.,

It sounds like we're sharing the same son, except mine is 10 months old. My son has always been fairly average in length and weight (perhaps a bit under in weight) and 5th percentile for his little head. The bottom line is that he looks proportional and that's all you should worry about. Do either of you have a small head? I know that I have a tiny head - hats have always been too big on me.

I don't think you should worry about it one iota.

Do not worry! He's on the charts so that means he is in within range. I was always way OFF the charts (below) in weight when I was a kid and I am fine(after two kids I could definitely afford to lose a few pounds now). I was probably on the small side as far as head size too since today I have a small head (I have to buy kids glasses). I got high scores on the ACT and SAT and graduated from University with a good degree- head size does not determine brain power! Continue to monitor his growth and milestones but don't stress. There is a huge range for early development and kids learn at their own pace- in part due to personality(some kids want to move from day one, others are content to sit back and take it all in. )

I wouldn't worry at all. Your son sounds just like my daughter, who is almost 13 months. She has always been really long & skinny, with a small head. She eats like there's no tomorrow (this kid can pack it away! LOL!), but she's got the fast metabolism like her mom & dad.

Like your doc, mine isn't worried either. He said he would be worried if she wasn't so consistent each month. But she gains weight, she grows taller and her head size stays equal to that (which is also in the 5th percentile). At first we were worried, now we know it's just her.

Look at it this way, your son will look like a little doll because his head is proportioned to his body! :-)

C.

I know it's a Mommy's job to worry but, I think from your response I would endeavor to say you've got nothing to worry about. If you, hubby and doctor have not noticed any significant development delays then you have nothing to worry about. If by chance your child is missing the mark on certain things, then you may want to ask your Pedi to refer you for a second opinion.

My son was preemie, and we were told he was going to be delayed on ALL kinds of things. He actually caught up a whole year earlier than the Pedi thought he would. Long story short, don't let the little voice in the back of your head rule your world. Keep an eye on him and make a journal, so you know when he hits milestones and be prepared to answer and ask the Pedi ALL questions that come to mind (journal is handy for this). Even make another appointment to sit down and chat for a few moments to get your questions answered.

Don't worry until you have to!

Good Luck.

My son had the same thing! He was average weight at birth! His 4 month check was the same, his head circumference was a ton smaller than average! He grew out of it and has a normal size head and is very advanced as far development! Every kid does grow differently! Don't worry to much!

No need to worry. I agree with your doc. My kids' heads were under average too and they're highly intelligent. (normal) They're heads don't seem unusually small or anything so I guess their heads caught up with the rest of their growing.

At 4 months I think its too early to tell. Was he tiny when he was born? I have twin boys...the smallest was born 5lbs 12 ounces at 37 weeks. I believe at 4 months he was average height, average weight but 10% for head. Hes now 14 months at at his 1 year check up he was 70th height, 50th weight and 50th head. Each baby grows differently...just give it time and see how he develops. I can tell you my son is smarter than he needs to be and completely amazes me everyday on the things he learns. If everything seems fine...dont let the charts scare you!

Good Morning J.,

Have you every considered food allergies?

I have had allergies my entire life, and along with that came many problems, such as hormonal problems. At 37, I am now being treated for my allergies. Allergies can affect growth rate and hormones along with other body functions.

I recommend that you log onto site NAET.com. NAET.com is a group of allergists around the world who treat and elimiate allergies. They are the ONLY allergists in the world who eliminate allergies. And drug free.

I have been seing my NAET allergist for a few months and I am seeing many changes in my body and I my health is improving and my allergies are being eliminated.

You may contact me at ____@____.com, if you have any questions. But, I recommend that you log onto site NAET.com, locate an allergist near your home, and make an appointment for allergy testing for your child.

Be Well.

N.

HI, at 2 months they made me get a skull xray for my son to make sure his growth plates hadn't fused prematurely. The doctor recommended again at 4 months and I refused, got a new doctor and my son is now perfectly normal and his head has caught up with his body. my son's head got as low as 5-10% but my new doctor said she wouldn't worry unless he fell off the charts, so don't worry.

My son was always below normal. My first Dr. was really worried but I changed Dr. and they said not to worry about it he would grow out of it. He was not on the growth chart cause he was too small. He is now 3 and he is back on the growth chart at 10th percentile. I don't think those things really matter as long as your baby is healthy.

