Medical Q&As

Developmental delay - head size?

My aunt and uncle adopted a Romanian boy 11 months ago. He is almost three and is having a problem with his speech. They brought him to their local paediatrician who suggested his head was very small for his age. They would like to get a second opinion and were wondering if you could recommend a paediatrician who has experience with Romanian children, or with children who were institutionalised. We would appreciate your suggestions.

It might be useful in the first instance to discuss the detail of the first paediatrician’s report in relation to the size of the child’s head. I am sure your relative’s GP would be happy to discuss the detail of the report with them. I note your comments about institutionalisation but it may be that the child’s current difficulties are more physical in origin. Small skull size can affect a child’s developmental progress. If the head circumference were significantly reduced then an assessment by a paediatric neurologist would be appropriate. I doubt that a paediatrician would comment about the child’s head circumference if it weren’t significant. However, if it were not significant the child could be assessed at your local child and family centre. A multidisciplinary team consisting of a psychiatrist, psychologist, speech therapists, and social workers staffs such centres. I think the team approach would be the most appropriate way to proceed because it sounds as if the young boy may have a broad range of needs that have to be addressed. Your GP could assist with this referral. However, your first step should be to address the issue of the child’s head circumference.