Growth of Children With Cerebral Palsy and Health Outcomes

OBJECTIVE: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.