american academy of pediatrics what age to stop measuring head circumference

In 1968, Nellhaus documented the continuous growth of the cranium of boys and girls through 18 years of historic period. In reviewing 14 reports in the literature, he institute there were no meaning racial, national, or geographical differences in head circumference size through 18 years of age.¹¹ He indicated that pediatricians should document head circumference growth through 18 years of age. In 1980, Weaver and Christian documented the importance of comparing head circumference of the child evaluated by the pediatrician to that of the parent.²⁰ He recommended that biological parents accompany the child to the office visit so that the head circumference of the child could be compared with that of the parents.

Emphasis has been placed in wellness intendance agencies, wellness care insurance documents, and other sources of information for chief care providers to measure head circumference up to 36 months of age,^1,ten,19 with limited emphasis for the role of caput circumference measurements after 36 months of age despite documentation that the cranium continues to grow until 18 years of age.^6,12,xvi The purpose of this report is to review the importance of measuring caput circumference through 18 years of historic period. The rationale for this includes, but is not limited to, documenting the caput size in proportion to the child's other growth parameters, the rate of growth over time, and the child'due south head circumference in proportion to that of the same-sex parent, and initiating appropriate diagnostic workup if there is an unexplained microcrania, macrocrania, or significant modify in the charge per unit of the growth of the attic during infancy, childhood, or adolescence. We also addressed whether the referring pediatrician and/or the pediatric subspecialist measured head circumference of the kid after 36 months of age, and whether these treatment providers measured the caput circumference of the aforementioned-sexual activity parent.

Methods

Patient Population

In the period from January 2004 through December 2007, the lead author examined approximately 190 children referred by pediatricians or pediatric subspecialists because of concerns related to the head size of the child. Seventy per centum of these patients had undergone some grade of neuroimaging prior to referral (cranial ultrasonography, CT, or MRI), ordered by their primary care provider because they believed neurosurgery would not perform a consult without the availability of imaging.

We and so wanted to study the issue of caput size in children besides as the need for neurosurgical consultation in more than detail. A proposal was submitted to the University of Florida (UF) Institutional Review Board to study the issue of the impact of neurosurgery consultations due to a given child'due south head size on the categories of macrocrania and microcrania. The Board members were informed that more than 90% of those who underwent imaging prior to referral had no abnormal findings. They requested that the authors focus on a demonstrative group that would highlight the instance sampling of macrocrania and microcrania and emphasize unnecessary neuroimaging. The focus was to be office of the review of the charts of the Neurosciences Dispensary patients that was and so ongoing for the menstruum of 2008–2009. Therefore, a retrospective nautical chart review authorized by the UF Institutional Review Board was performed past the UF Divisions of Pediatric Neurosurgery and Clinical Genetics on patient charts from January 2008 through Dec 2009. As part of the physical exam protocol, all of the patients evaluated had their head circumference measured and charted on the Nellhaus Scale regardless of age or reason for referral.¹¹ For the purpose of review and clinical sit-in, we volition present the patients grouped into 3 categories: ane) patients with macrocrania; 2) patients with microcrania; and iii) patients with unrecognized macrocrania.

Patient Groupings

The outset subset of patients was referred by the primary care provider or other referral source to the Pediatric Neurosurgery Heart for the concern of having a head that was too big for the patient's age.

The 2d subset was patients evaluated by the primary care provider or other referral sources referred to the Pediatric Neurosurgery Middle and/or UF Division of Clinical Genetics for the chief concern of a small caput circumference. These patients were adamant past the referring source to have a "caput too modest for their age."

The last subset was patients referred to the Pediatric Neurosurgery Center who, in childhood or adolescence, had undetected macrocrania at the time of referral from the primary care provider or other referring source. These patients were referred because of concerns including, but not limited to, changes in beliefs and/or neurological findings that could be associated with intracranial pathology, or patients who had neuroimaging procedures every bit role of the primary care workup for neurological findings, with intracranial pathology. All of these patients had a common characteristic of macrocrania that was not recognized past the referring source.

Results

Results are presented for sit-in of the diverse referral categories for the purpose of a focused give-and-take on the subject affair.

