The association of small for gestational age (SGA) and central nervous system (CNS) abnormalities is controversial. Some reports suggest that SGA infants are at higher risk, whereas other data indicate that growth retardation may have a protective effect on the CNS. We compared the cranial ultrasound results of 197 SGA infants with 197 appropriate for gestational age (AGA) neonates, matched for gestation and gender, to determine if growth retardation is associated with a difference in ultrasound detectable CNS abnormalities. Infants with external dysmorphology or toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH) infections were excluded. We found 51 (26%) intracranial abnormalities in the SGA infants compared with 41 (21%) in the AGA controls (difference not significant). The most common lesions were hemorrhagic or ischemic, and the incidence was similar for both groups, 43 (22%) for SGA and 35 (18%) for AGA infants. The type and severity of hemorrhagic or ischemic lesions was also the same. Ventriculomegaly, not associated with hemorrhage, and structural lesions were also comparable, nine (5%) in the SGA and six (3%) in the AGA infants. We conclude that SGA infants without external dysmorphology or TORCH infections are not at increased risk for CNS abnormalities detectable by cranial ultrasound.