Growth patterns in a population of children and adolescents with cerebral palsy
Steven M Day* PhD FAACPDM; David J Strauss PhD FASA; Pierre J Vachon PhD MPH, Life Expectancy Project, San Francisco, California, USA. Lewis Rosenbloom FRCPCH, Royal Liverpool Children’s NHS Trust, Liverpool, UK. Robert M Shavelle PhD MBA, Life Expectancy Project; Yvonne W Wu MD MPH, Departments of Neurology andPediatrics, University of California, San Francisco, CA, USA. *Correspondence to first author at 1439 17th Avenue, San Francisco, CA 94122, USA. E-mail: Day@LifeExpectancy.com
This study examined growth of children and adolescents with cerebral palsy (CP) who received services from the California Department of Developmental Services from 1987 to 2002. In all, 141 961 measurements of height andweight were taken from 24 920 patients with CP (14 103 males, 10 817 females). Centiles of weight and height were determined by age, sex, and five levels of functional ability ranging from fully ambulatory to unable to walk, crawl, or feed self, and fed via gastrostomy tube. Resulting charts of height and weight centiles were compared with Centers for Disease Control and Prevention weight and heightcharts for the general population of the US. Centiles of height and weight of patients with CP were close to those of the general population for the highest functioning groups with CP, but lagged substantially for other groups. Presence of a feeding tube was associated with greater height and weight in the lowest functioning groups, with centiles for weight being 2 to 5kg higher for those withgastrostomy tubes. The charts may assist in early identification of nutritional or metabolic difficulties beyond what might be expected for patients with similar functional disabilities.
See end of paper for list of abbreviations.
Patterns of human growth are predictable.1 As significant deviations from predicted patterns may indicate serious underlying health problems, early identification isimportant for timely treatment. Thus, plotting a child’s weight and height on charts that permit direct comparison with age and sexspecific centiles in the general population1 has become standard practice for pediatricians. Studies have documented that growth patterns for patients with cerebral palsy (CP) are different from those in the general population.2–13 Patients with CP have below averageweight,2 linear growth,2,13 muscle mass,2 and fat stores2 compared with their peers in the general population. Bone mass density is also reduced, especially among patients who are non-ambulatory.3 Feeding difficulties and resulting nutritional problems are partly responsible for these deficits in growth.2,5–9 Stepwise increases in level of feeding difficulty have been shown to correspond withsuccessive decreases in nutritional status as measured by weight, stores of body fat, and arm muscle mass.2 However, this stepwise relationship did not hold for patients with the most severe feeding difficulties who received nutrition primarily via a feeding tube: these patients weighed more, and had more muscle mass and fat stores than peers with a similar disability who took all food orally.2 However,non-nutritional factors also contribute to the deficits in growth in patients with CP 7,8,11 For instance, patients . with hemiplegic CP who had statures and triceps skin-fold measurements within population norms had significantly smaller length and girth measurements of limbs on their affected side than their unaffected side.11 Other studies similarly found involved limbs to have delayedskeletal maturation14 and reduced bone density15 compared with uninvolved limbs. Thus, muscular atrophy in affected limbs appears to impede growth independently of poor nutritional intake. Endocrine function may also be impaired in patients with brain injuries involving the pituitary gland, and the question of whether growth hormone treatment may be beneficial to some patients with CP has been...
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