Patients With Macrocrania

There were a total of 11 patients referred to dominion out whatsoever underlying etiology that was causing progressive intracranial pressure because of the business organisation "the head was too large for the corresponding age of the patient." Eight patients underwent neuroimaging procedures prior to referral (Table 1). None of the patients had their caput measurement compared with that of their same-sex parent prior to imaging and/or referral. When evaluated in the Pediatric Neurosurgery Center, the head circumference of the patient was compared with that of the same-sex parent, if he or she attended the visit.

TABLE 1

Macrocrania in infancy^*

Case No.	Age at 1st Visit (mos)	Imaging	Physical Examination	Head Circumference†
				Infant	Same-Sexual activity Parent
1	2	Cranial ultrasound	Normal, total fontanelle	98	95
ii	9	None	Normal, concave fontanelle	90	80
iii	12	Cranial ultrasound	Normal, concave fontanelle	98	98
4	two	None	Bulging fontanelle, "split" sutures‡	98	threescore
5	8	None	Normal, concave fontanelle	98	98
6	12	Cranial ultrasound	Normal, flat fontanelle	98	90
7	6	Cranial ultrasound	Normal, apartment fontanelle	70	65
viii	xi	Cranial MRI	Normal, small anterior fontanelle	98	98
9	13	Cranial MRI	Normal, small anterior fontanelle	98	95
ten	ten	Cranial MRI	Bulging fontanelle‡	98	45
11	19	Skull radiographs	Normal, no fontanelle	98	98

Nine patients had a head circumference that was proportional in percentile to the same-sex parent on the Nellhaus Calibration.¹¹ On examination they were all normal. The diagnosis of familial macrocrania was made. No further interventions or imaging procedures were performed. A representative patient of this subset is presented in Fig. 1.

FIG. 1.

Head circumference nautical chart of i of the male person infants referred due to macrocrania at 12 months of historic period (blueish foursquare). The father'south head circumference is plotted on the graph in the 98th percentile at xviii years of age (green square).

Six of the 9 patients were diagnosed as having "benign subdurals of infancy," as originally described by Robertson et al.,¹⁴ and now more often referred to as "benign extra-centric fluid collections."⁷ These patients underwent imaging procedures prior to the referral for macrocrania. No further interventions or surgical recommendations were performed.

Two patients, 2 and ten months of age, had a caput size that was disproportionate to that of the parent of the corresponding sexual practice. On neuroimaging, both these patients had hydrocephalus secondary to aqueductal stenosis. Tabular array ane summarizes this subset.

Patients With Microcrania

V patients with ages ranging from 5 months to 7 years were referred because of the business organization of microcrania and the possibility of associated craniosynostosis (Table 2). All patients in this subset underwent imaging studies prior to referral. None of the patients had their head circumference measurement compared with that of their same-sex parent prior to imaging and/or referral. In the Pediatric Neurosurgery Center, the patient head circumference was compared with the aforementioned-sex parent, with the exception of ane patient, whose corresponding parent was not available for cess. Three patients who had a normal examination and whose head circumference corresponded to similar percentiles of the same-sex parent were diagnosed as having familial microcrania. One female had congenital hypothyroidism and a disproportionately smaller head circumference than her female parent. The plain skull radiographs revealed patent cranial sutures. No farther interventions or diagnostic procedures were performed. The patient was undergoing follow-up by pediatric endocrinology. The subsequent caput circumference measurements indicated the patient's cranium was notwithstanding growing on the 2nd percentile of the curve.

Table 2

Patients with microcrania^*

Case No.	Age at 1st Visit	Imaging	Physical Test	Head Circumference†
				Babe	Same-Sex Parent
1	8 mos	Head CT browse	Pocket-size anterior fontanelle, metopic suture ridge	two	NA
2	v mos	Skull radiographs	Small anterior fontanelle	xx	fifteen
3	seven mos	Skull radiographs	Modest anterior fontanelle	20	10
iv	11 mos	Skull radiographs	Small inductive fontanelle, metopic ridge	20	15
5	half-dozen yrs	Cranial MRI	Small nose, long eyelashes, upslanting palpebral fissures, pocket-sized child	Under 2	60

