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    Pattern of growth in children with cerebral palsy JACK KRICK, MS, RD, CS; PATRICIA MURPHY-MILLER, MS, RD, CS; SCOTT ZEGER, PhD; B JEN WRIGHT, PRD ABSTRACT 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 interpreta tion 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 QOP. 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 Statisties (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 iength for age, weight for age, and weight for length between children wilh QCP and NCHS standards were -2.3 z, -2.4 2,132 for boys, and -2.1 2,-2.1 2,-1.1 2 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 clildren with QCP should be accessible to parents an health care professionals to facilitate evaluation and snonitoring of nutritional status, J Am Diet Assoc. 1996; 96:680-085. tuman growth corresponds to a predietable pattern. Growth deviation may be the first oronly signalofamore serious underlying health problem that requires study. ‘The earlier treatment is initiated, the better the chance of remediation and achievement of full growth potential Growth references permit the assessiment of growth by defining the deviation froma populationaverage. Using growth references ta categorize nutritional status provides objective data for planning and program development. Trends in growth, performance and nutritional status of one child ora population ‘of children can be established. Reference data permit educa- tion of health care providers and families about the issue of ‘growth as well as the evaluation of the impact of intervention, strategies aimed at improving health, Children with quadriplegia have alterations in muscle tonein all four limbs as well as Lorso involvernent. They are unable to initiate movement, have limited physical activity, and experi- fence frequent muscle contractures, Table I presents a review of the literature relative to growth inchildren with cerebral palsy. Fourteen studies over a 40-year period are listed, The research conducted included a range of 5 to 179 subjects fram 2 months t0 21 years of age; the type of cerebral palsy was identified in only three studies. The findings of all reports were similar in that the children with cerebral palsy were deseribed as shorter and lighter than the refer- enced standards. However, growth curves were not generated from any of these reports, 600 / JULY 1996 VOLUME 96 NUMBER 7 Most reference data on children’s growth are based on the general pediatric population, s0 that application to children with cerebral palsy is inappropriate. Growth references spe- cific to children with cerebral palsy would facilitate uniformity ‘nclinical appraisal of growth and nuteitional status and would simplify comparative interpretation of growth data. This ar- ticle provides a reference growth standard for children with cerebral palsy. I. Krick is a certified specialist in pediatrics and an ‘assistant in pediatrics in the Department of Pediatrics at Johns Hopkins University and director of nutrition at Kennedy Krieger Institute; P- Murphy-Miller is a certified specialist in pediatrics and a senior staff clinical nutritionist at Kennedy Krieger Institute; and 8, Zeger is a professor of biostatistics and senior associate dean of academic affairs in the School of Hygiene and Public Health at Johns Hopkins niversity, Baltimore, Md. E. Wright is a research fellow in medical statistics al the Royal Postgraduate choot in London; at the time of this study, she was a postgraduate student at the University of Glasgow in Scotland, Address correspondence to: Jackie Krick, MS, RD, Kennedy Krieger Institute, 70? N Broadway, Room G14, Baltimore, MD 21205, —_—_—_— Tablet Feview ofthe iterature relatve to growth in chdren with cerebral palsy (CP) ‘Author, yoor ° ‘Age range Type of cP Findings Team 055 0 a wy ‘ai Tigran wih GP ave Shore tan average chien oF ‘ay age Sieng, 1060 (20) 700 emo 8y i Chicken wih GP we short’ and igor ran the normal ‘sings and nan ranges on standarg antwopometic. Kare. 1957 @ Oy ‘Gueaipesia Chicken wih GP are shot han average ion oF “Sie 39, ons. 1987 2) w Bey ai Height and weight ct chidren with OP are significantly below accoptod standards and below a matched age fn athe cine population. Fiaby 1082 23) iw Bey ar Fornalght ard weight, aye are 12-15 a below the 16h tcenile cave, gis are 18 mo below ay, 1965 2) 3 Biey ‘at ‘Chisien wi GP we Shaler han average Glen of ‘ear age Farmond, 1966 2) a Tey ar Ghikten wih GP ae Shorr and Igher compared wit ranges on stance artvopomeins share iver 1967 26) 19 ey ar “landing height and al vurk dameler are nthe normal Tange or theft 10 hen shaw a dette simp, perhaps ‘flectng ale of he adcescont grow spurt Beg 19730) B Tay a ‘Crikien wih GP are eho Tor erage ana hay the hog Gouge, 978 v8 Bmoaty Wandicapped ‘had heigh

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