title: Growth and nutritional status in residential center versus home-living children and adolescents with quadriplegic cerebral palsy.
abstract: OBJECTIVE
  To describe growth and nutrition in nonambulatory youth (<19 years of age) with cerebral palsy (CP) living in residential centers compared with similar youth living at home.
  
  
  METHODS
  A multicenter, cross-sectional, single observational assessment of 75 subjects living in a residential care facility compared with 205 subjects living at home. Primary outcome measures included anthropometric measures of height, weight, triceps, and subscapular skinfolds, and mid-upper-arm muscle area. Z scores were calculated from reference values for healthy children. Age, use of a feeding tube, and Gross Motor Functional Classification System (GMFCS) level were included as important confounders.
  
  
  RESULTS
  Use of a feeding tube was associated with higher skinfold Z scores, and a significantly higher percentage of the residential subjects had a feeding tube. Height, weight, and arm-muscle area Z scores all diverged (negatively) from reference values with age, and the residential subjects were on average older than the home-living subjects. After controlling for age, GMFCS level and use of a feeding tube, residential living was associated with significantly greater weight, height, skinfold thicknesses, and mid-arm muscle area Z scores.
  
  
  CONCLUSIONS
  Poor growth and nutrition in children with CP is a prevalent, important, and complex problem. Although factors intrinsic to the condition of CP likely play a significant role, it is also clear that environmental factors, including the living situation of the child, can have an impact.
authors.affiliation: Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina 27599, USA. rchh@med.unc.edu
authors.forename: Richard C
authors.initials: RC
authors.lastname: Henderson
authors.forename: Richard I
authors.initials: RI
authors.lastname: Grossberg
authors.forename: Jeanine
authors.initials: J
authors.lastname: Matuszewski
authors.forename: Nitasha
authors.initials: N
authors.lastname: Menon
authors.forename: Julie
authors.initials: J
authors.lastname: Johnson
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Kecskemethy
authors.forename: Lois
authors.initials: L
authors.lastname: Vogel
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ravas
authors.forename: Megan
authors.initials: M
authors.lastname: Wyatt
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bachrach
authors.forename: Richard D
authors.initials: RD
authors.lastname: Stevenson
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D017028:Caregivers; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006128:Growth; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D011336:Probability; D011782:Quadriplegia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012112:Residential Facilities; D018570:Risk Assessment; D012720:Severity of Illness Index