I am looking for the growth chart to reflect the "norm" for my adopted nephew who is from guatemalan. he was also premature with alcoholic mother. is there a place where I can find such chart?

I think it's safe to say that there is no specific growth chart for prenatally alcohol-exposed premature Guatemalan (Maya or Ladino ethnicity) children ... but if you find one, please let us know! You could probably do well enough with one of the preemie charts above, cross-referenced with Dr Monteil's head circumference charts.

However, in a child whose birth mother drank during pregnancy, I would be very careful about calling a small head circumference an "ethnic" issue, since it could also be a sign of alcohol's impact on brain growth, which would be worrisome.

We are planning to adopt a newborn boy from Guatemala. He is currently less than one month old. At birth, he weighed 6.4 lbs and measured 18.89", making him between the 10th and 25th percentiles for weight and length. His head circumference was measured as 32.5 cm, making him below the 5th percentile. We have no other medical information, but we are concerned about his head circumference. Is it likely that his intellectual ability will be affected, or can we expect him to have normal intelligence?

I get 32.5cm to be at the 7th percentile or so, which is pretty good for Guatemala. Birth head circumferences can also be affected by molding of the skull bones during birth ("conehead") which gives a lower head circumference until things reexpand. As always, you want to follow growth over time, but I wouldn't consider that head size to increase his risk for developmental issues. Good luck!

We are adopting an infant from Ethiopia and are looking for a growth chart for girls 0-12 months from Ethiopia. Is there any information available on this please?

I'm not aware of growth charts for Ethiopia - Google and Pubmed searches aren't turning up anything either. If you find any when you're over there, please send us a copy!

One article that analyzed growth of kids aged between 2 and 10 years from urban and rural areas of Ethiopia found that, similar to reports from other developing countries, "the great amount of malnourished children is preoccupying as reflected by about 15% of children below the 5th centile of weight for height and about 53% of children below the 5th centile of height for age and about 45% below the 5th centile of weight for age." Kinda awkward translation, but you get the picture.

Honestly, any available Ethiopian growth chart would probably not reflect how Ethiopian children could/should grow given adequate access to clean water, adequate nutrition, prenatal care, and modern health care. See the WHO info above ...

Nice overviews of other Ethiopian adoption issues can be found at: http://www.orphandoctor.com/medical/regional/ethiopia/index.html and http://www.adoptionadvocates.org/AAI/Info.htm ...

I'm adopting a boy from Guatemala. He's one week old, and the info. I received about him is that he weighs 4.2 pounds, 42.5 cm long, with a head circumference of 31 cm. He's small, but I don't know if any of this is worrisome or not. We are trying to find out more information to see if he was premature and if so, what the gestational age was. I have no info. regarding drug or alcohol history for mother, but we're asking just in case. I'm having trouble understanding the charts, so could you help me put his measurements, etc. in perspective? Thanks for your time.

These measurements are all quite small for a term newborn, even in Guatemala. You're asking the right questions, as far as trying to learn whether he was premature or small for gestational age (SGA).

Thanks Dr. Davies. I just got a bit more information. There was no drug or alcohol exposure, according to the birth mother, and the baby was about five days early. According to the attorney, the birth mom is poor, and she herself suffers from "nutritional problems".

I should mention that he was already out of the hospital and in foster care a week after his birth (I don't know how long he was in, but when I got the referral a week after his birthday, he was already in foster care). I take that as a good sign.

One month after birth our baby boy was 7 pounds 4 ounces,52 cms and head circumference was 34.2. At birth he was 6 ounds 2 oz and his length was 49 and his head was 33.5. His status dropped on the charts. What can we make of this. The doctor here is very concerned.

Hi everyone ... I think I have to make it clear that it's not feeling ethical, accurate, or particularly helpful for me to comment on individual children's growth trends from a comments section of a website, without knowing a lot more about the particular child. I goofed above by answering individual child questions in the context of sharing broader information about country trends, but am increasingly uncomfortable doing so.

