Related Experiment Video
Updated: Mar 15, 2026
Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
Longitudinal Growth, Diet, and Physical Activity in Young Children With Cerebral Palsy
Stina Oftedal1,2, Peter S W Davies2, Roslyn N Boyd3
1Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland Child Health Research Centre, Brisbane, Australia; s.oftedal@uq.edu.au.
Insights
Children with cerebral palsy (CP) in higher Gross Motor Function Classification System (GMFCS) levels show impaired growth. Gestational age is linked to height-for-age z-score, but energy intake and activity levels are not significant factors.
Area of Science:
- Pediatric Growth and Development
- Cerebral Palsy Research
- Longitudinal Growth Studies
Background:
- Children with cerebral palsy (CP) often exhibit growth impairments.
- Understanding factors influencing growth across different functional levels is crucial for targeted interventions.
- Previous research highlights variability in growth patterns within the CP population.
Purpose of the Study:
- To examine the longitudinal relationship between height-for-age z-score (HZ), growth velocity z-score, energy intake, physical activity, and sedentary time in children with CP across GMFCS levels I-V.
- To identify key determinants of growth faltering in young children with CP.
- To inform clinical practice regarding growth monitoring and management in CP.
Main Methods:
- Longitudinal study of 175 preschoolers with CP (aged 18 months to 5 years).
- Measurements included height-for-age z-score, growth velocity z-score, energy intake, habitual physical activity (HPA), and sedentary time.
- Statistical analysis employed mixed-effects regression models, controlling for GMFCS level and gestational age.
Main Results:
- Children in GMFCS levels II-V were significantly shorter than those in level I.
- Growth velocity was significantly slower in GMFCS levels III-V compared to level I.
- Height-for-age z-score was positively associated with gestational age across all GMFCS levels; energy intake, HPA, and sedentary time were not significant predictors after accounting for GMFCS level.
Conclusions:
- Functional status (GMFCS level) and gestational age are critical considerations in assessing the growth of children with CP.
- Further research is needed to explore interventions promoting active movement in higher GMFCS levels to improve growth and health outcomes.
Objectives:
To describe the longitudinal relationship between height-for-age z score (HZ), growth velocity z score, energy intake, habitual physical activity (HPA), and sedentary time across Gross Motor Function Classification System (GMFCS) levels I to V in preschoolers with cerebral palsy (CP).
Methods:
Children with CP (n = 175 [109 (62.2%) boys]; mean recruitment age 2 years, 10 months [SD 11 months]; GMFCS I = 83 [47.2%], II = 21 [11.9%], III = 28 [15.9%], IV = 19 [10.8%], V = 25 [14.2%]) were assessed 440 times between the age of 18 months and 5 years. Height/length ratio was measured or estimated via knee height. Population-based standards were used to calculate HZ and growth velocity z-score by age and sex categories. Feeding method (oral or tube) and gestational age at birth (GA) were collected from parents. Three-day ActiGraph and food diary data were used to measure HPA/sedentary time ratio and energy intake, respectively. Oropharyngeal dysphagia was rated with the Dysphagia Disorder Survey (part 2, Pediatric). Analysis was undertaken with mixed-effects regression models.
Results:
For GMFCS level I, height and growth velocity did not differ from population-level growth standards. Children in levels II to V were significantly shorter, and those in levels III to V grew significantly more slowly than those in level I. There was a significant positive association between HZ and GA at all GMFCS levels. Energy intake, HPA, sedentary time, Dysphagia Disorder Survey score, and feeding method were not significantly associated with either height or growth velocity once GMFCS level was accounted for.
Conclusions:
Functional status and GA should be considered when assessing the growth of a child with CP. Research into interventions aimed at increasing active movement in GMFCS levels III to V and their efficacy in improving growth and health outcomes is warranted.
