Concerns About Baby's Small Head Circumference: When to Seek Neurological Evaluation?

The baby's head circumference is too small?

Hello Dr.
Hsiao: My baby was born at 38 weeks and 3 days, and is now 2 months and 3 days old.
During each check-up, the head circumference has been measuring 2 weeks smaller.
My husband, my older child, and I all had normal head circumferences at birth, and we did not have a brain ultrasound done at that time! At birth, the head circumference was 32.5 cm, length was 46.5 cm, and weight was 2.8 kg.
At 1 month and 4 days, the head circumference was 34.5 cm, length was 50.8 cm, and weight was 3.4 kg.
At 2 months and 3 days, the head circumference was 35.8 cm, length was 55 cm, and weight was 4.2 kg.
The head circumference is below the 3rd percentile, which is concerning! Currently, in terms of development, according to the handbook, the baby cannot lift the head to 45 degrees yet, smiles (but not every time is prompted), can focus on moving objects, and makes a sound like "ah"! Should we check for pediatric neurological issues? What does a brain ultrasound evaluate? Thank you!

Li, 30~39 year old female. Ask Date: 2012/10/26

Dr. Xiao Kaiwen reply Pediatrics

The average head circumference of a normal newborn is 34 centimeters.
During the first six months after birth, it typically increases by 8 to 10 centimeters.
Therefore, your baby's rate of head circumference increase is not abnormal; it is just that the head circumference was smaller at birth.
At two months old, this level of development does not indicate significant delay.
You can continue to observe for a while longer, and if there are any noticeable abnormalities in head circumference increase or development, a pediatric neurological examination may be necessary.
A cranial ultrasound examination is performed through the baby's open fontanelle, and it can screen for most changes such as intracranial hemorrhage, hydrocephalus, and brain malformations.
It is currently the best tool for neonatal brain screening.

Reply Date: 2012/10/26

More Info

When it comes to concerns about a baby's small head circumference, it is essential to approach the situation with a combination of medical knowledge and parental intuition. In your case, your baby was born at 38 weeks and 3 days, and you have noted that their head circumference has consistently measured smaller than the average for their age. This situation can understandably cause anxiety for parents, especially when developmental milestones are also being monitored.

Firstly, it is important to understand that head circumference is a significant indicator of brain development. The average head circumference for newborns is around 34 cm, and it typically increases by about 8 to 10 cm in the first six months. Your baby's head circumference measurements, while on the lower end (below the 3rd percentile), do not automatically indicate a severe problem, especially if there is a consistent growth pattern. The key here is to monitor the growth over time and ensure that it is progressing, even if it remains on the smaller side.

Regarding the developmental milestones you mentioned, your baby is showing some positive signs, such as the ability to focus on moving objects and vocalizing sounds. While not yet able to lift their head to 45 degrees or smile consistently, these milestones can vary widely among infants. It is crucial to continue observing your baby's development and consult with your pediatrician if you notice any significant delays or abnormalities.

As for whether a neurological evaluation is necessary, it is generally recommended if there are additional concerns beyond just head circumference. If your baby shows signs of developmental delays, unusual movements, or other neurological symptoms, a referral to a pediatric neurologist may be warranted. A neurological evaluation can help assess the overall brain function and development, ensuring that any potential issues are identified early.

In terms of diagnostic tools, a cranial ultrasound is often used in infants, particularly those with risk factors such as prematurity or low birth weight. This non-invasive procedure takes advantage of the fontanelles (soft spots) in a baby's skull to visualize the brain. It can help detect conditions such as intracranial hemorrhage, hydrocephalus (water on the brain), and structural abnormalities. Given your baby's history and current measurements, discussing the possibility of a cranial ultrasound with your pediatrician may provide additional reassurance.

In summary, while your baby's head circumference is a concern, it is essential to consider the overall growth pattern and developmental milestones. Regular check-ups with your pediatrician will help monitor these aspects, and if any significant issues arise, they can guide you toward further evaluations. Remember, early intervention is key in addressing any potential developmental concerns, so maintaining open communication with your healthcare provider is crucial.

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