This bracelet is especially nice for a surprise gift since you do not need to know their exact wrist measurement. You can add, take out, or move the Italian charms around on the bracelet. Contact me what size you want. This bracelet comes with the charms as shown attached to a "SHINY" starter bracelet. The small Italian charms and links shown are 9mm (3/8 inch). The superlink medical charm is twice as long. See our "FREQUENTLY ASKED QUESTIONS" for more details. We have an Autism puzzle charm which can go in this bracelet. Look in MY search bar under ribbon.