World variation in head circumference for children from birth to 5 years and a comparison with the WHO standards

Hui, L. L., Ho, F. K., Wright, C. M. , Cole, T. J., Lam, H. S., Deng, H.-B., So, H.-K., Ip, P. and Nelson, E. A. S. (2023) World variation in head circumference for children from birth to 5 years and a comparison with the WHO standards. Archives of Disease in Childhood, 108(5), pp. 373-378. (doi: 10.1136/archdischild-2022-324661) (PMID:36927619)

Abstract

Objective: A recent review reported that the WHO 2006 growth standards reflect a smaller head circumference at 24 months than seen in 18 countries. Whether this happens in early infancy and to what extent populations differ is not clear. This scooping review aimed to estimate the rates of children in different populations identified as macrocephalic or microcephalic by WHO standards. Methods: We reviewed population-representative head circumference-for-age references. For each reference, we calculated the percentages of head circumferences that would be classified as microcephalic (<3rd WHO centile) or macrocephalic (>97th WHO centile) at selected ages. Results: Twelve references from 11 countries/regions (Belgium, China, Ethiopia, Germany, Hong Kong, India, Japan, Norway, Saudi Arabia, UK and USA) were included. Median head circumference was larger than that for the Multicentre Growth Reference Study populations in both sexes in all these populations except for Japanese and Chinese children aged 1 month and Indians. Overall, at 12/24 months, 8%–9% children would be classified as macrocephalic and 2% would be classified as microcephalic, compared with the expected 3%. However at 1 month, there were geographic differences in the rate of macrocephaly (6%–10% in Europe vs 1%–2% in Japan and China) and microcephaly (1%–3% vs 6%–14%, respectively). Conclusions: Except for Indians and some Asian neonates, adopting the WHO head circumference standards would overdiagnose macrocephaly and underdiagnose microcephaly. Local population-specific cut-offs or references are more appropriate for many populations. There is a need to educate healthcare professionals about the limitations of the WHO head circumference standards.

• Item Type: Articles
• Additional Information: This work is part of the ’Hong Kong Growth Study’, which was supported by the Health and Medical Research Fund, Government of the Hong Kong SAR (GC-CUHK).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ho, Dr Frederick and Wright, Professor Charlotte
• Authors: Hui, L. L., Ho, F. K., Wright, C. M., Cole, T. J., Lam, H. S., Deng, H.-B., So, H.-K., Ip, P., and Nelson, E. A. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Archives of Disease in Childhood
• Publisher: BMJ Publishing Group
• ISSN: 0003-9888
• ISSN (Online): 1468-2044
• Published Online: 16 March 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Archives of Disease in Childhood 108(5):373-378
• Publisher Policy: Reproduced in accordance with the publisher copyright policy