Related Experiment Video
Updated: Mar 20, 2026
Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
Growth of Children With Cerebral Palsy and Health Outcomes
Richard D Stevenson1, Mark R Conaway1, Gordon Worley2
1University of Virginia, Charlottesville, Virginia.
Insights
The cerebral palsy (CP) growth charts are validated for assessing health markers beyond mortality. Lower weight percentiles correlate with increased hospitalizations and reduced social participation in children with CP.
Area of Science:
- Pediatric endocrinology
- Growth and development in children with disabilities
- Clinical assessment tools for cerebral palsy
Background:
- Cerebral palsy (CP) growth charts from California (2011) linked Gross Motor Function Classification System (GMFCS)-stratified weight percentile (GWt%-ile) to mortality.
- Clinical use of these charts has been limited.
- The North American Growth in Cerebral Palsy Project (NAGCPP) provides data to further evaluate these charts.
Purpose of the Study:
- To validate the California CP growth charts using NAGCPP data.
- To assess the association between GWt%-ile and health markers beyond mortality.
- To explore the role of triceps skinfold thickness (TSF) and comorbidities.
Main Methods:
- Secondary analysis of NAGCPP data including 197 boys and 146 girls (2-18 years) with CP (GMFCS III-V).
- Weight and TSF data were collected; health care utilization and social participation assessed via questionnaire.
- GWt%-ile determined using sex and GMFCS-specific charts; 20th percentile cutoff used to assess relationships.
Main Results:
- NAGCPP weight data demonstrated good fit with the CP growth charts (P > 0.14).
- Children below the 20th GWt%-ile had significantly higher hospitalizations (5.7x), missed programs (3.1x), and missed activities (2.8x).
- TSF (fat stores) and severe feeding problems were independently associated with health and participation outcomes.
Conclusions:
- The study validates the CP growth charts for use in clinical settings.
- GWt%-ile is associated with key health and participation markers in children with CP, extending beyond mortality.
- CP growth charts are recommended for clinical decision-making and research.
Objective:
The California-based cerebral palsy (CP) growth charts, published in Pediatrics in 2011, demonstrated a link between Gross Motor Function Classification System (GMFCS)-stratified weight percentile (GWt%-ile) and mortality, but use has been limited. This secondary analysis from the North American Growth in Cerebral Palsy Project (NAGCPP) aims to evaluate the charts and the link between GWt%-ile and additional health markers.
Patients And Methods:
NAGCPP included weight and triceps skinfold thickness (TSF) in 197 boys and 146 girls, aged 2 to 18 years, GMFCS levels III through V, with CP. Health care utilization and social participation were assessed by questionnaire. GWt%-ile was determined from sex and GMFCS-specific weight charts. Using the 20th GWt%-ile cutoff previously associated with mortality risk over 3 years, we assessed the relationship with health care utilization and social participation with and without TSF and medical comorbidities.
Results:
NAGCPP weight data fit the CP charts (goodness-of-fit P = .14 for boys; P > .25 for girls). Adjusting for sex and GMFCS, children below the 20th GWt%-ile reported 5.7 times (95% CI, 2.2-14.8) more hospital stays (P < .001), 3.1 times (95% CI, 1.3-7.4) more missed regular programs (P < .001), and 2.8 times (95% CI, 1.2-6.5) more total days (P = .02) the family or child missed regular activities. TSF (fat stores) and severe feeding problems were associated independently with health and participation.
Conclusion:
This study validates the CP growth charts and documents an association between GWt%-ile and markers of health and participation other than mortality. CP growth charts warrant consideration for clinical decision-making and research.
