Skip to main content
SpringerLink
Log in

Development of disorder-specific normative data for growth in children with cerebral palsy

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The purpose of this study was to create growth-percentiles for Caucasian children with cerebral palsy (CP). The studied parameters were height and age. In a retrospective analysis, we converted measurements collected in our center to create disorder-specific percentiles of normative data. Patients were stratified due to sex (male and female) and to mobility levels using the gross motor function classification system (GMFCS) (A = walking; GMFCS I–III, B = non walking; GMFCS IV–V) into four groups. In total, 2363 measurements in patients 0–18 years were collected. The mean age for group “Am” was 6.8 years (n = 862), group “Bm” 7.6 years (n = 563), group “Af” 7.7 years (n = 600), and group “Bf” 8.2 years (n = 366). The created percentiles for all groups were below the reference percentiles for healthy Caucasian children (KiGGS). The median curve for children with GMFCS levels I–III is slightly above the 3rd percentile, whereas the 50th percentile for GMFCS levels IV–V is mostly below the 3rd KiGGS centile.

Conclusion: In conclusion, children with cerebral palsy are smaller than healthy children. The difference between 50th percentile of CP patients compared to healthy children supports the need for the use of disorder-specific growth charts. Those charts can help clinicians differentiate growth disorders in patients with CP.

What is Known:

• Children with cerebral palsy are shorter than healthy children and height is influenced by level of ambulation.

• Currently, only reference percentiles of American children with mixed ethical backgrounds are available to evaluate growth.

What is New:

• This paper presents disorder-specific reference percentiles for longitudinal growth of Caucasian children with cerebral palsy depending on motor function.

• These percentiles allow to asses longitudinal growth in children with cerebral palsy to detect other additional diseases impairing growth.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CP:

Cerebral palsy

IGF-1:

Insulin-like growth factor

LEP:

Life Expectancy Project

GMFCS:

Gross motor function classification system

References

  1. Bonthuis M, van Stralen KJ, Verrina E, Edefonti A, Molchanova EA, Hokken-Koelega ACS, Schaefer F, Jager KJ (2012) Use of national and international growth charts for studying height in European children: development of up-to-date European height-for-age charts. PLoS One 7(8):e42506

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Brooks J. Life Expectancy Project 2011 [Available from: http://www.lifeexpectancy.org/articles/NewGrowthCharts/All.pdf]. Accessed January 2018

  3. Brooks J, Day S, Shavelle R, Strauss D (2011) Low weight, morbidity, and mortality in children with cerebral palsy: new clinical growth charts. Pediatrics 128(2):e299–e307

    Article  PubMed  Google Scholar 

  4. Butler MG, Lee J, Manzardo AM, Gold JA, Miller JL, Kimonis V, Driscoll DJ (2015) Growth charts for non-growth hormone treated Prader-Willi syndrome. Pediatrics. 135(1):e126–e135

    Article  PubMed  PubMed Central  Google Scholar 

  5. Christesen HT, Pedersen BT, Pournara E, Petit IO, Júlíusson PB (2016) Short stature: comparison of WHO and national growth standards/references for height. PLoS One 11(6):e0157277

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11(10):1305–1319

    Article  CAS  PubMed  Google Scholar 

  7. Day SM, Strauss DJ, Vachon PJ, Rosenbloom L, Shavelle RM, Wu YW (2007) Growth patterns in a population of children and adolescents with cerebral palsy. Dev Med Child Neurol 49(3):167–171

    Article  PubMed  Google Scholar 

  8. Finbraten AK, Syversen U, Skranes J, Andersen GL, Stevenson RD, Vik T (2015) Bone mineral density and vitamin D status in ambulatory and non-ambulatory children with cerebral palsy. Osteoporos Int 26(1):141–150

    Article  CAS  PubMed  Google Scholar 

  9. Frost HM (1997) Biomechanical control of knee alignment: some insights from a new paradigm. Clin Orthop Relat Res 335:335–342

    Article  Google Scholar 

  10. Fung EB, Samson-Fang L, Stallings VA, Conaway M, Liptak G, Henderson RC et al (2002) Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc 102(3):361–373

    Article  PubMed  Google Scholar 

  11. Indrayan A (2014) Demystifying LMS and BCPE methods of centile estimation for growth and other health parameters. Indian Pediatr 51(1):37–43

    Article  PubMed  Google Scholar 

  12. Kim JS, Han ZA, Song DH, Oh HM, Chung ME (2013) Characteristics of dysphagia in children with cerebral palsy, related to gross motor function. Am J Phys Med Rehabil 92(10):912–919

    Article  PubMed  Google Scholar 

  13. Krick J, Van Duyn MA (1984) The relationship between oral-motor involvement and growth: a pilot study in a pediatric population with cerebral palsy. J Am Diet Assoc 84(5):555–559

    CAS  PubMed  Google Scholar 

  14. Krick J, Murphy-Miller P, Zeger S, Wright E (1996) Pattern of growth in children with cerebral palsy. J Am Diet Assoc 96(7):680–685

    Article  CAS  PubMed  Google Scholar 

  15. Neuhauser H SA, Schaffrath-Rosario A, Dortschy R, Kurth BM (2013) Referenzperzentile für anthropometrische Maßzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS). Gesundheitsberichterstattung des Bundes. Gesundheitsberichterstattung des Bundes: Robert-Koch-Institut; 2013

