roche et al pediatric ofc charts 1987 (2)

1987;79;706-712 PediatricsAlex F. Roche, Debabrata Mukherjee, Shumei Guo and William M. Moore

Head Circumference Reference Data: Birth to 18 Years

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706 PEDIATRICS Vol. 79 No. 5 May 1987

Head Circumference Reference Data: Birth to18 Years

Alex F. Roche, MD, PhD, DSc, Debabrata Mukherjee, PhD,Shumei Guo, PhD, and William M. Moore, MD, MPH

From Wright State University School of Medicine, Yellow Springs, and Ross Laboratories,Columbus, Ohio

ABSTRACT. Highly reliable data from a sample of 888white US children, measured serially in a single study,have been used to provide reference data for head circum-ference from birth to 18 years of age. The present datadiffer little from those already available for the age rangefrom birth to 36 months of age, but they are considerablyhigher (about 0.5 cm) at older ages for boys and tend tobe slightly higher for girls. These new reference data aresmoother across age than those used currently for screen-ing and evaluation. Percentiles for 6-month incrementsfrom birth to 6 years have been provided. Pediatrics1987;79:706-712; head circumference.

The measurement of head circumference is an

important part of the clinical examination of anyinfant. The method of measurement is highlystandardized’ and sets of reference data are avail-

able with which observed values can be compared.

The widely used National Center for Health Statis-tics (NCHS) percentiles for infants were derivedfrom participants in the Fels Longitudinal Study.2’3

The reference data complied by Nellhaus4 for agesfrom birth to 18 years are composites of 14 studies,

published between 1952 and 1965, in which childrenfrom families of low socioeconomic status wereovenrepresented and different ethnic groups wereincluded.

During infancy, the measunement and interpne-tation of head circumference has an important

place in screening for conditions in which head sizeis abnormal, eg, hydrocephalus and microcephaly.

This measurement is less important during child-

hood and adolescence, but it is relevant to the

Received for publication Jan 23, 1986; accepted June 20, 1986.Reprint requests to (A.F.R.) Division of Human Biology, De-partment of Pediatrics, Wright State University School of Mad-icine, 1005 Xenia Aye, Yellow Springs, OH 45387-1695.

PEDIATRICS (ISSN 0031 4005). Copyright © 1987 by theAmerican Academy of Pediatrics.

extended observation of children whose head cm-

cumferences were unusual during infancy. Afterinfancy, reference data can assist judgments of the

normality of recorded measurements and assist the

recognition of intrafamilial clustering of unusualvalues.

The aim of the present study was to providereference data for head circumference from birth to

18 years and 6-month increments from birth to 6

years using data from a single study in which all

measurements were made using the same methodand the observer differences were known to be

small.

SUBJECTS AND METHODS

The mixed longitudinal data that have been ana-

lyzed were recorded from 888 participants in theFels Longitudinal Study between 1930 and 1982.

Secular trends in these data are small and incon-sistent. Many of these data were used earlier to

construct the NCHS growth charts for the agerange from birth to 36 months.2’3 Also, the present

sample of Fels’ participants is similar to a samplefrom which 6-month increments in head circumfen-ence from birth to 36 months have been derived.5

The participants in the Fels Longitudinal Studywere from families with a wide range of socioeco-nomic status living in southwestern Ohio. Theseparticipants were the products of normal pregnan-

cies and were in good health. There are 13 blackchildren in the Fels Longitudinal Study; the ne-mainder are white. The data from the black partic-ipants were excluded from the present analyses.Data from four sets of participant triplets have

been omitted from the present analyses becausetriplets were ovenrepresented and because they were

omitted also from the analyses made previously to

construct sets of reference data.2’3’5 Data from the14 pairs of twins in the Fels Longitudinal Study



ARTICLES 707

have been used in the present and were used in thepast analyses; the data from these twins did not

differ significantly from those for the remainder ofthe group. There are some like-sex first-degree nel-

atives, eg, sister-sister, in the data set. Randomselection of one member from each such pair or

triad did not alter the descriptive statistics to astatistically significant extent, but the sample sizeswere reduced by about 20%. Consequently, exclu-sions were not made on the basis of familial nela-

tionships.