One patient was referred at vi years of historic period because of microcephaly. Her head circumference was at 46 cm, plac ing her below the 2nd percentile. The mother'southward head circumference was 56 cm (60th percentile) and the begetter's caput circumference was threescore cm (well above the 98th percentile) (Fig. ii). The child had a minor olfactory organ, long eyelashes, upslanting palpebral fissures, broad cervix, and short stature. She had a faint phonation and was nonverbal. Tapered thin fingers and small feet were also noted. Chromosome and claret-cell assay showed a small deletion of chromosome v (46,Xx, del5p15.two). Deoxyribonucleic acid fluorescent in situ hybridization targeted the region of chromosome 5, which is associated with the syndrome of Cri-du-chat, which finally confirmed the child's underlying status causing microcephaly, providing a clinical prognosis. Tabular array 2 summarizes this subset.

FIG. ii.

Head circumference nautical chart of a kid (blue square) referred at vi years of age due to cerebral palsy. The parents' head circumferences were likewise charted (mother = red square, father = dark-green square).

Patients With Unrecognized Macrocrania

There were iv children referred because of symptomatology, merely who had macrocrania undetected by the main care provider. None of the patients had their head circumference measurement compared with that of their same-sex activity parent prior to imaging and/or referral. At the time of evaluation in the Pediatric Neurosurgery Heart, physical examination revealed head circumference well above the 98th percentile on the Nellhaus Scale.¹¹ All patients had a history of subtle simply progressive deterioration for months to years.

At the fourth dimension of referral, the 4 patients were 5 (n = 1), 6 (n = ii), and 14 (n = 1) years of age. The starting time patient (5 years former) had a very big retrocerebellar arachnoid cyst. The head circumference at nascency was in the 2nd percentile, and at the time of examination he was above the 98th percentile (Fig. 3).

FIG. 3.

Caput circumference graph of a child referred at 5 years of historic period considering of headaches. The patient'south head circumference was plotted dorsum to birth from the pediatrician's notes.

The second patient had a head circumference well above the 98th percentile (60 cm at half dozen years quondam; Fig. 4). He had been referred to clinical genetics for a possible syndromal disorder due to astringent motor and developmental delay. On imaging he had severe obstructive hydrocephalus secondary to a midbrain glioma.

FIG. 4.

Head circumference measurements of a 10-year-old kid (blue squares) referred at the age of half-dozen years because of developmental delay and hypotonia. His macrocrania was not recognized.

The third patient (as well 6 years old) was evaluated considering of developmental delay and hypotonia. On exam he had macrocephaly (head circumference 57 cm), a prominent forehead, broad face, poor musculus tone, joint laxity, and delayed milestones. The male parent's caput circumference was 59.5 cm, which is greater than the 98th percentile, indicating macrocephaly (Fig. 5). The male parent was noted to have a history of hypotonia and was "a late bloomer." He had a sedentary lifestyle and never participated in sports. Further familial history revealed large heads in both parents' families, which led to a suspicion of a syndromal disorder. A brain CT scan had been performed at 4 months of age because of hypotonia and a big head, and mild ventriculomegaly was present at that time. Magnetic resonance imaging of the brain was performed at half-dozen years of age and revealed balmy ventriculomegaly, but was otherwise normal. Due to the in a higher place history, genetics testing was performed for Sotos syndrome. The NSD1 gene was positive, which confirmed the diagnosis.

FIG. 5.

Caput circumference graph of a child (blue square) who was referred with unrecognized macrocrania with progressive and severe motor and developmental delay. Imaging revealed severe hydrocephalus due to a midbrain tumor. The parents' head circumferences were besides charted (mother = red square, father = dark-green foursquare).

The 4th patient presented at 14 years of historic period with a 5-month history of headaches, intermittent facial numbness, and ataxia. The patient's head circumference (59 cm) was well higher up the 98th percentile (Fig. 6). Magnetic resonance imaging revealed severe hydrocephalus secondary to a pontine and cerebellar astrocytoma.

FIG. six.

Head circumference graph of a child referred at xiv years of historic period with a 5-month history of headaches, ataxia, and facial numbness. The patient had obstructive hydrocephalus due to a tumor.

