Should I worry about autism if my infant grandson's head is getting large?
Q) Dear Dr. Gwenn:
My grandson recently had his 9 months check up. At birth and 3rd month check up his head size was in the 55% range. His weight and height wereclose to the 90%.At the latest 9 months checkup, his head size was in the 90th% and his weight and height were lower than the earlier months, more like 75th percentile. His developmental milestones have been very normal or above. He's smiley, happy, eye contact, verbal--lots of sounds including mama and dadada---. He crawls everywhere and up on everything. First child for my son and daughter.
I've been reading online that rapidly increasing head size particularly towards the end of the first year may be an early indicator of autism. Should his parents and I be concerned?
-concerned grandma
A) Dear Concerned Grandma:
The first point I want to make is that your grandson is still on the growth chart so that is very reassuring. Plus, whenever there is a single jump in head circumference at a visit, measuring error always has to be considered. To have a truly “large” head, the kind we worry about when considering any sort of pathology, the head usually grows literally off the chart and there are often developmental issues. Neither of these situations are occurring with your grandson and that is very, very reassuring that he is A-OK!
Evaluating infants with expanding head size includes many possibilities with autism being on the list but much lower down than other, more common, nervous system conditions that also cause developmental issues. Pediatrician Ari Brown, MD, author of Baby 411 and Toddler 411 agrees. “Rapidly increasing head is just one finding with autism", Dr. Brown told me via an email interview. "I worry more about (other issues) when I see this but certainly keep my eye on developmental milestones when the head is enlarging.”
So, my best advice would be to talk to your grandson’s pediatrician about his head growth to see if it is truly enlarging or has just jumped a size but not to worry too much. And, keep in mind that more times than not, big heads are just big heads – and often run in families!
By the way, the American Academy of Pediatrics is very interested in helping parents identify autism in their children as early as possible and in October, 2007, came out with some very important guidelines for diagnosis that help us now identify children in infancy and as toddlers. From their press release, they list the following as “subtle signs” that autism may be present in an infant or young toddler:
- “not turning when the parent says the baby’s name;
- not turning to look when the parent points says, “Look at…” and not pointing themselves to show parents an interesting object or event;
- lack of back and forth babbling;
- smiling late; and
- failure to make eye contact with people. "
