Microcephaly is a medical condition in which the circumference of the head is small because the brain has not fully developed or has stopped growing. Microcephaly can be present at birth or it may develop in the first few years of life. It is most often caused by genetic abnormalities that interfere with the growth of the cerebral cortex during the early months of fetal development. Babies may also be born with microcephaly if, during pregnancy, their mother:

• Abused drugs or alcohol
• Became infected with a cytomegalovirus, rubella (German measles), varicella (chicken pox) virus, or possibly zika virus
• Was exposed to certain toxic chemicals
• Had untreated phenylketonuria (PKU), a harmful buildup of the amino acid phenylalanine in the blood

Microcephaly is associated with Down's syndrome, chromosomal syndromes, and neurometabolic syndromes. With viral-induced brain injury there is often widespread tissue and cell death leading to brain shrinkage rather than simply impaired growth.

Depending on the severity of the accompanying syndrome, children with microcephaly may have:

• Impaired cognitive development
• Delayed motor functions and speech
• Facial distortions
• Dwarfism or short stature
• Hyperactivity
• Seizures
• Difficulties with coordination and balance
• Other brain or neurological abnormalities

Severe microcephaly is a more serious, extreme form of this condition where a baby’s head is much smaller than expected. Severe microcephaly can result because a baby’s brain has not developed properly during pregnancy, or the brain started to develop correctly and then was damaged at some point during pregnancy.

Babies with microcephaly can have a range of other problems, depending on how severe their microcephaly is. Microcephaly has been linked with the following problems:

• Seizures
• Developmental delay, such as problems with speech or other developmental milestones (like sitting, standing, and walking)
• Intellectual disability (decreased ability to learn and function in daily life)
• Problems with movement and balance
• Feeding problems, such as difficulty swallowing
• Hearing loss
• Vision problems

These problems can range from mild to severe and are often lifelong. Because the baby’s brain is small and underdeveloped, babies with severe microcephaly can have more of these problems, or have more difficulty with them, than babies with milder microcephaly. Severe microcephaly also can be life-threatening. Because it is difficult to predict at birth what problems a baby will have from microcephaly, babies with microcephaly often need close follow-up through regular check-ups with a healthcare provider to monitor their growth and development.

Microcephaly is not a common condition. Researchers estimate that about 1 in every 800-5,000 babies is born with microcephaly in the United States.

The causes of microcephaly in most babies are unknown. Some babies have microcephaly because of changes in their genes. Other causes of microcephaly, including severe microcephaly, can include the following exposures during pregnancy:

• Certain infections during pregnancy, such as rubella, toxoplasmosis, or cytomegalovirus
• Severe malnutrition, meaning a lack of nutrients or not getting enough food
• Exposure to harmful substances, such as alcohol, certain drugs, or toxic chemicals
• Interruption of the blood supply to the baby’s brain during development

Some babies with microcephaly have been reported among mothers who were infected with Zika virus while pregnant. CDC scientists announced that enough evidence has accumulated to conclude that Zika virus infection during pregnancy is a cause of microcephaly and other severe fetal brain defects.

CDC continues to study birth defects, such as microcephaly, and how to prevent them. If you are pregnant or thinking about becoming pregnant, talk with your doctor about ways to increase your chances of having a healthy baby.

Microcephaly can be diagnosed during pregnancy or after the baby is born.

During Pregnancy

During pregnancy, microcephaly can sometimes be diagnosed with an ultrasound test (which creates pictures of the body). To see microcephaly during pregnancy, the ultrasound test should be done late in the 2nd trimester or early in the third trimester. For more information about screening and confirmatory tests during pregnancy, visit CDC’s birth defects diagnosis web page.

After the Baby is Born

To diagnose microcephaly after birth, a healthcare provider will measure the distance around a newborn baby’s head, also called the head circumference, during a physical exam. The provider then compares this measurement to population standards by sex and age. Microcephaly is defined as a head circumference measurement that is smaller than a certain value for babies of the same age and sex. This measurement value for microcephaly is usually more than 2 standard deviations (SDs) below the average. The measurement value also may be designated as less than the 3rd percentile. This means the baby’s head is extremely small compared to babies of the same age and sex.

Head circumference growth charts for newborns, infants, and children up to age 20 years in the United States can be found on CDC’s growth charts website. Head circumference growth charts based on gestational age at birth (in other words, how far along the pregnancy was at the time of delivery) are also available from INTERGROWTH 21st. CDC recommends that health care providers use the WHO growth charts to monitor growth for infants and children ages 0 to 2 years of age in the United States.

Microcephaly can be determined by measuring head circumference (HC) after birth. Although head circumference measurements may be influenced by molding and other factors related to delivery, the measurements should be taken on the first day of life because commonly-used birth head circumference reference charts by age and sex are based on measurements taken before 24 hours of age. The most important factor is that the head circumference is carefully measured and documented. If measurement within the first 24 hours of life is not done, the head circumference should be measured as soon as possible after birth. If the healthcare provider suspects the baby has microcephaly, he or she can request one or more tests to help confirm the diagnosis. For example, special tests like like magnetic resonance imaging can provide critical information on the structure of the baby’s brain that can help determine if the newborn baby had an infection during pregnancy. They also can help the healthcare provider look for other problems that might be present.

Microcephaly is a lifelong condition. There is no known cure or standard treatment for microcephaly. Because microcephaly can range from mild to severe, treatment options can range as well. Babies with mild microcephaly often don’t experience any other problems besides small head size. These babies will need routine check-ups to monitor their growth and development.

For more severe microcephaly, babies will need care and treatment focused on managing their other health problems (mentioned above). Developmental services early in life will often help babies with microcephaly to improve and maximize their physical and intellectual abilities. These services, known as early intervention, can include speech, occupational, and physical therapies. Sometimes medications also are needed to treat seizures or other symptoms.