Pattern of Growth in Children with Cerebral Palsy

Krick, Jackie; Murphy-Miller, Patricia; Zeger, Scott L.; Weight, Eileen

doi:10.1016/s0002-8223(96)00188-5

Cited by 147 publications

(172 citation statements)

References 17 publications

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“…It is clear that BMD in the femur, like other measures of various growth parameters such as height, weight, and arm circumference, falls further from normal standards as the child with CP ages. 42,43 Diminished growth in CP is a complex issue, with both nutritional and nonnutritional factors likely contributing. 44 -46 Difficulty feeding the child, skinfold measures of body fat, and use of anticonvulsant medications were some of the factors identified in multifactorial regression analyses as likely to be directly related to low BMD.…”

Section: Discussionmentioning

confidence: 99%

Bone Density and Metabolism in Children and Adolescents With Moderate to Severe Cerebral Palsy

Lark²,

et al. 2002

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ABSTRACT. Objectives. Diminished bone density and a propensity to fracture with minimal trauma are common in children and adolescents with moderate to severe cerebral palsy (CP). The purpose of this study was to provide a detailed evaluation of bone mineral density (BMD) and metabolism in this population and to assess the relationship of these measures to multiple other clinical, growth, and nutrition variables.Methods. The study group consisted of 117 subjects ages 2 to 19 years (mean: 9.7 years) with moderate to severe CP as defined by the Gross Motor Functional Classification scale. Population-based sampling was used to recruit 62 of the participants, which allows for estimations of prevalence. The remaining 55 subjects were a convenience sampling from both hospital-and school-based sources. The evaluation included measures of BMD, a detailed anthropometric assessment of growth and nutritional status, medical and surgical history, the Child Health Status Questionnaire, and multiple serum analyses. BMD was measured in the distal femur, a site specifically developed for use in this contracted population, and the lumbar spine. BMD measures were converted to age and gender normalized z scores based on our own previously published control series (n > 250).Results. Osteopenia (BMD z score <؊2.0) was found in the femur of 77% of the population-based cohort and in 97% of all study participants who were unable to stand and were older than 9 years. BMD was not as low in the lumbar spine (population-based cohort mean ؎ standard error z score: ؊1.8 ؎ 0.1) as in the distal femur (mean z score: ؊3.1 ؎ 0.2). Fractures had occurred in 26% of the children who were older than 10 years. Multiple clinical and nutritional variables correlated with BMD z scores, but interpretation of these findings is complicated by covariance among variables. In stepwise regression analyses, it was found that severity of neurologic impairment as graded by Gross Motor Functional Classification level, increasing difficulty feeding the child, use of anticonvulsants, and lower triceps skinfold z scores (in decreasing order of importance) all independently contribute to lower BMD z scores in the femur.Conclusions. Low BMD is prevalent in children with moderate to severe CP and is associated with significant fracture risk. The underlying pathophysiology is complex, with multiple factors contributing to the problem and significant variation between different regions of the skeleton. Pediatrics 2002;110(1). URL: http://www. pediatrics.org/cgi/content/full/110/1/e5; cerebral palsy, bone mineral density, osteoporosis, pediatrics, bone metabolism, growth, nutrition, osteopenia.

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Section: Discussionmentioning

confidence: 99%

Bone Density and Metabolism in Children and Adolescents With Moderate to Severe Cerebral Palsy

Lark²,

et al. 2002

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“…The observation of growth retardation among children with CP has been well described in previous studies. [18][19][20] Feeding difficulties and inadequate nutrition are common among children with quadriplegic CP, and their failure to thrive is often attributed to malnutrition. 5,6 Fat storage is often considered an indicator of nutritional status.…”

Section: Discussionmentioning

confidence: 99%

Weight-for-Height Values and Limb Anthropometric Composition of Tube-Fed Children With Quadriplegic Cerebral Palsy

Kong

Wong

2005

Pediatrics

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ABSTRACT.Objective. Research has shown that growth retardation among children with quadriplegic cerebral palsy (CP) is often attributed to feeding dysfunction and malnutrition. The study compared weight-forheight values and limb anthropometric composition of nasogastric and gastrostomy tube-fed children with quadriplegic CP with those of orally fed children with quadriplegic CP and normal children, to examine the plausible effects of tube feeding on weight-for-height, fat, and muscle values for children with quadriplegic CP.Methods. Triceps, anterior mid-thigh, and medial calf skinfold thicknesses and the corresponding circumferences of the right or less affected side were measured. The subjects consisted of 119 normal children and 62 orally fed and 48 tube-fed children with quadriplegic CP. Body weight and height were recorded. For children with CP whose height could not be measured, height was estimated from the ulna length. Weight-for-height z scores, limb skinfold thicknesses, fat areas, skinfoldcorrected muscle girths, and muscle areas of the children were compared.Results. Tube-fed children with CP had normal mean weight-for-height z scores. Weight-for-height z scores of the orally fed children with CP were significantly below those of normal children and tube-fed children with CP. For children with CP, whereas triceps skinfold thickness seemed to predict the mid-upper arm fat area correctly, leg skinfold thicknesses seemed to overestimate the corresponding fat areas. Stepwise multiple regression analysis showed that triceps skinfold thicknesses had good correlation (r ‫؍‬ 0.86) and the presence of CP had nonsignificant correlation with mid-upper arm fat areas. Multiple regression analysis of fat areas with skinfold thicknesses and the presence of CP, however, showed that CP was correlated negatively (partial correlation of CP: thigh, ؊0.45; calf, ؊0.53) with thigh and calf fat areas. Although skinfold-corrected mid-upper arm muscle girths of children with CP were quite similar to those of normal children, leg muscle girths were much reduced for both orally fed and tube-fed children with CP. The apparent thickening of leg skinfold thicknesses among children with CP probably was attributable to disproportional leg muscle wasting, with resulting reduced internal circumference of the subcutaneous fat layer. For tubefed children with CP, skinfold thicknesses and fat areas were increased significantly, although their leg skinfoldcorrected muscle girths and areas remained reduced.Conclusions. Skinfold thickness may overestimate the fat area in the affected limb with significant muscle wasting for children with CP. The condition was particularly obvious in the leg, where muscle wasting was prominent. Because leg muscles represent approximately one quarter of the normal body weight, low weight-forheight values among children with CP can be caused by leg muscle wasting attributable to disuse atrophy, which is unlikely to be correctable with tube feeding. Tube feeding may improve body weight mainly through fat depos...

