Doctor: My husband and I are adopting a child, 13 months of age, from Russia. Although there is no clear date of birth since he was found on the orphanage steps, it was estimated that he was 2 weeks of age when found. When found, his weight was 7lbs., height 20.6 inches and Head circumference 14.1 inches. At 11.5 months of age his height was 26 inches, weight 16 lbs and head circumference 17 inches. He is , of course well below the 5th percentile in all three areas. Our first child was adopted under very similar circumstances and did extremely well, although he is speech delayed. This child, on the video tape sent to us looks developmentally okay...at 11.5 months is standing and trying to walk...crawling....playing appropriately with toys...following commands...smiling etc. My question is about the head circumference. Our pediatrician seems concerned about possible neurological problems given that the head circumference was 14.1 when found and now is 17. What are the neurological implications of this information? Also...Is the fact that he is under the fifth percentile in all three areas more consistent with nutritional deprivation than a neurological problem?(lack of food is very common in Russian orphanages) Finally, the pediatrician thought this child looked good from a developmantal standpoint so wouldn't this tend to contradict the notion of neurological problems. Thank you so much for your assistance. Please do not worry about giving us the most honest information possible...we plan to bring this child home no matter what the potential problems may be.
THe average head circumference at birth is 34 cm, at 3 months it is 40 cm, at 9 months it is 45 cm, at 3 years it is 50 cm and at 9 years it is 55 cm. So as you can see, most of the brain growth occurs between birth and 1-2 years of age (most likely 2 years). The head circumference increases because of brain growth, the fact that the head has increased from 14 to 17 inches is good. You should also note that head size is genetic in that parents with small heads usually have offspring with small heads. Most of the developmental landmarks early in life, birth to 1 year are motor milestones for the most part. Language or cognition is only later: number of words, stringing words together, pointing at objects wanted, obeying commandments. Whether it is good or bad being below the 5th percentile in all categories is difficult to tell someone. It does show that although he is growing, he is small in all categories. Intellectual capacity is something that is difficult to predict from just measurements and growth patterns. Although some studies show that small head circumference with small length and weight are fairly normal in intelligence. I have many children in my practice that fall into this category and their parents only wish that their children would slow down and be less curious about their surroundings. Sorry, I can't be more informative. I wish you the best in your new little one. One recommendation, is to get him into early intervention as soon as possible. Maximize his potential, early and often.
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