Head circumference was measured serially at

birth, 1, 3, 6, 9, and 12 months and then each 6

months to 18 years. A nonstretchable tape gradu-

ated in millimeters was used. In 1976, the tapemeasure used previously was replaced by an inser-

tion tape (INSER-TAPE, Ross Laboratories), afterit had been shown that the differences between

pairs of measurements with the two types of tape

did differ significantly. Use of an insertion tapereduces the probability of measurement errors.6

The method of measurement was the same with

each type of tape. The tape was placed with itsinferior margin just touching the superior bonders

of the eyebrows. If superciliary arches were present,

the tape was placed superior to them. The posteriorpart of the tape was aligned so that the maximum

head circumference was recorded, even if the meas-urement included the external occipital protuber-

ence. Care was taken to ensure that the plane ofthe tape was the same on the left and night sides of

the head. Hair pins and clips were removed and

lange amounts of hair, eg, braids, were excludedfrom the plane of measurement.

The tape was pulled tightly around the head, and

the circumference was recorded to the nearest mil-

limeten by two observers measuring independently.If the difference between a pain of measurements

was less than 2 mm, the mean of the pair was used

in the analyses. If their measurements differed by

more than 2 mm, each observer repeated the meas-urement. The mean of the second pair of measure-

ments was used in the analyses if the separate

measurements differed by less than 2 mm. On the

rare occasions when the difference within each pairof measurements exceeded 2 mm, the mean of allfour measurements was used. Analyses of intenob-server differences (n = 1386 pairs of data) showed

technical errors (�J� (d�/2n) of 0.9 mm and coeffi-

cients of variation of 0.0002 that were independent

of age.

The head circumference data were grouped by

sex at ages corresponding to those of the scheduledexaminations. Selected percentiles (fifth, tenth,

twenty-fifth,, fiftieth, seventy-fifth, ninetieth, and

ninety-fifth) were calculated.7 Subsequently, the

calculated percentiles and the means and standard

deviations were smoothed across age using a familyof mathematical functions fitted by a nonlinear

iterative procedure. These functions gave satisfac-

tory results in terms of minimal differences betweenthe observed and estimated values. The mathemat-

ical functions were applied to the calculated valuesfor the selected percentiles, the means, and the ±2

and ±3 SD levels at each of the scheduled ages,although the estimated values are reported only at

annual intervals for ages olden than 6 years.

Six-month increments in head circumferencefrom birth to 6 years were calculated. Selected

percentiles, means, and standard deviations were

obtained and subsequently smoothed using a familyof mathematical functions.

RESULTS

Selected distribution statistics for smoothed val-ues from birth to 18 years are presented in Tables1 and 2 for boys and girls, respectively. The per-

centile levels tended to be higher for boys than

girls; differences between the distributions for the

two sexes were significant (P < .05) at each age bythe Kolmogonov-Smirnov test. The percentile

curves are shown in Figs 1 and 2 for the age range

birth to 18 years. Between birth and 6 months ofage, the separate percentile curves are close in these

figures. Consequently, percentile curves from birth

to 6 years are presented using a larger age scale inFigs 3 and 4.

The means were significantly larger (P < .05) forboys than for girls at each age except 13 years. The

significance of the differences between correspond-ing means was established using t tests, after ad-

justing for the Bonferroni inequality by o’/p wherep = number of tests performed, to maintain the

overall type I error.The smoothed means ±2 SD and ±3 SD from the

present data are shown in Figs 5 and 6 wherecomparisons are made with the data of Nellhaus,4who made available his unpublished means and

standard deviations. The differences between thepresent data and the corresponding values of Nell-

haus (mean ± 2 SD) were small from birth to 12months for boys and from birth to about 18 months

for girls. At older ages, the present values for boys

were about 0.5 to 1.5 cm greater than the come-

sponding Nellhaus values. For example, an 11-year-

old boy with a head circumference at the -2 SDlevel on the Nellhaus chart is at -2.5 SD level with

the present data, and a boy of this age who is +2

SD with the Nellhaus chart is +1.5 SD with the

present data. For the girls, there was only a slighttendency for the present values to exceed those of

Nellhaus. The present values were considerably



TABLE 1. Distribution Statistics for Smoothed Head Circumference Values (cm) of Boys

Age(yr)

n Percentiles Mean SD

5th 101h 25th 50th 75th 90th 95th

Birth 177 32.88 33.22 34.21 35.25 36.23 37.12 37.80 34.61 1.620.08 277 34.70 35.06 36.00 37.01 37.98 38.84 39.63 37.30 1.47