Head Circumference Measurement Afterwards 36 Months of Age past Pediatricians and Pediatric Subspecialists

In reviewing the referral sources of the patients referred to pediatric neurosurgery because of head size concerns, we identified variations in practice patterns as they relate to measuring the child'due south head size later on 36 months of age, as well every bit to measuring the head size of the biological parents. Clinical geneticists consistently measured the head size of patients afterwards 36 months whereas pediatricians and other pediatric subspecialists did not. These findings are summarized in Tabular array 3.

TABLE 3

Pediatricians and pediatric subspecialists and measurement of head circumference after 36 months of historic period

Head Circumference Measurement	Primary Care Pediatrics (northward = 25)	Clinical Genetics (n = 3)	Pediatric Neurology (n = half-dozen)	Pediatric Endocrinology (n = 2)
Measures head circumference after 36 mos	0	3	0	0
Does non measure out after 36 mos	25	0	vi	2
Measures head circumference of aforementioned-sexual activity parent	0	three	0	0
Does not measure aforementioned-sex parent	25	0	six	2

When the lead author queried the referring pediatricians and pediatric subspecialists as to why they did non measure the head size after 36 months, and/or consider measuring the head size of the parent when concerns arose about the head size of the child, the most common response was they "did not have head circumference charts that went past 36 months of age." These findings are listed in Table 4.

Table four

Reasons given by pediatricians and pediatric subspecialists for not measuring head circumference after 36 months

Reason	No. of Patients
Exercise not have caput circumference charts >36 mos of historic period in our office	28
The AAP does not recommend measuring head circumference >36 mos of age	three
The caput does not grow afterward 36 mos of age	2

AAP = American University of Pediatrics.

Give-and-take

In 1968, Nellhaus published head circumference tables for boys and girls from birth to 18 years of age, calculated from 14 reports in the literature since 1948.¹¹ He concluded there is no pregnant racial, national, or geographical difference in head circumference. He prepared graphs for males and females from the calculated grand means and standard deviations of each sex at birth and at i, three, 6, 9, 12, 18, and 24 months, followed by yearly intervals through age 18. He plant at all ages the hateful head circumference of males is 0.ix cm larger than females, and that caput growth nether 2 years of historic period is more rapid for boys than in girls, but so it levels off. The subsequent major growth of the caput occurs in girls between ten and 14 years, and in boys betwixt 12 and sixteen years of age.

In 1985 Ounsted and assembly reported on a study of series head circumference measurements (from birth to seven years of age) of 270 children built-in in Oxford hospitals between 1970 and 1977.¹² Results were then compared with those plotted for 1400 children from London published in 1926, and a tertiary series reported for the menstruation 1944 through 1948.^17,18 The children reported past Ounsted et al. had significantly larger heads at all measured ages from that of the ii earlier series.¹² The author noted that this positive secular trend indicates the need for growth charts to be updated with each succeeding generation.

Reports on standards for height and weight from nascence to maturity are readily available and not only plot chronological evolution, but likewise place height and weight velocity of growth from birth to maturity.^xvi–xviii Velocity standards differ from altitude standards. In velocity standards, a child does not have the aforementioned stiff tendency to stay in the aforementioned centile position from one age to the other, because there is always a reverse tendency to move from the outer centile position to a more central 1 in the subsequent year of growth.¹⁸ The velocity graphs permit the practitioner to identify whether an private child or adolescent is presently growing "inside normal limits."^eighteen After 18 years of age the cranium continues to grow due to increases in the thickness of the skull and scalp, just this accounts for only a ii% alter in the size of the caput circumference.⁶

More recently, Rollins et al. studied previous caput circumference results and charts, and by drawing on the strengths of these studies they were able to generate a more than useful gear up of male and female caput circumference charts for clinical use from birth to 21 years of age.^fifteen Nosotros have now converted from the Nellhaus charts to these updated Rollins graphs in our day-to-day practice.^eleven,xv Therefore, when comparison the percentiles of an baby, child, or adolescent to that of the same-sex parent, it is advisable to assign the parent the measurement at eighteen years of age.^xi The provider must take into business relationship that the child's head circumference may exist in a slightly higher percentile than the parent because of larger growth for each subsequent generation.¹² For individual measurements performed in immature adults and adults, in that location are standard head circumference charts.^four The authors of these developed charts emphasize that head circumference, as expected, is unlike for males and females and it is closely related to the superlative of the individual.