I'd love to be of help, but it's just impossible to say much about growth and risk without knowing a lot more than can be left in a comments section. For preadoptive international adoption referrals, I can review your whole file in an actual consultation, and for children who are already home, I'd recommend that you look for local in-person evaluations.

Thanks for understanding, and I'm still happy to answer more general adoption/growth questions in this comments section.

I'm hoping to adopt a boy, between 2 and 4 years old, from Guatemala. I received information (weight, height, head circumference) on a boy who is 3 and was told he is malnourished. His stats are way below where they should be on the WHO height-for age and weight for age chart. His weight and height stats are more consistent with a 20 month old.

I have 3 questions: 1. Is the WHO growth chart what I should be using to look up stats on Guatemalan boys? 2. What growth percentile is "normal" or acceptable, given the poor nutrition that some children may experience? 3. Can a 3 or 4 year old child recover from being malnourished his entire life without permanent damage? Thank you for your time.

The WHO charts seem appropriate, but since they have yet to publish head circumference charts, we still use the CDC charts for kids from Guatemala.

Without looking at the growth chart, it's hard to say how "typical" his growth is. The 3rd percentile (lowest rung of "normal") at 3 yrs old is the same weight as the 50th percentile (average weight) of a 19mo. 3rd percentile wouldn't be concerning. Way below the 3rd percentile, and poor head growth would be concerning.

For a child with a proportional growth failure (well below the chart, but weight for height is reasonable), it becomes likely that stress/neglect as well as malnutrition was involved.

Hard to say about complete recovery ... the older the age at adoption, the more likely are longer-lasting consequences of malnutrition, stress, lack of consistent caregiving, and other adversity. Many of those consequences are manageable, and kids are impressively resilient, but it is likely that there will be some impacts from those early years.

Those impacts can include a more "thrifty metabolism" that increases later risk for overweight, hypertension, and adult-onset diabetes (the "metabolic syndrome"); they can also include developmental impacts like ADHD, difficulties with emotional regulation, and so on. It's hard to be more specific without knowing more about those formative experiences.

Best of luck in your adoption!

Great info on this site!

Hello, my wife and I have a little boy (or not so little boy) in Guatemala. He is now 1 month old (born 1/18/2007). There was a weight discrepency at birth (birth certificate read 9lbs 5oz and medical report read 8lbs 5oz)- regardless, a big baby and was thinking there may have been diabetes with the mother. His length and head cir was 49.4cm and 33.8. We just received the 1 month photos and stats and he is now 9lbs 13oz and is 50.7cm and 36.4cm. It seems that his head cir is consistent, but his height isn't.

Another thing we noticed was the left side of part of his face seems to be lazy or maybe have some sort of facial paralysis. The left side of his lip seems like it hangs down a bit. We did see a picture where he is smiling a little so it looks like the muscles work- maybe just a little weak. We read that this happens once in a while with a challenging birth.

Any insight would be greatly appreciated.

Thanks.
Eric

Congrats on your referral! Please see my comments above about individual child questions ... it just doesn't feel right to analyze growth this way.

As for facial asymmetries, additional photos of facial expression at rest, smiling, and crying can be very helpful. Additional information about the labor and delivery could be helpful here too. One common cause for this is indeed compression of the facial nerves in a difficult birth. Less common are differences in nerve development. Spontaneous improvement usually happens with the former but not necessarily with the latter cause. You might have a local pediatrician or IA doc take a look at your referral when you have a bit more growth and photo information.

Hello,
We have already adopted a girl from Russia. We knew she was very small from the referral. We decided to adopt her even knowing how tiny she was. At adoption, she was 25 months, 15.5 pounds, 28" tall with a hc of 17". She is now 53 months, 24 pounds, 36" and a hc of 17.25".

