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Inuit children in Nunavut, Canada, exhibit unique head growth patterns that frequently lead to overdiagnosis of macrocephaly when assessed using World Health Organization (WHO) growth charts, according to a recent study published in CMAJ. The findings suggest that the use of population-specific growth curves could significantly improve diagnostic accuracy, ensuring appropriate care for Inuit children and reducing unnecessary travel and medical assessments.
The research, led by Dr. Kristina Joyal, pediatric neurologist at the University of Manitoba and University of Saskatchewan, was motivated by clinical observations of larger-than-average head sizes in Inuit children. “This is crucial, especially for those in remote northern areas,” said Dr. Joyal. “Current macrocephaly assessments necessitate travel to larger medical centers, which disrupts families and strains healthcare resources.” Dr. Joyal further explained that Inuit children with true neurological or genetic issues, such as those associated with microcephaly, may face delays in receiving necessary care due to reliance on WHO charts.
In this study, researchers analyzed head circumference data from 1,960 Inuit children born between 2010 and 2013 in Nunavut. The cohort excluded children with conditions affecting head size, ensuring comparisons aligned with WHO’s reference populations. Results showed that Inuit children’s head circumferences tended to fall between 0.5 and 1 standard deviation above WHO averages, with many children classified as “macrocephalic” under current standards despite normal neurological health. For instance, median head circumferences at 12 months were 1.3 cm larger for Inuit boys and 1.5 cm larger for Inuit girls compared to WHO standards.
This discrepancy led to overdiagnosis of macrocephaly by 25-30% for boys and 15-20% for girls. Adjustments using Inuit-specific growth curves would significantly reduce these figures, preventing misclassification for 651 children and facilitating timely intervention for those at risk of microcephaly.
A Broader Context: Population-Specific Growth Curves
Similar challenges in using standardized growth charts are observed among other Indigenous populations worldwide, including Cree children in Quebec, Inuit children in Greenland, and Indigenous communities in Japan, Australia, and Turkey. Dr. Joyal’s team plans to partner with Inuit leaders in Nunavut to develop culturally relevant growth metrics, which would augment existing WHO charts and provide clinicians with more reliable reference points.
“This [work] could impact Inuit children throughout Canada and globally — potentially benefiting other Indigenous children in Canada as well,” Dr. Joyal stated. She emphasized the importance of partnerships with Indigenous groups, highlighting the collaboration with Nunavut Tunngavik, Qaujigiartiit Health Research Centre, and the Government of Nunavut Department of Health.
Sorcha Collins, a public health researcher from The University of British Columbia, noted that Indigenous-centered research must carefully balance potential benefits against risks of stigma. “Avoiding research on growth disparities may also inadvertently harm communities by leaving health gaps unaddressed,” she added.
Funded by the Canadian Institutes of Health Research and the Government of Nunavut, this study represents a crucial step toward refining diagnostic standards for Inuit children, providing a model for similar initiatives in Indigenous healthcare globally.