I just wanted to say, we had the opposite problem. My daughter's head is in the 90th percentile, which can be a sign of serious problems. Our pediatrician suggested we see a neurologist to allay our fears and he said everything was absolutely fine. Your baby is still on the chart. Everything can become a fear when you're a parent. I;m sure your baby is just fine also.

What is most important is that your child is ON the chart. All 3 of my kids had smallish heads. My 2 yr old daughter had her appt today, and she was something like (okay, that is how you know she is the 3rd, I dont remember specifically) 80th for length, 40th for weight, and 20th for head. My almost 8 yr old son is 5th for height, and my 5 yr old sone is 90th for height. the oldest they are watching, he has had health issues, so, his height may be related to his past problems...But, I have learned the chart is what is the norm, and off the charts either direction is something to look at. I wouldn't worry.

J.,
I know it is difficult to accept that your son is not at a high percentile. My son is fifteen months, and on the last visit for the first he was in the curve for his height. His head circumference and weight have never touched the curve. My peditrician says that as long as he is growing, at his own pace, of course, it is okay.
Just keep an eye, don't worrry, they know best. I know its hard, I still get comments about my kiddo.
Good luck!!
ceci

Hi,
Yes, my son had a smaller head measurement the first year but then caught up. Don't worry. At least it won't be so hard to get shirts over his head. Now that my son is two and measures at around the 50 percentile for head circ some shirts are tough!

My son had the same problem. His head was tiny! It doesn't help that my friend had a baby a week later and his head was huge. My boy is now 2 1/2, ahead in most develpomental areas, and his head has grown to 25th percentile. Because he is so long and skinny, it looks normal. Don't worry. Those charts only measure averages.

um honestly I would get a second opinion just because I've always been told by our doctors that if they're below average or above it's fine as long as their weight length and head circumference are around the same percentile

Hi J.,

Mine was 95th% height, 90th% weight and 25th% head circumference at 2 months. She continued to grow to 98th% height, 90th% weight and 40th% head circumference at 6 months. Her head is "catching up". I was a little uncomfortable with the smaller head, but these proportions will even out, so don't worry. :)

Can you answer a few questions?
What were his percentiles at birth? What are they now (for all 3). Was he a preemie? Any other concerns during birth or pregnancy?

Has he always been at the 5th percentile or has this dropped? That is more of a concern rather than just being at the 5th. Is he consistently following this percentile?

My daughter (age 20 months) is in the same boat. She was born a few weeks early (she was adopted)and her head has always been on the small side (5th percentile). At first it was thought it was because her head was flat in back (in the country she was born it's considered a beauty trait, so babies are often left on their back) but then it rounded out but remains small. She is average weight and around 75th percentile on height, so I've been concerned too. However her development is right on track (slight speech delay, which is thought to be because she was exposed to another language for 10 months). Her pediatrician has been closely monitoring it every 3 months though, and her last visit it jumped a bit to the 10th percentile. He said that often times it's variable because it depends on the skill of the person measuring, making sure the tape is positioned correctly, etc. and sometimes the brain goes through growth spurts.

With that said, I would see if he's consistently on the curve. It's not considered microcephaly unless below the 3rd percentile. Monitor it closely, monitor his development closely. Is he on formula or breast milk? If breast, make sure you're getting enough good fats in your diet to support his brain growth. You are right to be concerned and to monitor it closely, but I wouldn't be worried yet unless you've noticed a drop in percentiles or have a concern about his development or his cranial sutures closing early.

The most important thing is to see if he's following a consistent curve and also his development is on track. Also they need to monitor his fontanelles to make sure his sutures aren't closing prematurely.

It can also be due to familial traits -- my son has a very large head (off the charts) and is perfectly fine. Some kids have big heads, some small and it's not a worry.

Keep us posted and good luck. My daughter's peds isn't concerned but is monitoring but thinks she'll have the smallest graduation cap at Harvard; )

Hi J.,

Every baby is different, especially when it comes to developmental and medical concerns. It's great to hear that other women have experienced the same thing that you are concerned about, but that does not necessarily mean that their experiences will adequately apply to you. In general, if you have a concern of this nature, press your doctor for more information. If you're not satisfied, besides asking other moms (there is definitely value in this), look for info on the the internet from reputable sources such as WebMD, Medscape, Mayo Clinic, and sites that carry the HONcode label (honesting and legitimacy in medical reporting).

