Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1010-1018 (doi:10.1542/10.1542/peds.2006-0298)

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ARTICLE

Growth and Health in Children With Moderate-to-Severe Cerebral Palsy

Richard D. Stevenson, MD^a, Mark Conaway, PhD^b, W. Cameron Chumlea, PhD^c, Peter Rosenbaum, MD^d, Ellen B. Fung, RD, PhD^e, Richard C. Henderson, MD, PhD^f, Gordon Worley, MD^g, Gregory Liptak, MD^h, Maureen O'Donnell, MDⁱ, Lisa Samson-Fang, MD^j, Virginia A. Stallings, MD^k of the North American Growth in Cerebral Palsy Study

^a Departments of Pediatrics
^b Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
^c Department of Community Health and Pediatrics, Wright State University, Fairborn, Ohio
^d Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
^e Department of Pediatrics, Children's Hospital Oakland, Oakland, California
^f Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina
^g Department of Pediatrics, Duke University, Durham, North Carolina
^h Department of Pediatrics, University of Rochester, Rochester, New York
ⁱ Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
^j Department of Pediatrics, University of Utah, Salt Lake City, Utah
^k Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania

BACKGROUND. Children with cerebral palsy frequently grow poorly. The purpose of this study was to describe observed growth patterns and their relationship to health and social participation in a representative sample of children with moderate-severe cerebral palsy.

METHODS. In a 6-site, multicentered, region-based cross-sectional study, multiple sources were used to identify children with moderate or severe cerebral palsy. There were 273 children enrolled, 58% male, 71% white, with Gross Motor Function Classification System levels III (22%), IV (25%), or V (53%). Anthropometric measures included: weight, knee height, upper arm length, midupper arm muscle area, triceps skinfold, and subscapular skinfold. Intraobserver and interobserver reliability was established. Health care use (days in bed, days in hospital, and visits to doctor or emergency department) and social participation (days missed of school or of usual activities for child and family) over the preceding 4 weeks were measured by questionnaire. Growth curves were developed and z scores calculated for each of the 6 measures. Cluster analysis methodology was then used to create 3 distinct groups of subjects based on average z scores across the 6 measures chosen to provide an overview of growth.

RESULTS. Gender-specific growth curves with 10th, 25th, 50th, 75th, and 90th percentiles for each of the 6 measurements were created. Cluster analyses identified 3 clusters of subjects based on their average z scores for these measures. The subjects with the best growth had fewest days of health care use and fewest days of social participation missed, and the subjects with the worst growth had the most days of health care use and most days of participation missed.

CONCLUSIONS. Growth patterns in children with cerebral palsy were associated with their overall health and social participation. The role of these cerebral palsy-specific growth curves in clinical decision-making will require further study.

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Key Words: cerebral palsy • health status • growth • growth and nutrition • growth patterns

Abbreviations: CP—cerebral palsy • NAGCPP—North American Growth in Cerebral Palsy Project • KH—knee height • UAL—upper arm length • SUB—subscapular skinfold thickness • TRI—triceps skinfold thickness • AMA—arm muscle area • GMFCS—Gross Motor Function Classification System • CDC—Centers for Disease Control and Prevention

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Accepted Mar 31, 2006.

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