Zahl and Wester reported in 2008 the first population-based report to investigate the office and importance of the routine utilise of head circumference measurements in children.²³ In a retrospective chart review of children under 5 years of age who were diagnosed and hospitalized in Norway due to having an expansive intracranial status (Jan 1999 through December 2002), they ended there was no need for pediatricians to mensurate the head circumference after 10 months of life. Another review attempted to identify the frequency of symptomatology in children that may assist the primary practitioner in early detection of brain tumors and they did not mention head circumference measurements.^three

Currently, pediatricians rail head circumference in charts that include birth to 36 months of age, which is probably a issue of the information generated by the National Center for Health Care Statistics of the Centers for Disease Command and Prevention (CDC) in 2000.¹⁰ The electric current head growth charts provided by the CDC terminate at 36 months of age.^1,x In 2007, the American Academy of Pediatrics revised the recommendations for preventive wellness care and they included head circumference measurements to 24 months of age.ⁱⁱ The WHO provides head circumference and growth charts upwards to v years of historic period, but these are mostly not used by pediatricians in the Us.²² Documentation, incentives, or practise guidelines for the apply of head growth charts from 36 months to 18 years of historic period accept not been required.¹⁹ These recommendations and reports appear to accept generated the prevalent concept in some pediatricians and pediatric subspecialists that the cranium no longer grows afterward 36 months of age.

In all referrals evaluated by the UF Division of Pediatric Neurosurgery for microcrania and/or macrocrania, we found that no infant, kid, or boyish had their head circumference compared with that of the aforementioned-sex parent. When the patient is evaluated in the UF Partition of Pediatric Neurosurgery or UF Division of Clinical Genetics, the kid's head circumference and previous measurements provided by the referring practitioner are plotted on the head circumference scale. We asking the parent of the same sexual activity attend the consultation.²⁰ If the biological same-sexual practice parent is unable to attend the consultation, an appointment is rescheduled for a subsequent date. The parent'due south head circumference is besides measured and documented on the aforementioned scale and the percentiles compared.^xx If there is a correlation between parental and child measurements, familial microcrania or macrocrania is diagnosed and no studies are requested, with the exception of clinical symptomatology that would mandate farther evaluation. It is important to define that the child is normal at the time of examination for the right diagnosis. Some children may take underlying genetic disorders that should atomic number 82 to appropriate testing.¹³ If in that location has been a history of trauma or subdural collections such as hygromas, they may demand further assessment.⁷

The vast majority of these cases take an underlying familial or genetic disorder every bit the cause for the microcrania.^8,ix,21 The kid and his or her family need a thorough evaluation by clinical genetics. The rare instance of microcrania due to pansynostosis should also exist evaluated by clinical genetics and pediatric endocrinology for hypothyroidism and other disorders.^v,21

The institution of routine head measurements and plotting using a scale through 18 years of historic period by pediatric providers, and when appropriate, comparing with the head circumference of the same-sex parent, would potentially reduce unnecessary referrals to specialists besides as reduce medical expenses and use of resources. In addition, the exposure of the child to radiological studies and radiation would be diminished.

Conclusions

The adoption of head circumference measurement, and when appropriate, comparing with the head circumference of the same-sex parent, volition reduce unnecessary referrals and neuroimaging procedures. It may besides allow the early detection of intracranial pathology such as insidious hydrocephalus, chronic subdural collections, intracranial tumors, and other chronic pathologies.

Acknowledgment

We wish to admit the secretarial support by Jennifer Santarone in the preparation of this manuscript.

References

• 1↑

  American Academy of Pediatrics Committee on Practice and Ambulatory Medicine : Recommendations for preventive pediatric healthcare (RE9535) . Pediatrics 105 : 645 – 646 , 2000

  American Academy of Pediatrics Committee on Do and Ambulatory Medicine : Recommendations for preventive pediatric healthcare (RE9535) . Pediatrics 105 : 645 – 646 , 2000

  )| fake

  • Search Google Scholar
  • Export Commendation

• ii↑

  American Academy of Pediatrics Committee on Practice and Ambulatory Medicine, Brilliant Futures Steering Committee : Recommendations for preventive healthcare . Pediatrics 120 : 1376 , 2007

