German head circumference references for infants, children and adolescents in comparison with currently used national and international references

Aim: To present valid head circumference (HC) percentiles from early infancy to 18 years and to compare them with percentiles currently used in Germany by Prader, as well as to international WHO and CDC references.

Methods: Nationally representative sample of 17,158 children and adolescents aged 0.25-17.98 years (KiGGS study 2003-2006) with standardized HC measurement. HC references were created using Cole's LMS method.

Results: The median growth of HC is largest in the first year of life. Adult HC is reached at age 16 years in girls, while in boys, HC growth continues through age 17 years and adult HC have to be derived from future KiGGS follow-up examinations. KiGGS percentiles are quite similar from early infancy to early school age compared to older Prader references, but higher thereafter (maximum difference of median HC: girls 1.4 cm, boys 0.9 cm). KiGGS percentiles are also higher than WHO and CDC percentiles over most of the compared age range, but differences are less pronounced compared to Prader.

Conclusion: The KiGGS HC references presented here for boys and girls aged 4 months through 17 years are more valid than currently used German references. Because of the similarity of KiGGS and the currently used reference by Prader in early infancy, the currently used Prader reference for 0-4 months could complement KiGGS to cover the entire age range from birth to the end of adolescence.