Worried about my little nephew's head circumference

[WiseElza]

Dear Mumsnet community,

I am new here but have been actively reading childcare threads since the birth of my dear nephew this year.

He was born three weeks premature through an emergency C-section due to oxygen deficiency in the womb.

He is now almost 7 months old, but has difficulty with head control and is not sitting up yet. At today's checkup with his neurologist, they measured his head at 41cm which, at his age put him at 1 percentile on the chart. He had trouble gaining weight but now he weighs a normal 8 kgs.

I am worried sick about his head circumference, especially because the doctor said his fontanelle gas closed.

I was wondering if you have had a similar case and what would you suggest?

Thank you

You do sound overinvolved! A MRI isn't risk free as at that age it'll need a general anaesthetic. Is it worth the risk if there's nothing they can change and he's already having physio to aid development?

@AriettyHomily definitely, I am aware of my over-involvement, and working on it. This thread had been an eye-opener too :)

Three weeks early is not premature. 3 weeks early is still classed as term.

7 months can be a tricky time for parents. You are at peak exhaustion. Probably the kindest thing you can do is cook a few good meals, babysit while they sleep, support their decisions and stop second-guessing and adding worry to their situation.

@WiseElza I think it is adorable that you are concerned for your nephew.

Ds1 was 4 days late, a normal 7lb 14oz baby but had a teeny head. 2nd percentile. Now he didn't look like he had a pea head compared to his body. But the HV continued to measure his head circumference every time we saw her (which was weekly as she ran a Mums and Baby class).

Anyway, the upshot is he still had a teeny head at 8 months old, again, it seemed to be totally in proportion to his body. I had completely forgotten that I too have a small head. Oops. So I got the HV to measure mine! When I shop for hats I am in the children's section of Accessorise, plus when I have bought a helmet to wear on bike rides I end up with a choice of children's helmets or teenage boy helmets, cue horrified looks from teens on bikes when I have the same one

She realised, yep, we just have small heads.

I think it is fine for you to be looking for ways to help your sister. Newish Mums can suffer from baby brain so having another person look things over is good, especially if you are close to your sister. You know what is going on with your nephew so clearly your sister is sharing information with you. I hope everything turns out well.

Can't help with the head issue, but just to say it's not unusual to but be sitting at 7 months. My (massive headed) son's wee both nearer 9 months before they sat properly. Then walked at 12 and 11 months

@bluebluezoo his heartbeat was constantly low and he wasn't growing well in the womb, to the point where they decided to go for an emergency C-section. He has since gained weight and is in the normal range for weight and height, which is great! I am glad that your daughter is well, thank you for sharing your story, helps a lot

I mean this kindly but my son was very poorly as a baby and we spent lots of time having medical appointments and hospital stays.
It was really difficult having family members googling and sending me advice/articles which I didn’t need because the doctors knew what they were doing.
It resulted in me not telling them anything and asking them not to visit us in hospital as it was just too stressful.

As long as he’s on the chart it’s usually ok. He could just have a small head. And with all due respect if you weren’t at the meeting with the pediatrician you wouldn’t know what was said. I highly doubt that if his fonatelle had closed the pediatrician would be so casual about it. There would be further tests.

@BluePaintSample thank you so much! My sister and I are very close, although I can be exhausting, I admit. I try to not voice my worries with her but give her some pointers for her appointments. We love miles and miles apart, and I am not able to physically be with her, which does not help at all.

Thank you for sharing your story, I am so glad it worked out for you!

If he was premature he will be followed up
By the neo natal team and they will monitor his head circumference. Step away from Dr Google.

OP my son is 7.5 months old and only just started to sit up on his own as soon as he turned 7 months old, he also has a rather flat head at the back and was born at 38 weeks and weighs 8kg. So everything is similar apart from the head circumference, I havnt measured his but he seems proportional so didn't cross my mind too. Does your nephew look like he has a smaller head in comparison to his body?
It's good that he's already getting physiotherapy, it's good that you're all on top of it.

You do need to step back. This is not your baby. You can't just demand an MRI as a pp said, it needs a GA.