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“…This is consistent with other reports showing trajectories of increasing rate and severity of growth failure for children with Mod/Sev CP. 9,10,13,16,17 Infant and child characteristics provide insight into factors associated with slow growth. During the neonatal hospitalization, infants in the ModSev CP group had greater illness severity reflected by level of HIE and longer duration of ventilatory support.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Decreased growth velocity in children with CP may be related to decreased oromotor coordination with suboptimal nutritional intake secondary to impaired chewing and swallowing, recurrent aspiration, chronic reflux, inadequate provision of required nutritional intake, increased caloric expenditure due to the excessive muscle contraction in spasticity for children with ambulatory CP, and the possibility of growth hormone deficiency. [10][11][12][13][14][15][16][17][18] In addition, comorbidities of CP, including gastroesophageal reflux and aspiration, are associated with slow growth and increased risk of rehospitalization. [19][20][21][22][23] Vigilance regarding growth of children with feeding difficulties goes beyond the concern of body size alone.…”

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confidence: 99%

Cerebral Palsy and Growth Failure at 6 to 7 Years

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Surviving infants with hypoxic ischemic encephalopathy (HIE) treated with hypothermia have decreased rates of CP in childhood. CP is associated with increased risk of slow growth. WHAT THIS STUDY ADDS:Term children with HIE who develop moderate/severe CP are at high risk of progressive impaired growth, high rates of cognitive impairment, and rehospitalizations from infancy to school age. Gastrostomy tube placement to facilitate feeds is protective of slow growth. abstract OBJECTIVE: To evaluate the association between severity of cerebral palsy (CP) and growth to 6 to 7 years of age among children with moderate to severe (Mod/Sev) hypoxic ischemic encephalopathy (HIE). It was hypothesized that children with Mod/Sev CP would have poorer growth, lower cognitive scores, and increased rehospitalization rates compared with children with no CP (No CP).METHODS: Among 115 of 122 surviving children followed in the hypothermia trial for neonatal HIE, growth parameters and neurodevelopmental status at 18 to 22 months and 6 to 7 years were available. Group comparisons (Mod/Sev CP and No CP) with unadjusted and adjusted analyses for growth ,10th percentile and z scores by using Fisher' s exact tests and regression modeling were conducted. RESULTS:Children with Mod/Sev CP had high rates of slow growth and cognitive and motor impairment and rehospitalizations at 18 to 22 months and 6 to 7 years. At 6 to 7 years of age, children with Mod/ Sev CP had increased rates of growth parameters ,10th percentile compared with those with No CP (weight, 57% vs 3%; height, 70% vs 2%; and head circumference, 82% vs 13%; P , .0001). Increasing severity of slow growth was associated with increasing age (P , .04 for weight, P , .001 for length, and P , .0001 for head circumference). Gastrostomy feeds were associated with better growth.CONCLUSIONS: Term children with HIE who develop Mod/Sev CP have high and increasing rates of growth ,10th percentile by 6 to 7 years of age. These findings support the need for close medical and nutrition management of children with HIE who develop CP. to 22 months and 6 to 7 years with growth data at birth discharge, 18 to 22 months, and 6 to 7 years. 7 Detailed demographic information and medical history were obtained at follow-up. Growth ParametersWT was obtained by using a horizontal scale at birth, discharge, and 18 to 22 months, and an upright scale at 6 to 7 years. Standard procedures were used. 7 Recumbent LT was used at birth, discharge, and 18 to 22 months and upright stature at 6 to 7 years with a permanently affixed stadiometer or upright scale. Horizontal measurement was obtained with a stadiometer for children who were unable to stand. The World Health Organization growth standards 26 were used to determine percentiles, velocities, and z scores at birth, discharge, 18 to 22 months, and at 6 to 7 years; the 2000 Centers for Disease Control and Prevention growth charts 27 were used at 6 to 7 years. Neurodevelopmental AssessmentsComprehensive assessments of neurologic statu...

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Pattern of Growth in Children with Cerebral Palsy

Cited by 147 publications

References 17 publications

Bone Density and Metabolism in Children and Adolescents With Moderate to Severe Cerebral Palsy

Bone Density and Metabolism in Children and Adolescents With Moderate to Severe Cerebral Palsy

Weight-for-Height Values and Limb Anthropometric Composition of Tube-Fed Children With Quadriplegic Cerebral Palsy

Cerebral Palsy and Growth Failure at 6 to 7 Years

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