We had an IA doctor look her over & dig into her background while we were in Russia. Some things he discovered were: family history of smallness--maternal birth grandmother is ~150 cm; prematurity (born at 32 weeks-1700 gm, 36.8 cm), EXTREME neglect for her first 10 months including 5 hospitalizations then removal from birthmother and placed in orphanage for 15 months. There is a probability of fetal alcohol as alcohol was one of the reasons given in the court order for removal. Also discovered since arriving home, celiac disease and inactive TB.

My question...Do you think our daughter will have any more "catch up" growth? She has been with us for over 2 years, on the gluten free diet for a year, finished with 9 months of INH last November. She is pretty bright but lacking in social skills. She is ALL OVER petite--her head is tiny, her body is tiny, her hands are tiny. Should we treat her as having a form of dwarfism?

Whatever happens, we love & cherish her. :o) Thanks

You bring up a good point here, which is that we should not assume that growth problems are an "orphanage" issue. Celiac sprue is a medical issue that was important to find here, and in fact, when we see children in our adoption or FAS children that are markedly small, we try to not pin it "just" on orphanage or alcohol issues, but also to do a full "short stature" or "failure to thrive" workup.

She has many many risk factors for poor growth here. I would consider endocrinology consultation to help with the workup but also to discuss possible treatment. Children who are born small and do not catch up in the 1st two years of life may be candidates for growth hormone therapy. That said, the longterm benefits of growth hormone treatment are modest, and it does involve frequent injections.

Another general point here is that children with very poor head growth need further workup. Depending on who's available to you, a neurodevelopmental pediatrician, neurologist, or FAS specialist would be a good idea to explore what's going on there. They might consider head imaging, genetic testing, and should certainly screen her for facial features of FAS. Early diagnosis and intervention for any delays or learning issues is also important, so I would have her evaluated formally if she hasn't been already. Knowing about delays before they show up as school frustrations is ideal.

Sorry for staying so general in my response ... since she's home and you have providers that know her well, I don't want to presume I know better. But please share these concerns with them.

Do I think she'll have more catchup? Perhaps, but she's past the point where we usually see very rapid catchup, so her gains, if any, will probably be more subtle over time. All the best to you and your daughter ...

I received a referral last week for a girl from Guatemala, born 2/28/07, 43.8cm height, 32.7cm head circumference. I have looked at the charts and am having a hard time determining what percentile she is in.

Also, because her head circumference seems small, I wonder if she could have FAS. Would you address whether FAS can be determined at birth and where newborns with FAS generally fall on the chart. Her eyes seem a little far apart, which I understand is an indicator of FAS as well.

Thank you

Please see the comments above, circa 10/11/06, for why I can't address your child-specific growth concerns in this forum.

As for FAS, it can be determined at birth IF the child has the classic facial features +/- growth defiency, which is a less reliable feature. Newborns with FAS are often, but not always, small at birth, so they can fall anywhere on or below the charts. To make a formal diagnosis, you also need a reliable history of alcohol exposure; however, even without the known prenatal drinking, having the full facial features of FAS is still quite predictive of future FAS.

Lots more on FAS in our "Fetal Alcohol Spectrum Issues" article (http://www.adoptmed.org/topics/fetal-alcohol-spectrum-issues.html). Wide-spaced eyes are actually not a reliable feature of FAS ... we look for small eyes by measuring visible eye widths, from inner to outer corner of each eye.

If your concerns persist, I would recommend consulting an international adoption pediatrician, or perhaps your local pediatrician. I'm sorry I can't be of more help here on the site.

We just received a referral from India. The boy's birth weight was 1200g, 38 cm height and 27 cm head circumference. He is now 9 months old and weighs 5.8 kg. Could you kindly advise us ? Are there any published data of VLBW children from India? Thank you in advance

Hello - I just updated the page with a new, more modern India growth reference. Unfortunately, you're going to have a hard time plotting his growth without more of an estimate of how premature he was. He's small enough that some degree of prematurity is likely; that would actually be reassuring in some ways, as unexplained very small for gestational age is considered potentially riskier than appropriately-grown-for-gestational-age prematurity.

