Ask Dr. Gwenn

Small Head Sizes in Infants

Toddler Sleep Resistance

Jerking Movements in Infants and Infant Formulas

(Ask Dr. Gwenn Information and Disclaimer)

All families worry about whether their babies are developing "normally".  Concern is often more heightened when a baby's head is on the small size. Here are two questions I received recently on this topic. As you'll see, appearances can be deceiving and more times than not there is no reason for alarm:

Question #1

Dear Dr. Gwenn:

I had my son two weeks early due to IUG. We had an ultra sound at 38 weeks and his head measurement was not what they expected so I had a c section immediately. He was 5lbs 13 oz. and 19.5 inches long. He has grown on a normal curve but his head circumference has been just below the curve since he was born. He seems very content and has for the most part developed normally but I am concerned about his head size being too small.

His head at 8 months is about 42 cm. Am I worrying too much? I have read lots on the internet about microcephaly and it just scares me more!

CW

Question #2

Dear Dr. Gwenn:

Yesterday at my two month old baby’s well child exam, his doctor said his weight and length are good but his head size, 15 ¼” is a bit on the low side, in the 25th percentile. It was 14 ½” at his 2 week visit. She didn’t seem worried and said she’d keep an eye on it over time.

I have read that head growth equals brain growth. I am really worried that his brain might not be growing at a normal rate. I feel so bad that maybe we did something. Is there anything we can do to help? Have any of you had the same problem? Will he grow normally, intelligence wise? I don't want my baby to be picked on. I am so scared that his body might keep growing but his head size might remain the same or very small. Is that likely to happen?

Thank you. 

J.

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Even though these questions contain many differences, the most important fact they both share: both babies are developing normally and achieving their milestones.  That is the best evidence that we have for realizing a baby's brain is doing exactly what it is supposed to do.

Growth parameters can be difficult to evaluate and can cause alarm if you are not quite sure what to make of them.  Growth curves represent the entire population so some kids will fall on the high end, some on the low end, and many in the middle. What we look for is the pattern over time and not just the isolated percentage.  Also important is prenatal history and birth history.  Many babies are born with IUGR and catch up nicely over time.  CW, if you plot your baby’s head circumference from birth you may see that it is increasing along its own curve but since it started below it is just tracking there.

While we do worry about outliers, kids falling below or above the curves, we don't worry so much about kids who are at the lower percentiles but grow along that curve.   The  Head Circumference Chart  can be very helpful because we can see that a baby’s growth is progressing at whatever line it should be one.

Your baby will tell us his brain is developing normally by meeting his developmental milestones.    Check out our Infant Development page for more information about what your baby should be doing today and what to expect in the coming months.   As long as he is on track developmentally, you need not worry. One of the advantages of the frequent infant well child visits is to catch infants early who may need some early intervention and help with milestones. If you have any concerns about this, you should discuss it with your pediatrician. If she is not worried, you need not be worried.

Finally, as in these questions, parents often worry that they “did something” to cause this.  If you took care of yourself during your pregnancy and had regular care, you did your job.    All you can do now is love and nurture your son. That above all is what determines later success in life.  Intelligence has a great deal to do not only with nurturing when young but genetics. All any of us can do is accept our kids for whatever learners they end up being and help them be the best they can be.  Both these babies will look just like all the other kids when he is in school!

I would encourage both these families to talk to their pediatricians who know the facts of the pregnancy and the baby’s development better to get more reassurance.  Both cases are different but the statistics are on the side of good outcome for both kids.

How can I help my toddler sleep better?

Hello Dr. Gwenn,

We have a 25month old who rarely sleeps through the night. On average she wakes up 3 times a night.  She sleeps in her own room and bed.  We read and tuck her in bed and leave the room so she can learn how to fall asleep by herself.  She cries out and we quietly reassure that we are close by, whispering through the crack to her bedroom door.  Sometimes she gets out of bed and come out to us, we then send her back to bed and it takes numerous times and could last for 1 hour.  Eventually she falls asleep.  However she wakes up several times in the middle of the night and cried out for us.  We don't rush in right away but eventually have to go in to check on her and make sure she's dry and comfortable.  Sometime all we have to do is lay her down and put her blanket on her.  Other times she continues to cry.   

In the morning she doesn't seem tired, fussy or cranky.  During the day she naps for about an hour to 2 hours maximum.  We have been trying this strategy to get her to sleep through the night for over a month now, and it doesn't seem to be working thus far.  Do you have any suggestions ? The Ferber method didn’t work for us.

looking forward to getting some sleep,

thanks!

HC

Dear HC:

It may help you to know that often finicky toddlers become good sleepers. The problem here is sleep associations and that can be tricky as you’ve found out. Over time she has associated needing your intervention to fall back to sleep. You have a number of options: first, you could go cold turkey and just let her cry until she falls asleep. The more you do to longer this will continue. You could also try going in the room to reassure her but not touching her at all. Or, try the whisper through the door. One way to start would be to make a list of what you do when you go into her and slowly cut those things out.  Who usually goes in, you or dad? Or Both? If she’s used to you, have dad go in. If she’s used to dad, you go in. If both, alternate who goes in.

As for the initial put down to bed, consider a gate on her door so she is confined to her room or a lock from the outside so she can’t open the door but you can. That may be the best time to go cold turkey.

You can also play with cutting her naps down and see if being more sleepy at night helps.

I’ve lived through with one of my daughters the very situation you are facing and I know how exhausting it can be. Since she is waking up rested it sounds like she is asleep for many of these crying moments. That can happen sometimes where a child has an arousal from sleep but is not fully awake. If I were you, I’d do what I could to not go in at all. She will eventually fall back asleep even if you have a few rough nights.

Finally,

Ask your pediatrician for advice. We all have different strategies and getting a few ideas can be helpful.

Best,

Dr. gwenn

Dear Dr. Gwenn:

My daughter Jordyn was born on the 7th of September,  weighing 7.3 pounds and was 21 inches long, four days past due date.  No health problems. We had planned to exclusively breast feed but was unable to due to the lack of milk production. So, we started feeding her Enfamil/Lipil within the second day of her being home. Within the fifth day we noticed one of her arms jerking, contracting in a rhythmic pattern. The next day, both arms, almost looked like "ringing a bell" third day, the "jerks were all over, legs arms, chest, also in a rhythmic type movement, lasting for about 20 to 30 seconds.  By the last night, her eyes would open, become fixed during the episode, we assumed seizures and went directly to the ER where every imaginable test was conducted.  They showed nothing. She seems perfectly healthy.  My husband had made the comment that maybe she was having a reaction to the Lipil in the formula and that he "just had a feeling" that the formula was "over stimulating" her.  We changed formulas to Enfamil without the lipil and so far there have been no episodes.

No one will give us a clear cut answer about the formula or whether or not it could have been a severe reaction.  Is it at least possible that these seizure type episodes were caused by a reaction to the formula? Any information you could give us would be greatly appreciated.

Thank you,

Dear DJ:

I consulted with a Dr. Yuan, a Pediatrics Gastroenterologist at Massachusetts General Hospital who confirmed for me that Lipil is safe and that he’s never heard of infants having a reaction to it. He also pointed out it has little nutritional benefit over regular formula.

What you describe is unlikely a seizure. Young infants can sometimes have movements you described akin to seizures but are more sleep related movements. And, as you saw, they disappear by the time the baby gets beyond the neonatal period which is a month of age.

In the end, rest assured you did not harm your baby with the formula. You were wise to have her evaluated, however, just due to hear young age. I’m glad all worked out well and she is thriving today.