title: Growth and health in children with moderate-to-severe cerebral palsy.
abstract: 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.
authors.affiliation: Department of Pediatrics, School of Medicine, University of Virginia, Kluge Children's Rehabilitation Center and Research Institute, 2270 Ivy Rd, Charlottesville, Virginia 22903, USA. rds8z@virginia.edu
authors.forename: Richard D
authors.initials: RD
authors.lastname: Stevenson
authors.forename: Mark
authors.initials: M
authors.lastname: Conaway
authors.forename: W Cameron
authors.initials: WC
authors.lastname: Chumlea
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenbaum
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Fung
authors.forename: Richard C
authors.initials: RC
authors.lastname: Henderson
authors.forename: Gordon
authors.initials: G
authors.lastname: Worley
authors.forename: Gregory
authors.initials: G
authors.lastname: Liptak
authors.forename: Maureen
authors.initials: M
authors.lastname: O'Donnell
authors.forename: Lisa
authors.initials: L
authors.lastname: Samson-Fang
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Stallings
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006128:Growth; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D012737:Sex Factors; D012919:Social Behavior