9 Month Old's Growth Question

Don't stress it. They are just numbers and a child can change from one visit to the next. I don't remember all of my son's stats at 9 months but he was 20lbs. He's always had a big head (13 inches at birth) and has always been long on the height side of things.

I don't blame you for feeling uneasy about the MRI and just keep an eye on her.

Good luck!
S.

Hi, I see that you have decided to go ahead with the MRI. I thought that you might want to hear from someone else that has been through the same thing. At 12 months my daughter’s head circumference went from the 97% curve to off the charts. My nurse and the pediatrician both measured twice to be sure that the measurement was accurate and it was. We weren’t too concerned because my husband has a large head, but my pediatrician still wanted to proceed with the MRI just to be sure. At the time, we were living in Alabama and it was done at Children’s in Birmingham. She was put under anesthesia for the MRI and they just did it of her head. The whole process was so extremely nerve racking because my daughter was very anxious and freaked out at pretty much everything that was done. (Especially the IV) I’ll never forget her screaming as they carried her away from me to do the MRI. A long story short, they did find something, but it wasn’t related to her head circumference (at least directly). She has Chiari Malformation (it is where the base of the skull is malformed and the cerebellum protrudes into the spinal column). She has no symptoms at this time so we would have never know if not for the MRI. I am telling you all this because she now has to have yearly MRIs and this year the process was SO MUCH better. We have moved so it was done at Nashville Childrens. When we first went in the nurse put the pulse-ox monitor on Ashley’s toe (a very painless thing) and she freaked out. The nurse practioner for anesthesia saw this and suggested that we give her a mild sedative before even attempting the I.V. They gave her some versette (spelling?) up her nose (which she didn’t like) and BOY did that make all the difference! She was so much more calm (of course she still fought it a little, but WOW it was so much better). We got to carry her back to the MRI machine and stay with her until they put her under (last year they carried her away screaming and crying to the MRI room and we had to wait)! The MRI took 2 hours (because it was of her head, neck, and spine this time) and they paged us to meet her in recovery. She woke up groggy, but later that day didn’t even remember what happened. I just wanted to be sure that you know a mild sedative is an option and it sure made my daughters entire process SO much better.

As far as the height/weight gain, did he show you her "curve" that is plotted out with all her past measurements? It should look like a steadily curving line. As soon as it deviates and goes more sideways or straight up, that is when you should be concerned. As far as HOW concerned, I don't know.

Now for the head circumference I can tell you my experience. First- the reason they want to check her head is for fluid on the brain (hydrocephalus). My son has a gigantic head as well. My doctor wasn't overly concerned once she found out my husband has a larger than normal head. (Thank god I didn't know that in advance of delivery, I would have been panicking!) But she was monitoring, also on that curve scale. He was always >99 percentile for his head but usually in the 15-20 percentile for height and weight. His curve was not a curve at all- it was a straight line going up. It wasn't growing gradually like it should.

At six months she gave a couple of options- wait and see what his measurements were again at the 9 month check up, or go and have an ultrasound done while his soft spot was still open. She said that if we waited and it was still going straight up at 9 months he would have to have an MRI to check for fluid on the brain. I was also told that he would be under anesthesia but that it would conscious sedation like jenni said below. She said there are still risks and she would prefer to do the ultrasound. She also told us that it is important to diagnose it as early as possible to have the best chances of successful treatment.

Maybe your other children had large heads but their growth was at a normal rate with the nice correct curve, and your daughter's is going straight up like mine was? It might seem to you that it did not get bigger all of a sudden, but according to the charts it might have. I agree since the other kids have large heads that it is probably just a big heads running in the family thing. But the doctor has to let you know about possible issues, that is why we do well-baby visits. To make sure everything is progressing normally. They can't disregard abnormal numbers on a hunch that it is just a family trait. I can't honestly say I would go with the MRI either in your situation. But the doctor has to recommend it in case something IS wrong. I would go back and talk to him more specifically about hydrocephaly, what it's risks are, what the odds of him having it are, and what to expect if you do get an MRI and the risks associated with that. Get a lot more specific info to help you make your decision. Good luck!

I think that if your doc isn't worried about the height/weight ratios you shouldn't either, my son had a slight rise in his ratio once and his doc wasn't worried but wanted to follow up in a month. As for the head measurement my son has also had large head all along, our ped suggested that since his fontanels hadn't closed yet she might be able to see what was going on with an ultrasound(this was at almost 1 year). Sometimes this works, if not she was going to have him get an MRI. Maybe you could ask your doc to do the ultrasound first.

I think your doctor gave you wrong information. I just checked babycenter.com and http://www.cdc.gov/growthcharts/data/set1clinical/cj41l01.... Both show that your daughter is actually in the 75% for height. As for her head, based on your family history and that she's been this way since she was born I wouldn't get the MRI. Is this a new doctor for your kids? You might want to consider changing them if they don't want to consider family traits. My friends daughter was barely on the charts for height/weight and was on the high end for her head. At 2 1/2 she's finally growing into her head. My daughter was 29 1/2 in tall 97%, 17.75 lbs 25%, and 17 in head 25%. I wouldn't worry about it.

Sounds totally normal to me. A child's height/weight can change so quickly.

