Parents of prems: growth curves question (head circ)

[hub2dee]

Hi,

Supposed to be in bed, but can't quite get this out of my head...

dd, 19 weeks old (4 weeks prem, IUGR) has grown in length and weight to 50th centile, which is great news, and developmentally seems 100%.

However, we saw the paed today and head circumference, whilst increasing between visits (and fontanelle still nice and open), has dropped from between 9th & 25th lines at birth to between 2nd and 9th today. It looks like we might get referred...

Anyway, whilst I appreciate the errors involved in measurement, and that there can be individual variance in head size etc... I wondered if others had had similar experiences (ie. uncorrelated weight / length and head circ), or prems catching up weight / length but lagging in head circ...

Thanks for any comments. Probably off to bed v. soon but will check / bump in the AM.

IME kangaboy's head was shaped in a "normal" extreme premature shape, which is extremely flat on each side {from being in incubator for 3 months} instead of floating about in womb IYSWIM

So when he came home his head gradually over next 2 years went into regular shape although 10 years later still has different shape at the back

my waffling means that could it be that her head is changing shape

or more likely it wasn't measured from same place ie was it from top of eyebrows or top of ears ???

Sorry I can't add anything here - I don't know much about baby's development once they are outside parameters for midwife visits!

As you so rightly say, there are so many variables such as different people measuring in different places. As there has been growth between visits though, that is very reassuring. Also reassuring that everything developmentally is OK.

It won't be a bad thing to monitor things a bit more closely by being referred. Does not mean that there is anything wrong. Hopefully someone will come along soon with experience.

Thanks Kanga, mears.

I think the community paed measured from the 'furthest out' spot at the back to the midline between eyes and hairline IYSWIM... (I think this is their target, although it's fairly tricky to hit)....

I imagine head shape is the last thing to 'normalise' as you point out, Kanga, so it could well be, given a bit more time, dd will slowly grow her pretty little head to a slightly more normal size.

Will bump over a few days to catch other input. Thanks.

Hub2dee, sorry if this is no help whatsoever but anyway.
Ds wasn't early but he was small for dates all the way through (even tho I was enormous)
When born HC was 60th, weight 25th. But at three months the HV noticed a drop in weight to 9th and a growth in HC to 91st! Sent to gp who didn't seem as worried as HV and said we'd monitor as he seemed fine developmentally. He's now 1yr and seems fine. HC is still 91st but weight has gone back up to just above the 50th.

I know it's the other way around and probably no help but in our case, uncorrelated weight/HC did not spell a problem.

Hope she is well.

Interesting to see the wide variation and subsequent swings, hm !

On one hand it might pay to disregard these growth curves, but on the other hand they can give useful early warning signs...

hmmm....

Yes, in our case I think it was less of a worry because it was the weight which seemed to fluctuate so much. HC did grow but then has stayed pretty constant since 3mths.

hub2dee, My ds2 was 4 weeks early, and is now 20 weeks. He has a tiny head, but also plagiocephally where the back of his head is flat, his head is on the 2nd centile, his length 75th and his weight has gone down to the 9th from the 50th. All very stressful and confusing, My GP has no worries about this, and is said to keep an eye on it. She said the fact that he is developmentally well is the main thing they go by. still doesn't stop me worrying though !
let us know how you get on
vicky

Hi vicky, your ds is just one week older than my dd ! Cute. Are you on the June antenatal threads ? (I post sometimes on the July, token bloke).

Sorry to hear about ds's plagiocephally - I presume you saw the multiple posts yesterday on the topic - looks like a good yahoo support group. Was wondering about dd... she sleeps for England - HOURS upon HOURS of naps during the day and massive night stretches ! (I should probably shut up and just count myself lucky, but one's mind does play 'what ifs').... Just out of interest, apart from repositioning exercises, do the docs suggest particular mattresses etc. with more support ?

It's kind of funny, but there isn't exactly a lot of supporting information / materials available to accompany these growth curves is there - pictures of tall / skinny babies, short / fat, babbas with bigger heads and babbas with little heads, how premies compare to term, how variations in weight etc. can be still deemed within 'normal' limited etc. etc.

Hub2dee- awww we should fix them up together !!
I was on the threads, but got very lapse and havn't been there for a good while !

I have invested in a goi goi pillow from Sweden for ds, they are government recommended from birth to stop pagio over there.
I have been repositioning and his head is getting more curved by the week which is fantastic !
On your centile chart are you plotting back by 4 weeks ? DS2 is still only on the 9th, and if I plotted him for 20 weeks he would be on the smallest of 0.4 I think !
My Gp also checked his fontenelles, which were fine. The differences between children is amazing, my dd was 2 weeks early and was off the chart for a big head !

