Small Head Circumference and Measurements

It seems like once in a while, a month or two, this topic comes up in the China adoption community. A family gets a referral for a child who has seems wonderful, but the head circumference is small, and the International Adoption Doctor is worried about that. The family does not know how to proceed. I know this because it happened to us, and our story is buried somewhere in my blog, but rather than making you find it, I'll post it again, and probably with more detail. I am NOT a doctor or expert. This is all from my months and months of digging information and reading others' experiences.

I have seen three main categories of small head circumference. One is when the height and weight look good, but the head is small. And by small I mean below the charts. The second is that the head seems to be not growing--it was normal size, and now it is not growing. The third is when all measurements, height, weight, and head circ, are all small.

All of these can be contributed to faulty measurements. We know that the nannies in China are not going to take the time to do a precise head measurement. Sometimes, and I've seen it often, adoptive parents get good weight measurements, and get to China and their child weighs less (like us!). The child may have been weighed with layers of clothes on or even a wet diaper. And as for height, all I can say is have YOU tried measuring the length/height of a toddler? There you go!

On Sept. 19, 2008, we sent our LOI for Chang Li Chen. He was adorable! Just look at the little baldy on the side of my blog! And that is how you can fall in love with a picture.

The head is the hardest to measure. My IA sent me directions that I was supposed to send to the orphanage. OK, sure...at teh time I had no idea how to get that done. But the directions said the tape needs to go around the biggest part of the head. You cannot get a measurement that is too big on head circumference is what I was told, assuming you don't have slack in the tape of course.

Here are Tyson's measurements. His first set we do not have an exact date on, and we have two head measurements.

8-9 months: head-40cm or 41.5cm. Now this was confusing because it is a HUGE difference. If he was 8 months and 41.5cm, then he was 0.2cm below the 5th%ile, and that I could live with and take the gamble that the nannies didn't measure right. But what if he was 9 months and 40cm, then that was scary small. His weight was 6.5kg, and his height was 63.5 cm, all below the charts.

This was all we had. We had a picture of him at what we believe was 11 months old, and he was propped with a pillow. But we also know he had just had his lip repaired, you could still see the scabs from surgery. This concerned the IA dr as well. BUT...the report looked great, and he was sponsored by Half the Sky! That meant that he was forming attachment, and in my heart I felt that if he had that, we could take care of the rest.

But still...the words "microcephally" "mental retardation" and "syndrome" kept me up at night. Clefting and small stature is very indicative of a syndrome, and that worried the IA dr. also. We just didn't know what to do.

In at the end of October we was 16 months, and we got updated measurements. His height was on the charts! Just above the 5th%ile. His weight and head circ were still below, but he had closed the gap a bit. But we learned he wasn't using words. After consulting with other adoptive parents, we decided that wasn't a big deal. But we weren't sure still. The IA doctor still sent us more literature to read, and then we got even more worried. I joined the yahoo group for microcephally and became even more worried.

We prayed for weeks for God to just make it clear, but everyday we were still in peril. My husband decided no, this was not our son. We decided we would call the agency the next day and pull our LOI. The risks were too big. I felt so guilty for even writing the LOI, and I wanted this little boy to be ours sooooo bad. What I failed to mention was we had turned away a referral a few days prior, and I was heartbroken over it. To turn away another file was devestating.

Then next morning we woke up, and my verse of the day on my email was clear answer we had been praying for: I Samuel 16:7: But the LORD said to Samuel, "Do not consider his appearance or his height, for I have rejected him. The LORD does not look at the things man looks at. Man looks at the outward appearance, but the LORD looks at the heart."

This did not mean that we knew Tyson would be fine, it just meant that we knew he was our son no matter what.

Here are Tyson's measurements that we have on him. They are approximate in some instances. Hopefully it will help someone.
*Gotcha

Length/Height:
8-9 months: 63.5cm, below the charts
16 months: 75.5cm, 5th%ile
22 months: 81cm, 5th%ile
*26 months: 83cm, 5th %ile
27 months: 84cm, 5th %ile
30 months: 86cm, 5th %ile

Weight--it's amazing what enough food can do!
8-9 months: 6.5kg/14.3lbs, below the charts
16 months: 8.5kg/18.5lbs, below the charts
22 months: 10.5kg/23lbs, 5th%ile
*26 months: 10kg/22lbs, below the charts
27 months: 12kg/26.5lbs, just under 25%ile
30 months: 30lbs, 50th %ile

Head Circumference
8-9 months: either 40cm or 41.5cm, all below the charts
16 months: 44cm, below the chart
22 months: 46.5cm, between 5th and 10th%ile
*26 months: 48cm, 25th %ile (I measured to confirm it too and watched 2 nurses as well)
30 months: 49.5cm, 50th %ile (based on my own measurement)

One of the things to note about Ty's head circumference is that he has a flat spot that has moved up the back of his head, which could be the reason for Ty's low head circumference measurements and why they suddenly showed up on the charts.

As you can see, just getting home and eating has made a huge difference. As I like to say, Ty is a shorty. He seems to be cruising along at the 5th%ile, and that's fine. But now he's just blossoming. His gross motor skills are developing nicely, and we could see in China that this child is SHARP! Even when he was assessed for devlopmental preschool, they said there was NO WAY he'd qualify for cognitive delays. He has problem solving abilities, understands cause and effect, etc...

This is not to say every child is this way. This is our story. We trusted the Lord, and He came through! Chinese measurements are scary. They can be low or high, accurate or in accurate. I think Ty's height measurements are very accurate, as even here at home, he's on the same growth curve.

OK, this has taken me all morning to write off and on, so I hope it makes sense! If you have questions, I'm happy to help with what I can.