"But His Head Doesnt Look Small" (from his caringbridge)

This is probably the comment I hear most often when I explain what the term microcephaly means. Head appearance can be deceiving. Because of how Drs measure the circumference of the head, many children who don't physically appear to have smaller-than-average heads in fact do. Even Silas' physical therapist had a difficult time seeing his "small head" until I showed her a photograph of him with a typically developing baby his age.

"But why does a small head matter?" comes in a close second. There is no way to measure the size or weight of the human brain while it is in the body. We can examine the structure, placement, size relative to other portions of the brain, proportionality overall, and even distinguish surface texture. A normally developing brain has ridges and groves that give it that funny wrinkled appearance we have all seen on models. Brain growth determines head growth. In fact, if the head is not growing, it is a sure bet neither is the brain. The growth of the brain is what CAUSES the head size to grow. Head circumference growth directly shows brain growth, ALWAYS. This is why you may also see microencephaly as part of Silas' diagnosis. Although, many physicians just use one or the other. Because we know Silas' head started out smaller than the average baby of his gestational age, is growing at a slower rate than typically developing babies, we also know the same is true for his brain

The next logical question usually follows: What does slow brain and head growth mean? How does it affect Silas

This may well be the most difficult and least conclusive question to answer. Brain growth accounts for a baby meeting milestones- like learning to eat, clap, roll over, sit up, walk- as well as emotional maturity, physical coordination, and intellectual ability. What we do know is that Silas has been slow to meet his milestones and required physical therapy help in this area and occupational therapy help to learn to feed properly. What we do not know and cannot predict is how the continued slow growth of his brain will effect him in the future. This effects every baby differently. There are children with small brains who are minimally effected and others who depend on their family for every aspect of daily living. Only time will reveal where on the spectrum Silas will fall.

We do have a few positive predictors to consider. One, physical therapy helped him catch up on his milestones. Two, his father has a smallish (about 5th%) head and is of normal inteligence. Three, he has been able to learn new skills with guidance. Four, he shows some signs of fine-motor development beginning (scratching, pointer to thumb reflex at random) which are precursors to later milestones.

So, how can you help? If you have the chance to play with Silas, use lots of varying positions for playing. He loves tummy time. Encourage him to try and reach for objects. Help him with supported sitting and give him a toy to hold. Talk to him, mimic his sounds, and let him try to mimic yours. Please do not give him food. He is not ready for this and cannot control his gag reflex which is a choking hazard. Love on him. Tickle him. Smile at him. He will probably smile back!