Wednesday, July 16, 2003

Another reason to obsess over head circumference

I remember when we first brought our son home from Russia at age 21 months, what a big issue his small head seemed to be. He was small all over, to be sure, about 18 pounds at almost 2, but it was his head size that elicited the most comment. We seemed to visit the pediatrician a lot in the first year or so, and to see a different doctor at the large pediatric practice every time, and every one of them would take a look at my guy and say something along the lines of, "Boy, his head is really small." His head measurement was well below the bottom of the growth curve, but so was everything else about him. His head looked proportional enough to me. But apparently it looked freakish to the medically trained eye.

His neurologist concluded that his small head size might be a sign of FAE, or just a sign that very small heads run in his birthfamily, and eventually his head grew to a less comment-worthy size, or maybe he just passed the age at which doctors stop measuring. Looking at youngsters in the early toddler years now, I can see that they often have what look to me to be enormous heads, and so maybe that's why my boy's much more proportional noggin seemed so striking to those who look at kids all day. At the time, though, the doctors' constant comments just seemed like another annoying part of society's obsession with measuring and plotting our children's development and discerning who had the honor of being most glowingly average. Not my guy, for sure.

That pediatric preoccupation with cranial circumference is likely to increase if the findings described in this news report pan out. It seems that researchers in San Diego, California, found a correlation between a rapid increase in head size among infants and autism. Apparently it's been noted before that autistic children tend to have large heads, but what the latest research indicates is that they may have smaller than normal head size at birth, then have abnormal bursts of brain growth and head expansion between the ages of 2 and 14 months, ending up with a larger than usual head and a troublesome brain structure. The hope is that these observations may lead to identifying autism in much younger children and starting interventions earlier. And that's certainly a good thing.

But just to summarize now for you parents of very small children: You need to worry about small head size. You need to worry about big head size. You need to worry about head size going from small to big. And given the difficulty that doctors and nurses seem to have in getting that tape around a wiggly child's head and giving a good reading, you need to worry about normal head size because the next time the measurement is taken it could be proven wrong.

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