BTW, if you trust your pediatrician, who has had primary experience with hundreds or even thousands of babies, then I would not be concerned if he or she is not concerned (although that does not mean that you shouldn't trust your gut instincts -- there's great value in that, too). I'm sure the doctor will reevaluate at your next well baby check, if it appears necessary. If you DON'T trust your pediatrician, then it's probably time to start hunting for a new doctor!

The article below was written by an expert from the Mayo clinic. The last paragraph should be fairly comforting.

(article begins here)

Microcephaly: When your baby's head is abnormally small

What causes microcephaly in an infant?
- Agnes / North Carolina

Mayo Clinic pediatrician Jay Hoecker, M.D., and colleagues answer select questions from readers.

Answer
Microcephaly is a rare neurological disorder in which the circumference of an infant's head is significantly smaller than average for children of the same age and sex. Microcephaly may be present at birth (congenital) or develop later in infancy.

Microcephaly usually occurs when the brain fails to grow at a normal rate. As a result, the child's skull doesn't enlarge to its normal size. This disorder is often associated with mental retardation.

Causes of microcephaly may include:

Fetal alcohol syndrome
Decreased oxygen to the fetal brain (cerebral anoxia) due to pregnancy complications or complications during delivery
Craniosynostosis — the premature fusing of the joints (sutures) between the bony plates that form an infant's skull
Chromosomal abnormalities
Infections of the fetus during pregnancy, such as toxoplasmosis, cytomegalovirus, German measles (rubella) or chickenpox (varicella)

In most cases, there's no specific treatment for microcephaly. Treatment is usually directed at managing the signs and symptoms associated with the disorder. If microcephaly due to craniosynostosis is detected early, treatment may include surgical opening of the sutures to let the brain grow normally.

If you're concerned about the size of your child's head, talk to your doctor. Doctors use growth rate charts — similar to those for height and weight — to compare your child's head circumference with that of other children of the same age and sex.

It's important to note that heads with circumferences in the 3rd, 2nd and even 1st percentiles are just small heads. Microcephaly is a head circumference that is significantly below the 1st percentile.

(end article)

If you want more detailed information, the following article written by a MedScape expert pediatric nurse will give you more complete information than you've received so far.

BTW, forget the allergy angle -- allergies don't cause every problem in the universe. In fact, trying to pin an allergic source to this issue doesn't make physiological sense, especially since your baby is growing overall, which indicates that he is being well nourished and is not having problems absorbing nutrients. It just goes to show you that not everyone who posts on this site knows what they're talking about! :-)

BTW, you can find this posting at http://www.medscape.com/viewarticle/463561

Article starts here:
How Should I Evaluate Small Head Size in Infants With Small Parents?

Question
How do I determine if head growth/circumference is appropriate when small size may be in the family history? I have patients that begin to drop below the 5th percentile, but I suspect this may not be a problem because of the size of their petite parents. Is there a formula based on the circumference of parents' heads?

Asked by Shatzie Montellano, MSN, FNP-C

Response from Laurie Scudder, MS, RN-C, PNP
Adjunct Assistant Professor, School of Health Sciences, George Washington University, Washington, DC, and Pediatric Nurse Practitioner in a primary care pediatric practice, Columbia, Md.

A child with growth that is trending downward on the growth curve is always a concern. Head circumference should never be measured and assessed in isolation but rather as part of the child's repeated growth measurements that include height and weight and an evaluation of parental and sibling stature. A child whose growth is decreasing, and crossing major centiles, should indicate that an investigation for growth failure is needed. (A report titled "Evaluating Pediatric Growth and Nutrition: Guidelines for the Primary Care Clinician," may provide guidance. In addition, the Centers for Disease Control (CDC) released new growth charts in 2000, which are available for download from their Web site.