  American University of Pediatrics Committee on Practice and Ambulatory Medicine, Vivid Futures Steering Committee : Recommendations for preventive healthcare . Pediatrics 120 : 1376 , 2007

  )| simulated

  • Search Google Scholar
  • Export Commendation

• 3↑

  Ansell P , , Johnston T , , Simpson J , , Hunker S , , Roman Eastward , & Picton S : Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS . Pediatrics 125 : 112 – 119 , 2010

  Ansell P , Johnston T , Simpson J , Hunker Southward , Roman E , Picton S : Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS . Pediatrics 125 : 112 – 119 , 2010

  )| simulated

  • Search Google Scholar
  • Consign Citation

• 4↑

  Bushby KM , , Cole T , , Matthews JN , & Goodship JA : Centiles for developed head circumference . Arch Dis Child 67 : 1286 – 1287 , 1992

  Bushby KM , Cole T , Matthews JN , Goodship JA : Centiles for adult head circumference . Arch Dis Child 67 : 1286 – 1287 , 1992

  )| false

  • Search Google Scholar
  • Export Commendation

• six↑

  Eichorn DH , & Bayley N : Growth in caput circumference from birth through immature machismo . Kid Dev 33 : 257 – 271 , 1962

  Eichorn DH , Bayley N : Growth in head circumference from birth through young adulthood . Kid Dev 33 : 257 – 271 , 1962

  )| false

  • Search Google Scholar
  • Export Citation

• 7↑

  Hellbusch LC : Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-upwards . J Neurosurg 107 : 2 Suppl 119 – 125 , 2007

  Hellbusch LC : Beneficial extracerebral fluid collections in infancy: clinical presentation and long-term follow-up . J Neurosurg 107 : 2 Suppl 119 – 125 , 2007

  )| false

  • Search Google Scholar
  • Export Citation

• 8↑

  Hofman MA : A biometric analysis of encephalon size in micrencephalics . J Neurol 231 : 87 – 93 , 1984

  Hofman MA : A biometric analysis of brain size in micrencephalics . J Neurol 231 : 87 – 93 , 1984

  )| false

  • Search Google Scholar
  • Export Citation

• 9↑

  Mochida GH : Genetics and biology of microcephaly and lissencephaly . Semin Pediatr Neurol 16 : 120 – 126 , 2009

  Mochida GH : Genetics and biology of microcephaly and lissencephaly . Semin Pediatr Neurol 16 : 120 – 126 , 2009

  )| simulated

  • Search Google Scholar
  • Consign Citation

• x↑

  National Middle for Health Statistics, Centers for Disease Control Prevention : Growth Charts

  National Center for Health Statistics, Centers for Illness Control Prevention : Growth Charts (http://www.cdc.gov/growthcharts/) [Accessed February 25, 2014]

  )| false

  • Search Google Scholar
  • Export Citation

• 11↑

  Nellhaus Grand : Head circumference from birth to 18 years. Practical composite international and interracial graphs . Pediatrics 41 : 106 – 114 , 1968

  Nellhaus M : Head circumference from nascence to eighteen years. Practical composite international and interracial graphs . Pediatrics 41 : 106 – 114 , 1968

  )| false

  • Search Google Scholar
  • Export Citation

• 12↑

  Ounsted Grand , , Moar VA , & Scott A : Head circumference charts updated . Arch Dis Child lx : 936 – 939 , 1985

  Ounsted M , Moar VA , Scott A : Head circumference charts updated . Arch Dis Child 60 : 936 – 939 , 1985

  )| fake

  • Search Google Scholar
  • Export Citation

• 13↑

  Paciorkowski AR , & Greenstein RM : When is enlargement of the subarachnoid spaces non benign? A genetic perspective . Pediatr Neurol 37 : 1 – vii , 2007

  Paciorkowski AR , Greenstein RM : When is enlargement of the subarachnoid spaces non beneficial? A genetic perspective . Pediatr Neurol 37 : 1 – vii , 2007

  )| false

  • Search Google Scholar
  • Export Citation

• 14↑

  Robertson WC Jr , , Chun RW , , Orrison WW , & Sackett JF : Benign subdural collections of infancy . J Pediatr 94 : 382 – 386 , 1979

