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Pattern of growth in children with cerebral palsy
J Krick1, P Murphy-Miller, S Zeger
1Department of Pediatrics, Johns Hopkins University, Baltimore, Md, USA.
Insights
Growth charts for children with quadriplegic cerebral palsy (QCP) show they fall behind national standards in length and weight. These new references aid in monitoring their growth and nutritional status.
Area of Science:
- Pediatrics
- Neurology
- Growth and Development
Background:
- Children with quadriplegic cerebral palsy (QCP) often exhibit growth deviations.
- Existing growth references may not accurately reflect the growth patterns of children with QCP.
- Standardized growth assessment is crucial for clinical appraisal and nutritional status evaluation.
Purpose of the Study:
- To establish a specific growth reference standard for children with QCP.
- To facilitate uniform clinical assessment and interpretation of growth data in this population.
Main Methods:
- Collected weight and length data from 360 children with QCP (1,630 observations) using standardized procedures.
- Utilized smoothing splines to estimate 10th, 50th, and 90th percentile growth curves.
- Employed statistical bootstrapping to compare QCP growth data against National Center for Health Statistics (NCHS) standards.
Main Results:
- Developed growth charts for boys and girls (0-120 months) detailing length-for-age, weight-for-age, and weight-for-length.
- Children with QCP showed significant deficits compared to NCHS standards (e.g., -2.3 z for length in boys).
- QCP patients progressively lagged in stature and weight, being over 10% shorter by age 8.
Conclusions:
- Growth charts specific to children with QCP are essential for accurate evaluation.
- These references will aid healthcare professionals and parents in monitoring growth and nutritional status.
- Improved monitoring can lead to timely interventions for children with QCP.
Objective:
To provide a growth reference standard for children with quadriplegic cerebral palsy (QCP). Growth references specific to children with cerebral palsy would facilitate uniformity in clinical appraisal of their growth and nutritional status and would simplify comparative interpretation of growth data.
Design:
Weights and lengths were obtained according to standardized procedures. Measurements were taken at time of visit to an orthopedic clinic and from retrospective review of charts.
Subjects:
Three hundred sixty children with QCP. Growth data were based on 1,630 observations.
Analysis:
Growth curves representing the 10th, 50th, and 90th percentiles were estimated using a smoothing splines technique. Statistical bootstrapping was performed to confirm significant differences from the growth charts of the National Center for Health Statistics (NCHS).
Results:
Growth charts were constructed for boys and girls, aged 0 to 120 months, depicting length for age, weight for age, and weight for length. Average differences in length for age, weight for age, and weight for length between children with QCP and NCHS standards were -2.3 z, -2.4 z, -1.3 z for boys, and -2.1 z, -2.1 z, -1.1 z for girls. Children with QCP fell progressively behind in stature and weight. Compared with their NCHS counterparts, they were 5% shorter at 2 years of age and more than 10% shorter at 8 years of age.
Application:
Charts representing the pattern of growth in children with QCP should be accessible to parents and health care professionals to facilitate evaluation and monitoring of nutritional status.