It is important that growth be measured accurately and plotted at every well-child visit. The new growth charts, unlike the 1977 National Center for Growth Statistics (NCHS) charts used in the past, are based on a national sample of children of all major ethnic groups and include both bottle- and breast-fed infants. "The differences between the 1977 NCHS Growth Charts and the 2000 CDC Growth Charts are most pronounced in the head circumference-for-age charts. In general, the 2000 percentiles for head circumference are higher than the 1977 percentiles until age 4-6 months. At this point, a crossover occurs, and the 2000 curve becomes lower than the 1977 curve."[1] Microcephaly is rarely associated with overall growth failure.[2]

You describe a situation in which head growth is falling below the 5th percentile. However, your question does not note that this decline is accompanied by a corresponding decrease in height and weight. Microcephaly is defined as a head circumference that measures more than 3 standard deviations below the mean for age and sex.[3] It may also be suspected in full-term newborns and infants under the age of 6 months whose head circumference is smaller than that of their chest.[4]

Microcephaly is divided into primary and secondary categories. Primary microcephaly is usually evident at birth and associated with a brain insult that occurred early in fetal life. It is typically accompanied by severe mental retardation. It is often associated with skull deformities, such as backward sloping of the forehead and narrowing at the temples and fontanelles that close earlier than expected.

Secondary microcephaly occurs from an insult to the brain later in fetal life or in the perinatal period.[5] Brain injury after 2 years is not likely to be associated with severe microcephaly. Some causes of secondary microcephaly, such as Rett syndrome, may not be noted until 2-4 months of age when head growth begins to decelerate and are accompanied initially by a slowing in acquisition of developmental milestones and later a loss of milestones.[6]

It can be helpful to measure the head circumference of other family members and plot the measurements on an age-appropriate chart. For older children, the Nellhaus curves for the ages 0 to 18 years are widely used. These were developed by merging data from 14 studies of head growth published worldwide between 1948 and 1965.[7] They do have limitations, however, because the majority of those included in these studies were white Americans. A 1997 study conducted in Turkey on 408 adults computed male and female adult head circumference charts plotted against weight and height.

More important, though, is your overall assessment of the child. Is the small head size part of growth that is trending downward, or does the child have a small head and is staying at the same percentile with relation to a standardized growth curve chart? Serial head circumference measurements are more important than a single determination, particularly when the variation is small.

There are 2 major concerns that should be addressed when a child presents with microcephaly. The first is developmental delay and mental retardation, since microcephaly may be the presenting condition in a wide range of neurodevelopmental disorders. A child with a small head warrants ongoing, serial, developmental assessments to be sure that he or she is meeting age-appropriate developmental milestones. Thorough exams should be conducted at well-child visits to document that the child is developmentally appropriate, does not have unusual facies or other features, has open fontanelles at an age where they should be open, and appears to have normal vision and hearing.

The second concern is craniosynostosis, resulting from premature closure of the cranial sutures, as the cause of the suspected microcephaly. This may occur if many or all sutures close prematurely. Typically, however, craniosynostosis is not associated with microcephaly because the inhibited growth along the involved suture is compensated for by increased growth at open sutures and fontanelles.[5] Closure of only 1 suture will not cause impaired brain growth. The management of craniosynostosis is directed toward preserving skull shape.

The bottom line with this child is that an isolated measurement should be followed by repeated careful assessment of both growth and development. Yes, small parents may lead to small children, but before that conclusion is made, other causes must be ruled out.

Posted 11/11/2003

--------------------------------------------------------------------------------

References
Measuring and plotting head circumference. Department of Health and Human Services: Available at: http://depts.washington.edu/growth/ofc/text/page1a.htm Accessed on October 18, 2003.

Barness LA, Cooper DS. Handbook of Pediatric Physical Diagnosis. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2001.

Behrman RE, Kligman RM, Jensen HB. Nelson's Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders; 2000.

Moe PG, Seay AR. Neurologic and muscular disorders. In: Hay WH, Haywood AR, Levin MJ, Sondheimon JM, eds. Current Pediatric Diagnosis and Treatment. 16th ed. New York: Lange Medical Books/McGraw-Hill; 2003.

McMillan JA, DeAngelis CD, Feigin RD, Warshaw JB. Oski's Pediatrics: Principles and Practices. 3rd ed. Philadelphia: JB Lippincott; 1999.

Rich J. Degenerative central nervous system (CNS) disease. Pediatr Rev. 2001;22:175-176.

Johnson DE. Does size matter, or is bigger better? The use of head circumference in preadoption medical evaluations and its predictive value for cognitive outcome in institutionalized children. Available at: http://www.russianadoption.org/Headcircumferencedj.htm Accessed October 18, 2003.