0.25 291 37.79 38.17 39.03 40.00 40.96 41.76 42.69 40.28 1.42

0.50 303 41.09 41.49 42.29 43.22 44.16 44.92 45.93 43.52 1.34

0.75 292 43.35 43.77 44.52 45.43 46.36 47.10 48.11 45.54 1.32

1.00 307 44.91 45.33 46.06 46.97 47.89 48.62 49.60 46.87 1.32

1.50 297 46.75 47.18 47.90 48.81 49.72 50.45 51.32 48.20 1.35

2.00 299 47.69 48.12 48.84 49.77 50.68 51.41 52.20 49.20 1.36

2.50 226 48.21 48.65 49.38 50.31 51.23 51.97 52.70 50.02 1.36

3.00 184 48.55 48.99 49.73 50.67 51.59 52.34 53.03 50.52 1.373.50 181 48.81 49.24 49.99 50.94 51.87 52.62 53.29 50.99 1.394.00 178 49.02 49.45 50.22 51.16 52.10 52.87 53.52 51.23 1.40

4.50 174 49.22 49.65 50.42 51.37 52.32 53.09 53.74 51.51 1.445.00 170 49.40 49.83 50.62 51.57 52.54 53.30 53.95 51.78 1.465.50 127 49.59 50.02 50.81 51.77 52.74 53.51 54.15 52.06 1.49

6.00 176 49.77 50.20 51.01 51.96 52.95 53.72 54.36 52.22 1.45

7.00 182 50.13 50.56 51.39 52.35 53.36 54.14 54.76 52.52 1.39

8.00 174 50.50 50.92 51.77 52.73 53.77 54.55 55.17 52.86 1.39

9.00 160 50.86 51.27 52.15 53.12 54.17 54.96 55.58 53.19 1.4310.00 157 51.22 51.63 52.53 53.50 54.58 55.38 55.99 53.57 1.50

11.00 152 51.58 51.99 52.92 53.89 54.99 55.79 56.39 53.93 1.54

12.00 150 51.94 52.35 53.30 54.27 55.40 56.20 56.80 54.11 1.45

13.00 132 52.31 52.71 53.68 54.66 55.81 56.62 57.21 54.43 1.56

14.00 127 52.67 53.07 54.06 55.04 56.22 57.03 57.62 54.99 1.60

15.00 124 53.03 53.43 54.44 55.43 56.63 57.44 58.02 55.48 1.58

16.00 113 53.39 53.78 54.82 55.81 57.03 57.86 58.43 55.97 1.59

17.00 113 53.76 54.14 55.20 56.20 57.44 58.27 58.84 56.38 1.56

18.00 108 54.12 54.50 55.59 56.59 57.85 58.68 59.25 56.74 1.77

smoother across age than those of Nellhaus.4 In to be highly reliable. Nevertheless, there were only

Figs 5 and 6, ±3 SD levels for the present data are small differences between the present data and theshown so that more extreme head circumferences composite data of Nellhaus,4 at ages younger than

can be evaluated readily. 12 months for boys and 18 months for girls. AtSelected smoothed percentiles for 6-month incne- older ages, the Nellhaus data are about 0.5 to 1.5

ments in head circumference are presented in Table cm less than corresponding present values for boys,3 and in Figs 7 and 8 for boys and girls, respectively. but the differences are considerably less for girls.These percentiles were smoothed using mathemat- This could reflect the low socioeconomic status ofical functions and are presented with each incre- many subjects in the composite Nelihaus data, sec-

ment opposite the end of the corresponding 6- ulan changes,9 or differences in the method of mea-

month interval. There was a rapid decrease in rate suning head circumference.

during the first year; later the decrease was slow The present data differ only slightly from the

but continued until at least 6 years. The patterns NCHS reference data for birth to 36 months.2’3

of change were similar for the two sexes, but the This was expected because these sets of percentile

early deceleration tended to be greater for the boys values were obtained from overlapping samples.than the girls. The median increments for the boys Replacement of the NCHS data by the present data

tended to be greater than those for the girls up to would not be justified. Because the NCHS percent-

the age of 4.5 years, after which there was a tend- iles extend only from birth to 36 months, they have

ency to an opposite sex difference. limited applicability in intervention programs that

extend to olden ages. Reference data for a larger ageDISCUSSION range allow the follow-up of children with abnormal

values during infancy and recognition of the catch-

Early in infancy there are rapid increases in head up growth in head circumference that can occur upcircumference and marked histologic changes in the to about 5 years, when the cranial sutures inter-

brain.8 Therefore, early recognition of deviations lock.’0” The present data will allow interpretation

from normal growth is important. The present nef- of head circumference values for parents, using 18-

enence data were obtained in a single study using a year values as reference data, and for children older

standardized measurement technique that is known than 36 months, that could lead to the recognition