Definitely follow-up with your agency about estimates of prematurity, and if they know of any newborn preemie-type complications. You'll also want up-to-date height and head circumference, as well, if you don't already. I would suggest sharing his complete referral information with a doc familiar with children adopted from India for a fuller, more informed discussion around growth and risk. All the best to you in this process ...

We adopted a girl from China 10 months ago. She is 24 months old now. According to her referral records, when she was in China her head size was in the 50%. Since she has been home she has been in the 98 or 99%. She had one MRI 3 months ago and it came out fine. Now at 24 months her head measured 51 1/2 cm, which is off the charts. She is developmentally fine, talking in sentences, etc. Should we be worried about this new head measurement, since she has always had a large head?

In addition to the question above. I should have added that when we adopted her 10 months ago she was in the 75% for height and the 25% for weight. Now at 24 months old she is in the 75% for height and the 70% for weight. Also, her MRI 3 months ago was because of her large head size.
Thanks.

I'm generally not able to give specific medical advice in this forum, usual caveats apply, ... but generally speaking, a normal head MRI, normal development, and normal neurologic examination would rule out most of what we worry about with large heads. Worth following her head growth, but sounds like you're in good, cautious hands with your current providers.

Thanks for a wonderful site. I am wondering how malnourishment affects growth. We are adopting a boy from Guatemala - measurements taken at 5 yrs. old. He was said to be severely malnourished - distended abdomen, extremely anemic, and wormy. However the height and weight measurements given don't seem to be all that small for a Guatemalan child - 43 lb. 4 oz and 41.75 inches. Thanks for any info on malnourishment.

I am currently adopting preemie twins from Guatemala (DOB 12/30/06). The belief is that they were born around the 34 week mark, give or take a couple weeks. Which growth chart should we use given the circumstances?

I'd probably use the 1st premature chart listed above (26wks to 1 year) ... unfortunately I've not been able to find a reliable premature + twin growth chart, which would be quite useful since twins are often born early, and are each often smaller than singletons.

Our son was adopted from Russia at age 4. He was very small for his age at that time. He is now 14. We do not know his actual birthdate. He is 66.5 inches tall and 124 lbs. My pediatrician best guess is that he will probably hit 6' tall. He is average to late entering puberty. My son is always asking how tall will he be?

What charts would be most accurate?

Nothing is very accurate in this situation, but your best guess might be this height predictor ... have fun, and don't invest in expensive Italian suits for his predicted size.

My son came home from Guatemala when he was 8 month old. He is now about to turn 2 years old and is in the 5th percentile on the CDC growth chart. I was wondering if there is some way to find out what percentile he would be in for little boys from Guatemala or Central America. He is 32 inches or 81.3 cm.

Thank you.
Anne

I'm not aware of any Guatemalan or Central American-specific growth charts, but if you find any, please let me know!

We have just gotten a referral for a beautiful 5 month old girl from Vietnam. Her head circumference is well below 3% according to the CDC growth charts, and right at about 3% on the China chart. A review of online groups tells me that small head circumference is not uncommon for Vietnamese adoptees. Have you found this to the case (in general) at your practice?

We just got the reports on our sons: Zachary @ 8 months is 14.8 lbs, height 61 cms & cc 39 cms & Matthew @ 5 months is 14.8, height 69 cms & cc 41 cms. Are these within the percentile for their ages?

Jennifer -
In our experience, children from China, Taiwan, and more recently Vietnam have trended lower on the US head circumference charts, but not typically "well below", although that would depend on your definition of well below. Just below the 3rd percentile and gaining well with time, with no known microcephaly risk factors or neurodevelopmental concerns would not raise big alarms for us, but would be worth following closely. Very roughly speaking, if head size is more than one centimeter below the 3rd percentile line, or statistically at or below "-3 standard deviations from the mean", that's more unusual and potentially concerning. This is where a preadoption review of all available records and followup questions can be helpful.

