Longitudinal Growth, Diet, and Physical Activity in Young Children With Cerebral Palsy.
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).



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.



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.



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.
Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland Child Health Research Centre, Brisbane, Australia; s.oftedal@uq.edu.au.|Children's Nutrition Research Centre, and.
Stina
S
Oftedal
Children's Nutrition Research Centre, and.
Peter S W
PS
Davies
Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland Child Health Research Centre, Brisbane, Australia.
Roslyn N
RN
Boyd
Division of Developmental Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.
Richard D
RD
Stevenson
School of Public Health, The University of Queensland, Brisbane, Australia.
Robert S
RS
Ware
Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland Child Health Research Centre, Brisbane, Australia.|Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand; and.
Piyapa
P
Keawutan
Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland Child Health Research Centre, Brisbane, Australia.
Katherine A
KA
Benfer
Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland Child Health Research Centre, Brisbane, Australia.|Dietetics and Food Services, Lady Cilento Children's Hospital, Children's Health, Queensland, South Brisbane, Australia.
Kristie L
KL
Bell
D001827:Body Height / Q000502:physiology*; D002547:Cerebral Palsy / Q000145:classification / Q000503:physiopathology*; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D002149:Energy Intake / Q000502:physiology; D004750:Enteral Nutrition; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D005865:Gestational Age; D006801:Humans; D007223:Infant; D008297:Male; D012016:Reference Values