Medical Resources :: Common Diseases :: Developmental Issues :: Head Circumference in Children Adopted from Abroad

Significance of Head Circumference

• Head circumference (HC) can be used as a measure of brain growth in the first years of life (Winick J Peds May 1969)
• "Number of cells in the brain increases linearly until birth and then more slowly until about 6 months of age after which there is little if any increase in brain cell number." Winick Ped Res 1968

Brain Growth in Children

• Most rapid period of myelin synthesis is around birth, but significant synthesis is still occurring at two years of age
• Brain cell migration for development of essential connections in the brain are occurring in the first years of life

Malnutrition and Brain Growth

• During severe malnutrition the normal rate of increase in HC is reduced (Stoch et al Arch Dis. Child 1968)
• Curtailment in the normal increase in brain weight, protein, and DNA content
• HC is directly proportional to the reduced brain weight and protein content

Head circumference and Malnutrition

• Degree of reduction in HC in children malnourished during infancy is an indication of the severity of this nutritional deprivation on actual cellular growth of the brain (Winick J Peds May 1969)

Other causes of decreased brain growth in children in orphanages?

• Poor pre-natal care with malnourishment during pregnancy
• Smoking during pregnancy causes low birth weight and microcephaly
• Alcohol abuse during pregnancy leads to toxic effects on growing brain cells (FAS, FAE)
• Drugs and environmental toxins in pregnancy can be neurotoxic
• Genetic syndromes
• Prematurity
• Craniosynostosis ( premature closure of the bones of the calvarium-rare)

Brain Growth

• The anterior fontanelle may remain open longer than normal (closes 9-18 mos.) due to malnutrition and rickets
• This may enable catch-up brain growth
• It is difficult to really know about the qualitative growth of the brain that exhibits catch-up

Measurement of Head Circumference

• Measurements may be unreliable (staff are poorly trained, tapes not standardized, conversion from metric to English inaccurate)
• HC should be measured in the middle of the forehead around the largest diameter of the back of the head

Standardized Growth Curves

• G Nelhaus. Head Circumference from Birth to Eighteen Years/Practical Composite International and Interracial Graphs. Pediatrics, 1968: 41, 106-114
• Curves for premature infants are essential Babson et al. Growth graphs for the clinical assessment of infants of varying gestational age, J Pediatr 89: 815, 1976

Growth Curves from other Countries

Although head size does seem to be universal, there may be enough of a difference in the heads of Asian children for country specific curves to be more appropriate Certainly for height and weight, country specific growth curves are essential

Brain growth catch-up

• Can head circumference change in children adopted from orphanages with decreased brain growth?

Head Circumference Study

• 34 children adopted from Eastern Europe and Russia evaluated at Winthrop Adoption Center
• Retrospective chart review from November 1996 to December 1998
• Mean age at arrival was 13.2 months
• Mean age at follow-up was 26 months
• Range of ages at arrival: 5.5-32 mos.
• Range of ages at follow-up: 15 -43 mos.
• 11/34 (32.4%) children had head circumferences less than the 5th% (microcephaly)
• 7/11 ( 64%) microcephalic children's heads grew placing them on the growth curve
• 16/34 (47%) children's heads which were on the curve on arrival grew from arrival to follow-up
• 23/34 (67.6%) children's heads grew!