AIM To assess the accuracy of skinfold equations in estimating percentage body fat in children with cerebral palsy (CP), compared with assessment of body fat from dual energy X-ray absorptiometry (DXA).METHOD Data were collected from 71 participants (30 females, 41 males) with CP (Gross Motor Function Classification System [GMFCS] levels I-V) between the ages of 8 and 18 years. Estimated percentage body fat was computed using established (Slaughter) equations based on the triceps and subscapular skinfolds. A linear model was fitted to assess the use of a simple correction to these equations for children with CP. RESULTSSlaughter's equations consistently underestimated percentage body fat (mean difference compared with DXA percentage body fat )9.6 ⁄ 100 [SD 6.2]; 95% confidence interval [CI] )11.0 to )8.1). New equations were developed in which a correction factor was added to the existing equations based on sex, race, GMFCS level, size, and pubertal status. These corrected equations for children with CP agree better with DXA (mean difference 0.2 ⁄ 100 [SD=4.8]; 95% CI )1.0 to 1.3) than existing equations.INTERPRETATION A simple correction factor to commonly used equations substantially improves the ability to estimate percentage body fat from two skinfold measures in children with CP.Although accurate assessment of nutritional status for children with cerebral palsy (CP) is important from clinical and research perspectives, physical impairments and growth differences hinder evaluation and interpretation in this population. Difficulties in measurement of stature arise from altered body posture and fixed contractures that interfere with reliable estimation of height or recumbent length. Equations that estimate height from segmental measures 1 have been developed and are widely used. Additionally, it is possible to use specialized chair scales or weigh a child along with a caregiver. 2 These modifications have allowed clinicians to obtain reliable measures of height and weight. Despite these improvements in measurement ability, clinicians continue to have challenges in interpreting growth and nutritional status in children with CP.Because children with CP often have malnutrition associated with short stature, simple measurements of weight and height are not adequate to identify nutritional abnormalities. Known alterations in body composition in malnourished children with CP include increased total body water, depleted fat and muscle stores, short stature, and decreased bone density. [3][4][5] Reliable measures of weight and height have allowed the use of weight-for-height centiles and body mass index (BMI), but the validity of these measures in assessing nutritional status in children with CP has been called into question. 3 Reliable and valid methods that are also quick and readily available are needed to estimate fat mass (as an indicator of nutritional status) for research and to guide clinical care for children with CP because of the constraints described above. Dual-energy X-ray absorptiometry (DXA) is one m...
Pain frequency and its association with participation, function, and health-related quality of life were evaluated in a sample of 198 children (58% male; mean age 10 years 7 months, SD 3 years 11 months; range 5 to 18 years) with moderate to severe cerebral palsy (CP). Gross Motor Functional Classification System (GMFCS) levels were III to V (23% level III, 23% level IV, 31% level V without a gastrostomy tube, and 23% were level V with a gastrostomy tube). Assessment was carried out using the parent-report Child Health Questionnaire (CHQ) and questions assessing health, medical utilization, and medication use. Pain frequency ranged from 'none' to 'every day'. Eleven percent of parents reported pain almost every day (z score=-0.38, p<0.001). Pain was related to severity of motor impairment and the presence of a gastrostomy; parents of the most severely affected children reported the highest pain frequency (p=0.05). Pain was correlated with school days missed (p=0.03) and days in bed (p=0.01). Children taking gastrointestinal medications were reported to have greater pain frequency (p<0.001). The Parental Impact--Emotional subscale of the CHQ was correlated with reported pain (r=0.38, p<0.001). Pain was frequent in children with moderate or severe CP. Pain was more prevalent with more severe impairment and was associated with educational and social consequences.
The pattern of sexual maturation in children with CP of moderate to severe motor impairment differs from that of children in the general population. Puberty begins earlier but ends later in white children with CP, compared with white children in the general population. In addition, menarche occurs later in white girls with CP. More advanced sexual maturation was associated with more body fat in girls but less body fat in boys.
Pain frequency and its association with participation, function, and health-related quality of life were evaluated in a sample of 198 children (58% male; mean age 10 years 7 months, SD 3 years 11 months; range 5 to 18 years) with moderate to severe cerebral palsy (CP). Gross Motor Functional Classification System (GMFCS) levels were III to V (23% level III, 23% level IV, 31% level V without a gastrostomy tube, and 23% were level V
Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. 1 Osteoporosis remains a major health problem worldwide, costing an estimated $13.8 billion in health care each year in the United States. Despite advances in treating osteoporosis in the elderly, no cure exists. Osteoporosis has its roots in childhood. Accrual of bone mass occurs throughout childhood and early adulthood, and peak bone mass is a key determinant of the lifetime risk of osteoporosis. Because the foundation for skeletal health is established so early in life, osteoporosis prevention begins by optimizing gains in bone mineral throughout childhood and adolescence. 2,3 Osteoporosis evaluation and prevention is relevant to children with cerebral palsy (CP). CP is the most prevalent childhood condition associated with osteoporosis. Bone density is significantly decreased, and children with CP often sustain painful fractures with minimal trauma that impair their function and quality of life. Preventing or improving osteoporosis and maximizing bone accrual during critical stages of growth will minimize the future lifelong risks of fractures in children with CP. This article addresses the anatomy and structure of bone and bone metabolism, the clinical assessment of bone mass, the causes of osteoporosis and its evaluation and treatment in children with CP.
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