Mary -
Sorry, we can't provide that sort of specific advice here on the website, but there's no shortage of growth charts above for you to plot them on. They're not hard to figure out, and you'll find other online resources like this one that can plot things for you if you like. Google has a neat feature that will convert units for you if you type things like "40 cm in inches" in the search box.

We've just received a referral for a girl in Vietnam, born around August 4 with an exam date of August 31. Her head circumference was 34 cm which seems within the normal - if low - range for her ethnicity. However, my husband is worried - her weight was 7.5 lbs and her length 20.4. Does this seem into a worrisome range, or within normal?

Sorry, but again, I can't comment on specific children and whether their growth is worrisome or not in this forum.

We received a referral for a baby girl born in Korea. Gestational age 36 weeks 1 day.
Measurements are as follows:
Birth: Weight 2.38 kg, Height 47 cm, HC 31 cm
5 weeks: Wt 3.7 kg Height 52 cm HC 34.1
3 mo/3wks: Wt 6.3 kg Height 60.6 cm HC 42.8 cm
4 mo 1 wk HC 38.8 cm

Since she is "technically" 3 weeks premature, I've been plotting growth on a preemie chart. There is a history of mother having anemia a few weeks prior to birth requiring multiple blood transfusions. There is also possible congenital syphilis (not confirmed as they think it was mother's antibodies and baby was treated at birth anyway), possible congenital CMV (test was done at 4 mo and cannot tell however if this was true infection vs. maternal antibodies), minimal smoking and she said she drank 3 glasses of liquor after the 5th month on one occassion.

We are particularly concerned about her head circumference at birth as well as now, since it's significantly disporportionate to her body growth. We're also concerned about her measurements at birth, as although we know she was preemie, she seemed to be on the small side for that as well.

My questions are: what growth charts should we be using? What is the criteria for microcephaly? Is there a general concern if the head growth does not go at the same rate as the rest of the body? If a baby is SGA but starts to really take off growing, is there still a concern? She has a somewhat flattened head in the back now which could account for a smaller circumference, but her head has always been on the small side it seems.

Thanks for any information. We are very concerned about her.

Whoops - sorry I missed your post. I'm not aware of VLBW charts for children from India. It would be reasonable to use the Western preemie charts above, though. That would require knowing a gestational age, however ...

This is the most complete collection of baby growth charts I have ever seen. Thanks for the great work. I just implemented an interactive Flash based baby growth chart program at http://babygrowthchart.org

Please feel free to take a look and let me know your comments. If possible, I'd like to include more charts to the program.

We have just received a referral from Russia for a 30 month old boy. His head circumference is 44.5 CM, which is two CM below the 5% quartile on the CDC chart. Am I looking at the correct chart to compare a Russian child and, in general, do you find that Russian adoptees are smaller then an average American child?

Thank you!

Hi all,

This is so heartbreaking. I just received a referral for a little girl who is totally off the chart for Russia in terms of height, weight and head circumference (lower than 3%). I am convinced the reason her Mother was deprived of her parental rights. I cannot imagine giving up the referral after waiting so many years - but I am fully aware of the difficulties that she will face in life. How do you gather the strength to face the inevidable?

Deb

Its hard. We have waited a long time too, but turned down our 1st referral because we had concerns about the need for long-term care (we just are not prepared for that). It was a very painful decision and one I hope we don't have to make again. But unless you are fully prepared to become a full time caregiver its probably in the best interest of the child to turn down the referral (as hard as that is). Good luck.

Hi Mark -
The CDC charts have been a good fit for our Russian adoptees so far. They may arrive smaller (due to prenatal exposure, stress, malnutrition, etc) but tend to grow like US/European kids overall. Particularly for head size, I wouldn't use a country-specific chart of uncertain origin.