Hub2dee, I was talking to someone recently about ds3 being prem, he was 8 weeks prem. I was discussing how a lot of people had said to me that a 7 months baby "does better" than an 8 months baby and was wondering whether it was just an old-wives-tale as no paediatrician had ever said any such thing but a nurse in hospital had said it to me just before my Emergency C-Section.
I didn't know whether she was just trying to make me feel better about having a 32-weeker! This person, actually just a customer at work,no medical qualifications! said that she had heard that a 7 months baby is better proportioned than an eight months baby, that their heads are more in correct proporiton to their bodies when compared with a full-term baby. In the next 4 weeks of gestation, the head grows more than the body, so the organs, liver, heart etc have a more difficult job if the baby is born at this stage. After this, the body grows faster than the head again. Maybe Camille is just growing into the prortions she was meant to have, IYKWIM
BTW my ds1 slept all the time as a baby, he tuned out fine, didn't appreciate it till I had ds2 and ds3!
Maybe its just that she's developing the proportions she was supposed to have? Head size can run in families, too, all mine have big heads but so do dh and I

Don't know if this is of any help, but my daughter was also born 4 weeks prem, IUGR. She was on the 0.4th centile for everything.

At about 6 months she was on the 25th centile for her head circumference and height and the 10th for weight. She is now 18 months old her head circumference has dropped to the 10th along with her weight and she is above the 75th centile for height.

No one I have ever asked in the medical profession seems concerned about her head & weight re her height - despite me posing the question pretty often!! Developmentally she is right on track and that seems to be all they are interested in.

vicky - some of the threads move very fast, LOL... just jump in occasionally and say hi - that's the easy way ! Sounds like the pillow is helping. Yeah, at 19 weeks we're plotting on the 15th week line.

chip - never heard that 7 month vs 8 thing. Interesting, but not sure it stands up to stats - at least re survival, which obviously is increasing likely the longer the gestation IYSWIM. I suppose what you outline re head and organs might come into play. Yeah, child2 could well be a big shock for us, LOL ! Will be fun to have our heads measured, LOL. Last time was for uni graduation !

awayfromhome: Yes, it does seem they basically focus on 'the big picture' - ie. are you seeing normal development...

Thanks again for all input.

Both my dds had heads that were at the bottom of the growth charts. GP was about to refer dd1 but then we moved and nobody else expressed concern. We worried and worried since she had a traumatic birth and we didn't have a clue how babies worked so didn't know if she was ok but when she started walking at 10 months we realized she perfectly fine! Now 3 1/2 and obviously very lively and clever.

Still having frequent visits from HV to weigh dd2 and measure head also cos she was 4 wks prem (you know this is only just considered premature) and has a little head as well as being skinny but she's now 16 months and again is obviously absolutely fine and walking and talking. One of my midwives told me that we're obsessed with weighing and measuring in this country and it causes parents all kinds of unncessary anxiety and my experience tallies with this. If it weren't for the charts it wouldn't occur to you to worry. This is especially true with breastfed babies (which mine were) where the charts don't apply as these are worked out with bottle-fed babies. Compared to bottle-fed babies my children were much lighter but this is normal and, of course, breastfed babies are healthier despite being lighter yet there's a lot of ignorance about this in the health profession and elsewhere. The charts are based on averages and don't take into account individual circumstances and genes (dp has a small head too for example but the chart doesn't take this into account). I find that I often know more than the HV and can see dd2 is absolutely fine and find her visits intrusive and unncessary (quite like her though so haven't got the heart to tell her to go away). Hope this helps.

Thanks for your post spiderfan.

Yep, 4 weeks prem is just inside the 'official' label of 'term' (37+ weeks), but dd also experienced IUGR because of maternal blood pressure issues affecting the placenta etc. so she came out even more skinny / small than a 36 weeker should be IYSWIM. Thank you for sharing your outcomes though ! (cute little video of her at 10 days here . (Requires latest Apple Quicktime ).

I agree with your sentiments re the charts. It's ridiculous that there is not more associated information available, or at the least, text to explain how bf babies might experience less weight gain but still be fine etc. etc.

Anyways, we are seeing a pediatrician on Tuesday (privately, grrr) because the NHS appointment would have been Xmas / mid Jan, and we'll be away, so wanted to get the ball rolling sooner rather than later were any further tests / scans etc. required.