  Robertson WC Jr , Chun RW , Orrison WW , Sackett JF : Benign subdural collections of infancy . J Pediatr 94 : 382 – 386 , 1979

  )| false

  • Search Google Scholar
  • Export Citation

• 15↑

  Rollins JD , , Collins JS , & Holden KR : United States caput circumference growth reference charts: birth to 21 years . J Pediatr 156 : 907 – 913.e2 , 2010

  Rollins JD , Collins JS , Holden KR : United States head circumference growth reference charts: birth to 21 years . J Pediatr 156 : 907 – 913.e2 , 2010

  )| imitation

  • Search Google Scholar
  • Export Citation

• sixteen↑

  Tanner JM , Physical growth and development . Forfor JO , & Arneil GC : Textbook of Pediatrics Edinburgh , Churchill Livingston , 1984 . 278 – 330

  Tanner JM , Physical growth and evolution . Forfor JO , Arneil GC : Textbook of Pediatrics Edinburgh , Churchill Livingston , 1984 . 278 – 330

  )| imitation

  • Search Google Scholar
  • Export Citation

• 17↑

  Tanner JM , , Whitehouse RH , & Takaishi M : Standards from nascency to maturity for height, weight, elevation velocity, and weight velocity: British children, 1965. I . Arch Dis Child 41 : 454 – 471 , 1966

  Tanner JM , Whitehouse RH , Takaishi G : Standards from birth to maturity for height, weight, acme velocity, and weight velocity: British children, 1965. I . Arch Dis Kid 41 : 454 – 471 , 1966

  )| simulated

  • Search Google Scholar
  • Export Citation

• eighteen↑

  Tanner JM , , Whitehouse RH , & Takaishi M : Standards from birth to maturity for height, weight, elevation velocity, and weight velocity: British children, 1965. II . Curvation Dis Child 41 : 613 – 635 , 1966

  Tanner JM , Whitehouse RH , Takaishi Thou : Standards from birth to maturity for summit, weight, superlative velocity, and weight velocity: British children, 1965. Two . Curvation Dis Kid 41 : 613 – 635 , 1966

  )| faux

  • Search Google Scholar
  • Export Citation

• xix↑

  Tricare's comprehensive well-child care benefit . Tricare Provider News 8 2008 . iii ,

  Tricare's comprehensive well-child care benefit . Tricare Provider News 8 2008 . 3 , (https://www.hnfs.com/content/dam/hnfs/tn/prov/news/pdf/PN%202008/PN_8_2008_V4_I8.pdf) [Accessed March 10, 2015]

  )| simulated

  • Search Google Scholar
  • Export Citation

• 20↑

  Weaver DD , & Christian JC : Familial variation of head size and adjustment for parental caput circumference . J Pediatr 96 : 990 – 994 , 1980

  Weaver DD , Christian JC : Familial variation of head size and adjustment for parental head circumference . J Pediatr 96 : 990 – 994 , 1980

  )| false

  • Search Google Scholar
  • Export Citation

• 22↑

  World Wellness Organization : WHO Child Growth Standards: Methods and Development. Caput Circumference-for-Age, Arm Circumference-for-Age, Triceps Skinfold-for-Age, and Subscapular Skinfold-for-Age Geneva , Globe Health Organization , 2007 .

  World Health Organization : WHO Child Growth Standards: Methods and Development. Head Circumference-for-Age, Arm Circumference-for-Age, Triceps Skinfold-for-Age, and Subscapular Skinfold-for-Age Geneva , World Wellness Arrangement , 2007 . (http://www.who.int/childgrowth/standards/second_set/technical_report_2/en/index.html) [Accessed February 25, 2014]

  )| false

  • Search Google Scholar
  • Consign Commendation

• 23↑

  Zahl SM , & Wester K : Routine measurement of head circumference equally a tool for detecting intracranial expansion in infants: what is the gain? A nationwide survey . Pediatrics 121 : e416 – e420 , 2008

  Zahl SM , Wester K : Routine measurement of head circumference as a tool for detecting intracranial expansion in infants: what is the proceeds? A nationwide survey . Pediatrics 121 : e416 – e420 , 2008

  )| false

  • Search Google Scholar
  • Export Citation

sizerandints80.blogspot.com

Source: https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/16/2/article-p186.xml

Share this post