Deb -
If a child already in your family developed special needs, you'd of course rise to the occasion. It's this "decision" based on incomplete and worrisome information that seems so unfair and impossible for many of our parents ... I think every person in every family faces it differently, with their head, their heart, or both. Best of luck ...

We are adopting a beautiful baby girl in Russia. Absolutely no facial FAS. At birth she was 2300 grams, 48 cm, hc 32.5. At approx 6 mos 3 weeks her weight was 6100 grams, length 64 cm and head 41 cm. Her birth mom admitted to using alcohol and nicotine, but the extent is not known. Is there anything you can tell us in general regarding the growth charts based on what little info we have thus far?

I forgot to add, her APGAR was 8/9.

������ ����!

�������� � ��� �� ����� ��� �������� ���������� ���� � ��������� ���������!
��� ���� <a href=http://gsmtricks.ua>������� ��������� ���������</a> ������ ������� ����� 3000!
���������� �������� ��� �� ����� ����, �������, ��������, ��������� � ������ ������..
�� ����� ����� - ����� ������� ���������� ���������� �������� � ��������� ���������, ������ � ��� �����..

��� ��� ����� ���������� www.gsmtricks.ua

P.S. ���� �� � ���� ������� ����� ����������� � ������ ���������.

Hello,
I am 35wks pregnant and of Indian origin (South Indian to be more specific). I was looking for a FETAL growth chart specific for Indians as the growth plotted on charts here (Australia) show that the baby is small and dropping its centiles. I would be grateful if you could direct me to the right place to find one.

<b>Calligraphy</b> is one of the old part of the human culture. It has been brushing up together with script. It is characterized by the eternal striving for something beautiful. The art of handwriting both ancient and contemporary, its aesthetic distinctiveness should be taken tremblingly, with reverence.

But alas� a typewriter, computer, communicator� The mankind is steadily going away from the "handmade speech", that's is the words written on parchment, elm, paper or on turns. The scientific articles, novels, verses and love letters, all these we type on the keyboard.

But things are not too bad! Recently there was initiated a new project "International Calligraphic Exhibitoin". Its main goal is to form beautiful and healthy society through the art of calligraphy. The exhibition will be opened on Seprember 16th at the St.Petersburg State Academic Institute of Painting, Sculpture and Architecture n.a. I.E. Repin. One of the mottos of the event : <a href=http://www.calligraphy.mvk.ru/en/>Calligraphy</a> is the frozen poetry.

The exhibition will include the works of the best <a href=http://www.calligraphy.mvk.ru/en/?idx=28>calligraphers</a> from Russia, Belarus, Ukraine. To clearly understand the international level of calligraphy there will be organized a special exposition of the calligraphic schools of Europe, Baltic states, USA, Israel, China, Japan, Cyria and UAE.

The framework of the exhibition will also include the museum exposition displaying the ancient manuscripts of different epochs. Children and their parents, and all the comers will take pleasure of the calligraphic lessons and interesting lectures, while the professionals will take the opportunity to brush up their skills at the master-classes.

<b>On May 14th at 2 pm </b> there will be organized the presentation of the International Calligraphic Exhibition at Crocus Expo. At the presentation one will see a part of the master-pieces of <a href=http://www.calligraphy.mvk.ru/en/?idx=8>the calligraphic gallery</a>, which everyday is added by new works and authors.

Source: <a href=http://www.calligraphy.mvk.ru/en/>"International Calligraphic Exhibition"</a>

<b>P.S.:</b> I would add for myself: undoubtedly, they do the right deal. Russia has always been living with fervor. The least I can do for the "International Calligraphic Exhibition", in which I trust and believe it is right and necessary is to present this beautiful art to the wide audience, to you, dear forum participants. I would be grateful if the art of calligraphy awaken interest and a drop of enthusiasm.