708 HEAD CIRCUMFERENCE. Provided by Natl Inst Of Hlth Library on August 5, 2009 www.pediatrics.orgDownloaded from


4’

� 44

� 42

3,

56

56

54

360 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Fig 2. Selected percentilesfor smoothed head circum-ference values of girls from birth to 18 years.

of intrafamilial clustering of unusual values.’2 ments from birth to 6 months are larger by aboutReference data for 6-month increments are al- 0.7 cm at the median level. This may reflect differ-

ready available fon the age range birth to 3 years.5”3 ences in the sample used, which included data ex-The present study has extended the mange of avail- tending to 1982 instead of 1978 but excluded blacks,

able reference data for 6-month increments to 6 rather than differences in measurement technique.years. The larger age range will be useful in the The present tables and figures can be used toevaluation of changes observed in intervention pro- evaluate the normality of head circumference fromgrams. The distributions of the present increments birth to 18 years. There is a pubescent spurt in

from birth to 36 months are similar to those pub- head circumference which has been reported to belished previously,5”3 except for the increments from larger in girls than in boys,’4 unlike the spurts in

birth to 6 months. In the present data, the incre- stature and in weight. The spurt in head cincumfer-

ARTICLES 709

TABLE 2. Distribution Statistics for Smoothed Head Circumference Values (cm) of Girls

Age(yr)


5th 101h 25th 50th 75th 90th 95th

Birth 165 32.27 33.01 33.79 34.64 35.38 36.11 36.81 33.88 1.42

0.08 247 33.76 34.49 35.31 36.13 36.89 37.59 38.18 36.42 1.13

0.25 247 36.47 37.18 38.04 38.80 39.61 40.28 40.71 39.10 1.65

0.50 285 39.53 40.19 41.06 41.79 42.63 43.29 43.63 42.20 1.22

0.75 272 41.75 42.36 43.21 43.94 44.79 45.48 45.81 44.18 1.28

1.00 270 43.38 43.94 44.75 45.50 46.35 47.07 47.45 45.46 1.33

1.50 264 45.47 45.95 46.68 47.47 48.30 49.09 49.62 46.92 1.25

2.00 261 46.63 47.05 47.73 48.56 49.37 50.23 50.89 48.02 1.40

2.50 210 47.31 47.70 48.34 49.21 50.01 50.91 51.67 48.71 1.31

3.00 159 47.74 48.11 48.74 49.63 50.42 51.35 52.17 49.40 1.253.50 151 48.03 48.41 49.02 49.93 50.73 51.67 52.53 49.78 1.29

4.00 161 48.26 48.64 49.25 50.17 50.98 51.93 52.80 50.11 1.274.50 146 48.46 48.83 49.46 50.39 51.20 52.16 53.03 50.40 1.295.00 153 48.63 49.02 49.65 50.59 51.42 52.37 53.23 50.68 1.335.50 120 48.80 49.19 49.84 50.78 51.62 52.57 53.43 50.99 1.36

6.00 155 48.96 49.36 50.02 50.97 51.82 52.77 53.61 51.16 1.347.00 168 49.27 49.69 50.38 51.35 52.22 53.17 53.96 51.58 1.42

8.00 163 49.58 50.03 50.74 51.72 52.62 53.56 54.32 52.00 1.41

9.00 156 49.89 50.36 51.09 52.09 53.01 53.95 54.67 52.27 1.3810.00 166 50.20 50.69 51.45 52.46 53.41 54.34 55.01 52.65 1.4111.00 150 50.51 51.02 51.81 52.83 53.81 54.73 55.36 53.05 1.47

12.00 162 50.82 51.35 52.17 53.20 54.20 55.12 55.71 53.50 1.50

13.00 140 51.13 51.68 52.52 53.57 54.60 55.52 56.06 53.96 1.4914.00 140 51.44 52.01 52.88 53.94 54.99 55.91 56.41 54.21 1.4315.00 133 51.75 52.34 53.24 54.31 55.39 56.30 56.76 54.31 1.4416.00 132 52.06 52.67 53.60 54.68 55.79 56.69 57.11 54.45 1.4817.00 139 52.37 53.00 53.95 55.05 56.18 57.08 57.46 54.57 1.39

18.00 110 52.68 53.33 54.31 55.42 56.58 57.47 57.80 54.55 1.33

60� .