As far as head circumference- my son's head was gigantic- off the charts until he was about 3 years old. Seriously. Our pediatrician had dad come in (who also has a gigantic head), measured his head, and said, "Oh, ok, seems normal." I would nix the MRI.

Has the doctor clearly laid out for you what the risks of the MRI are? What is the risk of not getting one? What does the pediatrician think may be causing this abnormality? Those are all questions I'd want answered before consenting to the MRI.

Doctors are trained not to tell you anything that might make you concerned and full of anxiety. When I found a lump on my collarbone (that was eventually diagnosed as cancer - Hodgkins lymphoma), everyone told me they weren't really "concerned". It gave me a false sense of hope - even my Oncologist was very black/white when he first met me because his opinion was based upon what evidence showed.

Pediatricians usually following the recommendations of the American Academy of Pediatrics (aap.org).
Perhaps, the AAP has recently changed their policy on this issue. They're constantly updating their policies and guidelines. Our kids are 21 months apart, and their guidelines on introducing solid foods, swaddling, etc changed considerably between kids. It's possible a new policy or new clinical evidence has emerged since your other 3 kids were this age.

You can also always get another opinion, or 2 and come to a consensus. I asked my Oncologist for the names of other specialists when I needed to make a critical decision in my treatment. He gladly referred me to 2 people he highly regarded. I ended-up going against my own doctor's recommendation in favor of theirs.

Good luck. Please keep us all posted on what you decide and what her outcomes are.

Children and growth spurts happen all the time; however, if your doctor wants to do an MRI to confirm or eliminate a problem, I'd say let him.

The general anesthetic you referred to is what is called a twilight sleep or conscious sedation. It's where the child is put under just ever so slightly because children at your child's age do not know how to be still and the knocking noises heard while in an MRI machine would scare her otherwise. This way, she has the test without the fear and it will keep her body still so the images will come out as clear as possible so if there is a problem, it will be easily detectable on the exam. Any movement can distort the image and that's the last thing you want to have happen.

I have an older daughter with a heart condition (type of birth defect of sorts); she was born with severely crossed eyes that required pretty major eye surgery at 7mos where the specialist had to turn the eyes the maximum amount but it kept her from going blind.

I've personally had several MRIs to try to find the root of migraines and with my blindness to rule out any problems that might be related to tumor or even trauma as I was severely abused and beaten within an inch of my life when I was a child on numerous occasions by an abusive alcoholic of a father. It's just all cautious optimism in the hopes to rule out certain things or even rule in others. An MRI will in no way hurt your child. It is nothing more than a magnetic imaging machine. It takes pictures, usually of the brain but it can also take pictures of other areas of the body.

If this were my child, I'd do it. I'd have the MRI and I would agree to conscious sedation so as not to frighten her and to help the results come out as clear as possible so your doctor can come to a better conclusion.

I am concerned that your dr. is disregarding your child's previous percentages. My daughter is four now but has always been 55% for weight, >95% height and head size, those are just her measurements. I asked her dr on a previous visit if we should be worried because her weight is low compared to her height, I was told as long as she maintains close to her percetage previously, if there's no significant change in percentile than she is doing fine. If as your saying your child have changed 40% in height in 3 months, I would think that's much more concerning than the head size. My daughter's head is large, always has been, and she's fine and without a medically sound reason I wouldn't feel comfortable with an MRI either. Maybe a second opinion is in order?

I wouldnt worry about the height yet. Are you sure they got a good accurate height check? Sometimes if a baby is slightly squirmy or if they were rushing even a 1/4 or 1/2 inch can mean a lot on the percentage charts. If she continues to drop on the charts then it becomes a problem. My daughter completely stopped growing from age 1-2, didnt grow at all (and at age 5 is the size of some 2year olds) now that was cause for concern but as long as they keep growing its ok. As for the head if her siblings heads were big and she has always had a big head then Id address that with her dr first before doing the MRI.

I would get a second opinion. Your doctor doesn't seem to be very comforting and even if he were, something like MRI/anesthesia is serious and you dont want to do it this young if you don't need to. But on the other hand, you dont want to overlook something that could be wrong. It's probably nothing but I know if it were me, I'd want to make sure the height and the head situation was OK. Get a 2nd opinion and/or change doctors.

I wouldn't do the MRI, but that's me.
I remember O. well child visit when my son was 3, I think. The ped measured him and kept flipping back & forth on his chart saying "Hmmmmm....hmmmmm....." Then she stated she wanted him back in 3 months to check his growth to make sure he was "on track". Talk about panic! Turns out, all was fine. His dad & I are not tall.....when I mentioned my angst for the previous 3 months...she was like..."oh...I didn't mean to upset you..." Really?

If you decide to get an MRI, your child doesn't need to be put under general anesthesia. General anesthesia required your child to be intubated (breathing tube with a ventilator) and an anesthetist to be present at all times.
My daughter was three when she had an MRI and they did conscious sedation. They use versed or phenobarbital to let her sleep deeply but she wouldn't need to be intubated. They monitor their oxygen saturation to make sure she is breathing well. See if this is an option for you, or I would recommend going somewhere where it is an option.
Good luck. My kids have larger heads too!