BTW, Your question piqued my interest because I am currently working on an presentation to educate laboratory personnel and general practioners on different aspects of infectious diseases that can be passed from a mother, often unsuspecting, to a developing baby. Many of these diseases cause microcephaly, which is a condition marked by an abnormally small head size, developmental delay and mental retardation. I do NOT suspect this for your baby, so DON'T FREAK OUT! It's just an explanation of why your question interested me. I'm assuming that you had a normal pregnancy and carry either natural immunity to or vaccinated against viruses such as rubella, parvovirus, Epstein-Barr and CMV, and practice good hygiene around cats so that you did not contract primary toxoplasmosis, as is the usual and fortunate case in this country.

My little one is a year old ad at her 4 month visit she ws in the 75th for length, 10-25th for weight and 3-5th for head circumference. I was in shock! I thought it must be the 35th but no it was 3-5th. She just had her 1 year visit and is still doing great and there is no problem with her meeting her milestones. I think she is very smart!!

Please don't worry about it now. Just go with your mothers instict. When he gets older and if you see things that cause you concern, then talk to your doctor.
On your next appointment, if his head circumference is still small, then ask the doctor if he has seen any developental problems in children with head circumferences below average.
If he is still on the charts, then seriously...don't worry.
Take care!

It sounds like you've gotten some good advice. My son had the opposite problem. He's almost 3 and his head size is big, off the charts and always has been. They did a CT to be sure there weren't any problems. He's a bright and very normal child.

My point is, don't fixate on the chart. Observe your child and if you think there are issues persue them, but don't base it soley on his head size.

M.

At his first checkup, my son was in the 50th% for height and weight, but only the 25th% for head circumference. That concerned me too, but my pedi didn't seem worried.

At four months, he was in the 75th% for height and weight and still only in the 25th% for head circumference.

He's 8 months now and at his last checkup, he was in the 50%th for height, weight, and head circumference.

I wouldn't worry too much about it.

No need to worry. My little girl was always tall, skinny, and tiny head on those measurements. Now, at 20 months, her head is still smaller than the average, but to us she is very proportional (just without the big head like most babies), but she is catching up. I think her head is now 45% rather than 5%, so give it time and enjoy the tiny, cute head!!! My niece (2.5 months older than my daughter) always had a HUGE head and she looked so big, I kind of liked the smaller look! NOthing to worry about! He may just have smaller features rather than big features!!!

both of my children had small heads compared to their height/weight. My daughter was in 90th and 70th in height & weight while her head would be in the 25th. My son was more dramatic, height in 90th, weight in 50th and head in 20th I think eve the 15th at one check-up. But by the time my daughter was 2 her head was 50th, and my son is 14mos and at his 1yr his head was up to the 35th, so it evens itself out. Just think...your kid doesn't have the giant head many babies have! As long as the head IS GROWING, you are fine!

Same thing here. I have a long thin baby with a small head. That's how he was when he was born, and while his head circumference percent has increased somewhat (started at 25% and last check up was up to 27%) I would actually feel MORE concerned if his head suddenly shot up in size beyond regular growth. I think that would more likely signal a problem. BTW - at his last (4 month) check up, his height was 95% and his weight was 80%.

I think you also need to look at your son's genetics. My husband and I both have (relatively) small heads. I always have adjustable baseball caps cinched as tight as they can go. My husband usually adjusts them to about their middle range, but he's 6'7" so should theoretically be setting them to a Large setting.

As long as the growth is keeping pace, I really wouldn't worry about it. My son is, if anything, ahead of the curve developmentally. I really never think of his head size other than to be mildly amused by it.

As long as you trust your doctor (and I'm assuming you do since he's your doctor), if he is not concerned, I don't think there is anything to worry about. My daughter is all over the charts. The things you have to remember about those charts is that it is not a race to see who can be in the 100% in everything. It's not a test. It's a percentile or average of where your child lines up with the rest of the US babies. If your baby is 50% in weight, great. Your baby is average. Again, I wouldn't be worried if my doctor wasn't worried.

Hi J.,

I had similar concerns when my daughter was your son's age. At her 2 month, her head circumference was in the 25%. At her 4 momth, 10th percentile. Definitely was thinking that was the direction we didn't want to go! Thought about it often and worried and stressed as we mothers do...(and of course, googled all about small head circumference!) However, at her 6 month, head circumference now in the 45%. Like everything else, it will be monitored- My ped was also unconcerned, but it did relieve some anxiety when it came back up. If you can, don't worry too much until your next check-up. See where he is at then...