� � _

AGE (Y#{149}a�)

0 � 2 3 4 5 6 7 8 9 10 1112131415161718

58 58

56 56

54 54

52

� 50

44

� 42

�iiL.� �

32r�� -��:: -:�- 2 3 5 6 7 8

3,

AGE (Yeas)

Fig 1. Selected percentiles for smoothed head circum-ference values of boys from birth to 18 years.

AGE Y�as)

0 � 2 3 4 5 6 7 8 9 10 1 12131415161718. . �.60

GIRLS



3

AGE Yea’s)

03

AGE )Yea,s)

t- � . �-t-�T �--#{149}�-#{149}

��---�.--. � � � � -.�.ii�j�Ii ± � �-.I� �

. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 180 1

AGE (Yea’s)

00 05

GIRLS

0 15 20 25 30 35 40 a5 50 55 60

� � �

� � �_____

00 05 10 15 20 2.5 30 35 40 45 50 55 60

0 1 2 3 4 5 I 8 9 10 11 1 ( 13 1 I 15 16 17 18

710 HEAD CIRCUMFERENCE

AGE (Yeals)

#{182}5 20 25 30 35 40 45 50 55 60

Fig 3. Selected percentiles for smoothed head circum-

ference values of boys from birth to 6 years.

AGE (Yea�s)

-‘ S

38

36

34

32

Fig 6. Smoothed means (±2 SD and ±3 SD) from headcircumference data for girls. Present data (-) com-pared with data from Nellhaus4 (- -

40

38

� �--- 3#{128}

� � 34

-�-�--� � 32

36

AGE (Yea’s)

Fig 4. Selected percentiles for smoothed head circum-

ference values of girls from birth to 6 years.

AGE (Y�a,s)

AGE (Yeaes)

Fig 5. Smoothed means (±2 SD and ±3 SD) from head

circumference data for boys. Present data (-) com-pared with data from Nellhaus4 (- -

ence is associated more with changes in scalp thick-ness than in cranial thickness.’5”6 Because pubes-

cent spurts in head circumference are small and

36 occur at different ages among individuals, they are54 not apparent in the present reference data. There-

: fore, serial data for individuals can be plotted at all48 5 ages in relation to the present reference data with-46 � out problems of interpretation resulting from mdi-

� vidual differences in the timing of pubescence. The� finding that head circumferences were significantly� larger in boys than in girls is in agreement with

� earlier reports.’7”8The present percentile values were derived from

a sample of white US children, but they should beapplicable to US black children also.’9 However, itshould not be assumed that they are appropriate

for other ethnic groups, because large differencesin head circumference have been reported betweenethnic groups.20’2’ Various socioeconomic levelswere represented in the Fels sample and some low

birth weight infants were included (4.6% < 2.5 kgbirth weight). Adjustments were not made for so-cioeconomic status because of the vague and sub-jective nature ofthis categorization. The prevalence

� of low birth weight infants was similar to that

� expected in a random sample; the numbers were� too few to allow the development of separate ref-

� erence data for this group.� Head circumference is an important measure be-

cause it is highly correlated with brain weight,especially during infancy.22’23 Many infants withvalues more than 3 SD below the mean from the

time of birth, as may occur in those with fetal

alcohol syndrome, on with values that decrease from

the normal range to be 2 SD on more below the

mean are mentally retarded.24’25 Lange values, es-

pecially those that increase in percentile level on

are associated with large increments, suggest theneed for tests to exclude hydrocephalus. Less com-mon causes of large values for head circumferenceare familial megalencephaly, which may be associ-



10

3

B

AGE (Yea,s)AT ENDOF INTERVAL

06�

5�

4�

REFERENCES

1. Roche AF: Growth assessment in abnormal children. Kidneymt 1978;14:369-377

2. Hamill PVV, Drizd TA, Johnson CL, et al: NCHS growthcurves for children birth-18 years, United States, Vital andHealth Statistics, series 11, No. 165, Department of Health,

ARTICLES 711

TABLE 3. Distribution Statistics for Smoothed Head Circumference 6-Month Incre-ments (cm)