I'll post after we've seen the doc. I think at this age, though, the real determinant of whether any of the growth characteristics (length / weight / head circ) are alarm signs is how the child is developing overall, and, thankfully, dd seems to be 110% OK !

Hi my DD has plagiocephaly (flat head syndrome) & her head is the opposite to your dd - it's bigger than her weight/length... Not sure whether this is to do with her condition, however our craniofacial neurosurgeon didn't seem worried etc... I guess babies just develop differently & also it depends upon who measures their head...

hi hub

my twins were prem by 11 weeks and twin 2 has same problems.

they are 22 months and he weighs 19 lb now, his weight is dipping drasticlly. say his height and head circ is not to hot either he is just below 2nd centile.

we have loads of refferals going on

MummyVicky, what is the pillow that you mentioned? WHere did you buy it from?

jambuttie - maybe you could revive this thread if there are any great 'findings' / progress / discoveries / treatments etc. ?
Good luck !

MIL wants us to try craniosacral therapy.... she is deeply interested in many of the complementary / alternative treatments (which is interesting for a retired doctor), but they don't really fit into my v. v. sceptical / scientific approach at all. I can appreciate the benefits of direct musculo / skeletal manipultation in osteopathy, but from what I've read re: cst, it's untestable and unverifiable with no peer-reviewed, published, randomised controlled tests. (Which is the sort of thing which would make me consider it very much more openly). I know there are many MNers who have used cst (I searched the archives - many feel it benefitted, a few didn't), but I am a strong believer in the placebo effect and also in the 'time heals all' phenomena (ie. collicy babies get better as they age... if you have 5 treatments every week from when baby is 5 weeks, they will be much better / less pain etc. when (often, IMHO) you would see such improvements anyway).

Oh well, suppose I should start a cst discussion rather than ranting in this thread, LOL !

will do hub no probs

ChicPea its called a goi goi pillow, from Sweden.
This is the website: here

Ds2s head has really improved in a month, due to the pressure not being on the back of his head.

Thanks for that MummyVicky!!

Just to say we had our ped appointment today. Basically, he felt dd's developmental progress seemed spot on and thus the small head was likely to not signify anything seriously wrong... I kind of suspected this was as advanced as the analysis would go at this stage, but it was good to get it first hand from a pro.

We'll check measurements in a few months and take things from there. If she continues to decline through the centiles possibly they would do brain scans etc. but he basically said that even if she continued to sit on a lower centile line, this was still within 'normal limits' and given continued normal development, fontanelle OK etc. etc. she probably just has a small head !

We got our heads measured too (both very large apparently !), so why dd should have a small head remains a mystery, LOL.

Hope this post maybe helps someone in a similar position in the future.

Thanks for letting us know hub2dee, nice to know she is fine!!
She is just dainty then!!

Hub

Sorry, have no idea about the head thing, but anyway it sounds as if it's all under control. Just wanted to butt in about your concern about your dd sleeping a lot. My dd1 was exactly the same. She was born in quite similar circs to yours. (4 weeks early but small for dates. She was 4lb 12oz. I had placenta praevia and we think the slow-down in her growth was caused by the fact that some bits of placenta had come away before she was delivered.)My dd was extremely sleepy at birth (she'd sleep for about 23.5 hours out of 24) and completely uninterested in feeding. She stayed very very sleepy for a long time and people were always commenting on it (usually in envious tones, but it did used to make me feel anxious about her development). However, she developed totally normally, is now 5 and doing well at school etc. She still sleeps incredibly deeply and will happily sleep for 12-13 hours a night. I normally have to physically wake her up at 7.30 a.m. to get her to school. On the other hand, she stopped sleeping in the day on her first birthday (unless driven around in the car), which was tough for a while. I believe that her initial sleepiness was caused by her prematurity/under-development, but that she then just got into the habit of sleeping well and deeply and has kept that habit. That's just a feeling though - it could be that she was always going to be a sleepy child. Dd2, incidentally, is just the opposite. She has taken to coming into our room at any time from 1 a.m. onwards announcing 'I think it's day now, I've been asleep for a very long time'!!! Good luck with everything, and I hope this helps a bit.

Yes, Vicky, she is destined to be tall and slender and elgant, not at all like mum and dad, LOL.

Hi JEB, LOL @ the envious comments re: sleeping synchronising with a tiny bit of parental concern regarding the little one. Same here ! Massive sleep at night, fair few hours in the morning, more around lunch / afternoon etc. etc. I'm failry sure it's just a blessing and in no way indicates some problem, but, hey, who wouldn't worry (especially with one's first) ? LOL