Letters Failure to thrive

Head circumference is useful in assessing weight gain in babies who fail to thrive

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6917 (Published 17 October 2012) Cite this as: BMJ 2012;345:e6917
  1. Martin W English, paediatric oncologist1
  1. 1Birmingham Children’s Hospital, Birmingham B4 6NH, UK
  1. martin.english{at}bch.nhs.uk

Parents often worry about their baby’s poor weight gain. Most are healthy, and Shields and colleagues offer practical advice about when to refer for further investigations.1

I suggest a simple additional examination and other indications for referral.

Head circumference should be measured in babies with failure to thrive. It is reproducible, reliable, and easy to perform anywhere. If circumference is at a higher centile than weight, and particularly if it is increasing from the centile recorded at birth, early assessment is needed to review neurodevelopment and consider other diagnoses such as hydrocephalus or tumour.2 This measurement should be repeated at follow-up.

Persistent parental concern is another indication for referral.3 If parents continually return with the same anxieties, serious underlying conditions such as cancer are more likely. Most babies will not have underlying disease, but the increased relative risk justifies further referral. Detailed guidance on when to refer children with suspected brain tumours is available at www.headsmart.org.uk.


Cite this as: BMJ 2012;345:e6917


  • Competing interests: None declared.


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