Your nephew is lucky to have a loving aunt like you. But do chill out a bit as he is already under medical care so will be well looking after. Also it's not good for you or the parents to have extra stress. I would also be wary of giving/ getting different advise from the medical professionals.
My nephew had a flat head and he is fine. Perfectly normal for a baby that isn't sitting yet.

Keep telling your sister that
Whatever and however he develops he will have a happy life and be loved and you will be there for them.
If they asking your views sure you can suggest they see paediatrician and given history an mri may be on the cards if paediatrician orders it.. Doing such tests when he isbaby and knows no different can be a good way forward.

3 weeks isn't premature so no need to call him prem or adjust dates.

Some babies do things later than others, some need some extra encouragement, some just have small heads. He's having the physio and being monitored by a neurologist, they are the people your sister needs the advice from not strangers on the internet.

How does your sister feel about your over involvement? Is she concerned about this?

As it's your nephew, not your dc, the best thing you can do is tell your sister he's adorable and let her deal with the health professionals.
If you start suggesting things (MRI in infants needs a general, so should only be done if necessary as by no means risk free) then firstly, you may not have the information she has, but also you're implying that you care more than her and she's failing by not demanding what you think should be done.

For what it's worth, ds had a tiny head-8% dropped from 50% at birth to 8% at 6 week check.
The GP gave me a grin and said, that they'd keep an eye on it, but the most likely explanation was that head measurements are not very accurate and the chances are he'd always been 8%. At that age 1cm can make a difference in the percentages.

They checked his head two or three times more. It stayed at the 8% (it's not so much the size, so much as is it growing) and he's had no issues.

I think though, when you are talking to your sister, you need to calm down a bit. It won't help her if she's worried, having you flapping. And if she's not worried, then your flapping will come across as very attention seeking.
You're using dramatic language-3 weeks premature is born at 37 weeks, which is counted as full term, for example.

Just talk about how gorgeous he is and assume your sister will tell you anything she wants you to know on his health. If she does, listen and let her vent. Don't go in trying to offer solutions.

When we got foster son he was 5 but in age 3 clothing and baggy on him. He was in bottom 1 percentile for eight, height, did not know his colours or even name a cat or dog and had trouble walking as such poor coordination. His head circumference was small too. Now he is 14, he caught up in terms of weight and height by 9 or 10 and his coordination is amazing. He is a county cricket player and swims for his district. Is he happy? That is the main thing.

I disagree with those saying you’re over involved if that’s what your sister is happy with. I’m so close with my sister our kids are all basically each other’s and I wouldn’t say we are over involved. Just that we are involved.

The flat head at the back is so normal since the back to back sleep campaign- kids now sleep on their backs so spend way more time lying on the back of their head.

I got my eldest this:
www.amazon.co.uk/Future-Founder-Orthopaedic-Deformation-Washable/dp/B089GVS8YK/ref=mp_s_a_1_4?dchild=1&keywords=flat+head+pillow&sprefix=flat+head&tag=mumsnetforu03-21&qid=1597312152&sr=8-4

For his flat head- I didn’t use it at night time though just when supervised like in his pram or playing on his jungle gym mat thing!

Did your sister go to a country with zika when pregnant? If not, I wouldn’t even give microcephaly another thought!

He’s lucky to have such a caring Aunty

Microcrphsly and numerous genetic de novo conditions can occur anywhere. And anybody. May not be pucked up in prenatsl tests.
A seven month old with poor head control (and a reported lack of oxygen) is cause for concern and assessment.
And tests.
No one can say long term implications yet. But
Dont dismiss it .

It isnt helpful to say oh well my coousins nephew had small head etc now goes to oxford. You are right to support your sister to continue to get physio and assessment with pardiatrircian.. the head size may or may not be an issue.

But in the end whatever issues the baby can be loved and can be happy
Op you could post on the special needs board if your nephew continues to develop slowly they wont dismiss your concerns.

(Have Ds with a genetic microdeletion condition )

Completely agree @Embracelife it is a cause for concern but it sounds like his parents have already got the appropriate professionals involved so it will play out, as it will play out. I say this with experience.

MRI's can be done at any age, including while in the womb. My son had one at 2 days old. It's not risk free though and the drs will only do one if they think it's necessary. You need to stay away from dr google (easier said than done I know). Your nephew is getting great care from a neurologist and physio.