Microcephaly
Microcephaly is a condition in which a person's head size is much smaller than that of others of the same age and sex. Head size is measured as the distance around the top of the head. A smaller than normal size is determined using standardized charts of head circumference.
The sutures or anatomical lines where the bony plates of the skull join together can be easily felt in the newborn infant. The diamond shaped space on the top of the skull and the smaller space further to the back are often referred to as the soft spot in young infants.
Microcephaly is a head size (measured as the distance around the top of the head) significantly below the median for the infant's age and sex. Significantly below is generally considered to be smaller than three standard deviations below the mean, or less than 42 cm in circumference at full growth. It most often occurs because of failure of the brain to grow at a normal rate.
This is a normal fetal ultrasound performed at 17 weeks gestation. The development of the brain and nervous system begins early in fetal development. During an ultrasound, the technician usually looks for the presence of brain ventricles. Ventricles are spaces in the brain that are filled with fluid. In this early ultrasound, the ventricles can be seen as light lines extending through the skull, seen in the upper right side of the image. The cross hair is pointing to the front of the skull, and directly to the right, the lines of the ventricles are visible.
Causes
Microcephaly most often occurs because the brain does not grow at a normal rate. The growth of the skull is determined by brain growth. Brain growth takes place while a baby is in the womb and during infancy.
Conditions that affect brain growth can cause smaller than normal head size. These include infections, genetic disorders, and severe malnutrition.
Genetic conditions that cause microcephaly include:
- Cornelia de Lange syndrome
- Cri du chat syndrome
- Down syndrome
- Rubinstein-Taybi syndrome
- Seckel syndrome
- Smith-Lemli-Opitz syndrome
- Trisomy 18
- Trisomy 21
Other problems that may lead to microcephaly include:
- Uncontrolled phenylketonuria (PKU) in the mother
- Methylmercury poisoning
- Congenital rubella
- Congenital toxoplasmosis
- Congenital cytomegalovirus (CMV)
- Use of certain drugs during pregnancy, especially alcohol and phenytoin
Becoming infected with the Zika virus while pregnant can also cause microcephaly. The Zika virus has been found in Africa, the South Pacific, tropical regions of Asia, and in Brazil and other parts of South America, along with Mexico, Central America, and the Caribbean.
When to Contact a Medical Professional
Most often, microcephaly is diagnosed at birth or during routine well-baby exams. Talk to your health care provider if you think your infant's head size is too small or not growing normally.
Contact your provider if you or your partner has been to an area where Zika is present and you are pregnant or thinking about becoming pregnant.
What to Expect at Your Office Visit
Most of the time, microcephaly is discovered during a routine exam. Head measurements are part of all well-baby exams for the first 18 months. This takes only a few seconds while a measuring tape is placed around the infant's head.
The provider will keep a record over time to determine:
- What is the head circumference?
- Is the head growing at a slower rate than the body?
- What other symptoms are there?
It may also be helpful to keep your own records of your baby's growth. Talk to your provider if you notice that the baby's head growth seems to be slowing down.
If your provider diagnoses your child with microcephaly, you should note it in your child's personal medical records.
References
Antoniou E, Orovou E, Sarella A, et al. Zika virus and the risk of developing microcephaly in infants: a systematic review. Int J Environ Res Public Health. 2020;17(11):3806. PMID: 32471131
Centers for Disease Control and Prevention website. Zika virus.
Kinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 609.
Marcdante KJ, Kliegman RM, Schuh AM. Congenital malformations of the central nervous system. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 187.
Mizaa GM, Dobyns WB. Disorders of brain size. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology: Principles and Practice. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 28.
Version Info
Last reviewed on: 11/6/2023
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