End ofInterval


5th 101h 25th 50th 75th 90th 95th

Boys0.501.00

1.50

2.002.503.00

3.504.004.505.005.506.00

Girls

0.501.001.502.002.503.003.504.004.505.005.506.00

163282

285

287223181

176174

171168125165

149251254253206153148156143147120150

7.372.08

0.550.11

-0.03-0.07

-0.09-0.10-0.11-0.12-0.13-0.13

6.902.070.600.14

-0.01

-0.08-0.12-0.14-0.16-0.18-0.19-0.20

7.872.38

0.850.370.190.11

0.060.040.020.010.010.00

7.272.430.890.360.160.080.040.020.010.010.000.00

8.402.82

1.210.680.450.32

0.240.180.130.100.080.06

8.182.791.300.770.520.360.260.190.130.100.070.05

9.493.33

1.550.950.690.53

0.430.340.280.230.180.15

8.703.281.641.060.780.610.480.390.310.250.200.16

10.223.89

1.921.230.930.75

0.630.530.450.380.320.27

9.373.661.931.321.020.830.690.570.480.400.33

0.28

10.96

4.48

2.331.541.19

0.980.830.710.610.530.460.39

9.914.182.341.651.311.090.920.790.670.580.49

0.42

11.31

5.032.701.781.37

1.140.990.88

0.780.700.620.55

10.374.632.812.071.66

1.381.160.970.820.650.58

0.49

9.43

3.411.521.010.71

0.500.440.350.290.300.240.18

8.553.221.711.080.800.57

0.400.370.270.290.25

0.24

1.460.93

0.850.550.43

0.370.350.380.240.540.280.25

2.310.850.780.920.530.31

0.350.300.380.280.27

0.28

AGE (Yea’s) AT ENDOF INTERVAL

1� � 10 15 20 25 30 35 40 45 50 55 60.2� � �---�+- - � - f---� + � 11

15 � � � BOYS

05 10 15 20 25 30 3�5 40 45 50 55 65

AGE (Yea’s(AT END OF INTERVAL

Fig 7. Selected percentiles for 6-month increments in

head circumference for boys (birth to 6 years).

ated with mental retardation and neunologic signs’2

and benign subdural effusion.26A head circumference value outside the normal

range (±2 SD) can be adjusted for prematurity27(on reference data specific for premature infants

can be used),28’29 head shape,’7’3#{176}recumbent length,weight,3’ or parental head circumference.32 Such

adjustments remove the effects of these variablesfrom unusual head circumferences and thus helpdetermine whether these values are indicative ofabnormalities or diseases.

7�

10 15 20 25 30 35 5

AGE (Y.wS)AT ENDOF WITERVAL

Fig 8. Selected percentiles for 6-month increments inhead circumference for girls (birth to 6 years).

ACKNOWLEDGMENT

This research was supported by a grant from RossLaboratories, Columbus, OH, and by grant HDAM-12252from the National Institutes of Health, Bethesda, MD.



712 HEAD CIRCUMFERENCE

Education, and Welfare Publication No. (PHS) 78-1650.Government Printing Office, 1977

3. Hamill PVV, Drizd TA, Johnson CL, et al: Physical growth:National Center for Health Statistics percentiles. Am J GunNutr 1979;32:607-629

4. Nellhaus G: Head circumference from birth to eighteenyears: Practical composite international and interracialgraphs. Pediatrics 1968;41:106-114

5. Roche AF, Himes JH: Incremental growth charts. Am J GunNutr 1980;33:2041-2052

6. Zerfas AJ: The insertion tape: A new circumference tape foruse in nutritional assessment. Am J GUn Nutr 1975;28:782-

787

7. SAS User’s Guide, Basic. Raleigh, NC, SAS Institute, 1982,p 579

8. Rabinowicz T: The differentiate maturation of the human

cerebral cortex, in Falkner F, Tanner JM (eds): HumanGrowth, ed 2. New York, Plenum Press, 1986, vol 2, pp 385-410

9. Ounsted M, Moar VA, Scott A: Head circumference chartsupdated. Arch J Dis Child 1985;60:936-939

10. Roche AF: Possible catch-up growth of the brain in man.Acta Med Auxol 1980;12:165-179

1 1. Laron Z, Galatzer A: Effect of hGH on head circumferenceand IQ in isolated growth hormone deficiency. Early HumDev 1981;5:211-214

12. Schreier H, Rapin I, Davis J: Familial megalencephaly orhydrocephalus? Neurology 1974;24:232

13. Baumgartner RN, Roche AF, Himes JH: Incrementalgrowth tables: Supplementary to previous published charts.

Am J Glin Nutr 1986;43:7711-7722

14. Eichorn DH, Bayley N: Growth in head circumference from

birth through young adulthood. Child Dev 1962;33:257-27115. Roche AF: Increase in cranial thickness during growth. Hum

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1987;79;706-712 PediatricsAlex F. Roche, Debabrata Mukherjee, Shumei Guo and William M. Moore

Head Circumference Reference Data: Birth to 18 Years

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roche et al pediatric ofc charts 1987 (2)

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