Growth of Children With Cerebral Palsy and Health Outcomes.

Abstract

The California-based cerebral palsy (CP) growth charts, published in Pediatrics in 2011, demonstrated a link between Gross Motor Function Classification System (GMFCS)-stratified weight percentile (GWt%-ile) and mortality, but use has been limited. This secondary analysis from the North American Growth in Cerebral Palsy Project (NAGCPP) aims to evaluate the charts and the link between GWt%-ile and additional health markers. NAGCPP included weight and triceps skinfold thickness (TSF) in 197 boys and 146 girls, aged 2 to 18 years, GMFCS levels III through V, with CP. Health care utilization and social participation were assessed by questionnaire. GWt%-ile was determined from sex and GMFCS-specific weight charts. Using the 20th GWt%-ile cutoff previously associated with mortality risk over 3 years, we assessed the relationship with health care utilization and social participation with and without TSF and medical comorbidities. NAGCPP weight data fit the CP charts (goodness-of-fit P = .14 for boys; P > .25 for girls). Adjusting for sex and GMFCS, children below the 20th GWt%-ile reported 5.7 times (95% CI, 2.2-14.8) more hospital stays (P < .001), 3.1 times (95% CI, 1.3-7.4) more missed regular programs (P < .001), and 2.8 times (95% CI, 1.2-6.5) more total days (P = .02) the family or child missed regular activities. TSF (fat stores) and severe feeding problems were associated independently with health and participation. This study validates the CP growth charts and documents an association between GWt%-ile and markers of health and participation other than mortality. CP growth charts warrant consideration for clinical decision-making and research.