  16. Oftedal S, Davies PSW, Boyd RN, Stevenson RD, Ware RS, Keawutan P, Benfer KA, Bell KL (2016) Longitudinal growth, diet, and physical activity in young children with cerebral palsy. Pediatrics. 138:e20161321

    Article  PubMed  Google Scholar 

  17. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39(4):214–223

    Article  CAS  Google Scholar 

  18. Ranke MB, Pflüger H, Rosendahl W, Stubbe P, Enders H, Bierich JR et al (1983) Turner syndrome: spontaneous growth in 150 cases and review of the literature. Eur J Pediatr 141(2):81–88

    Article  CAS  PubMed  Google Scholar 

  19. Reilly S, Skuse D (1992) Characteristics and management of feeding problems of young children with cerebral palsy. Dev Med Child Neurol 34(5):379–388

    Article  CAS  PubMed  Google Scholar 

  20. Rigby RA, Stasinopoulos DM (2013) Automatic smoothing parameter selection in GAMLSS with an application to centile estimation. Stat Methods Med Res 23(4):318–332

    Article  PubMed  Google Scholar 

  21. Rivkees SA, Bode HH, Crawford JD (1988) Long-term growth in juvenile acquired hypothyroidism: the failure to achieve normal adult stature. N Engl J Med 318(10):599–602

    Article  CAS  PubMed  Google Scholar 

  22. Robson H, Siebler T, Shalet SM, Williams GR (2002) Interactions between GH, IGF-I, glucocorticoids, and thyroid hormones during skeletal growth. Pediatr Res 52(2):137–147

    Article  CAS  PubMed  Google Scholar 

  23. Rogol AD, Clark PA, Roemmich JN (2000) Growth and pubertal development in children and adolescents: effects of diet and physical activity. Am J Clin Nutr 72(2 Suppl):521s–528S

    Article  CAS  PubMed  Google Scholar 

  24. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D et al (2007) A report: the definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology. Supplement. 109:8–14

    Google Scholar 

  25. Royston P (1991) Constructing time-specific reference ranges. Stat Med 10(5):675–690

    Article  CAS  PubMed  Google Scholar 

  26. Royston P, Wright EM (2000) Goodness-of-fit statistics for age-specific reference intervals. Stat Med 19(21):2943–2962

    Article  CAS  Google Scholar 

  27. Shapiro BK, Green P, Krick J, Allen D, Capute AJ (1986) Growth of severely impaired children: neurological versus nutritional factors. Dev Med Child Neurol 28(6):729–733

    Article  CAS  PubMed  Google Scholar 

  28. Sterling HM (1960) Height and weight of children with cerebral palsy and acquired brain damage. Arch Phys Med Rehabil 41:131–135

    CAS  PubMed  Google Scholar 

  29. Stevenson RD, Conaway M, Chumlea WC, Rosenbaum P, Fung EB, Henderson RC, Worley G, Liptak G, O’Donnell M, Samson-Fang L, Stallings VA, of the North American Growth in Cerebral Palsy Study (2006) Growth and health in children with moderate-to-severe cerebral palsy. Pediatrics. 118(3):1010–1018

    Article  PubMed  Google Scholar 

  30. Surveillance of Cerebral Palsy in E (2000) Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of cerebral palsy in Europe (SCPE). Dev Med Child Neurol 42(12):816–824

    Article  Google Scholar 

  31. Tobis JS, Saturen P, Larios G, Posniak AO (1961) Study of growth patterns in cerebral palsy. Arch Phys Med Rehabil 42:475–481

    CAS  PubMed  Google Scholar 

  32. van Buuren S, Fredriks M (2001) Worm plot: a simple diagnostic device for modelling growth reference curves. Stat Med 20(8):1259–1277

    Article  Google Scholar 

  33. van der Eerden BC, Karperien M, Wit JM (2003) Systemic and local regulation of the growth plate. Endocr Rev 24(6):782–801

    Article  CAS  PubMed  Google Scholar 

  34. Zonta MB, Ramalho-Junior A, Puppi M, Bruck I, Magdalena N, Muzzolon SR et al (2014) Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation. Arq Neuropsiquiatr 72(5):360–367

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by the Koeln Fortune Program/Faculty of Medicine, University of Cologne by a thesis grant to PE and by a research grant from IPSEN PHARMA GmbH. The sponsor was not involved in the study design, collection, analysis, and interpretation of data or writing of the report. The decision to submit the paper was exclusively done by the authors without any involvement of the sponsors. The data was not presented before.

Author information

Authors and Affiliations

  1. Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, University of Cologne, Cologne, Germany

    Philipp Egenolf, Christina Stark, Kyriakos Martakis, Eckhard Schoenau & Oliver Semler

  2. Faculty of Medicine and University Hospital Cologne, Center for Prevention and Rehabilitation, University of Cologne, Unireha, Cologne, Germany

    Ibrahim Duran & Eckhard Schoenau

  3. Department of International Health, CAPHRI, FHML, Maastricht University, Maastricht, The Netherlands

    Kyriakos Martakis

  4. Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany

    Stefanie Hamacher

  5. Children’s and Adolescent’s Hospital, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany

    Oliver Semler

Authors
  1. Philipp Egenolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ibrahim Duran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christina Stark
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyriakos Martakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefanie Hamacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eckhard Schoenau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Oliver Semler
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PE, OS and ES designed the research project. PE KM, CS, ID and OS collected the data and OS, SH and ID performed the statistical analysis. ID, CS, KM ES and OS cared for the patients. EP, SH and OS drafted the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Oliver Semler.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethics committee of the University of Cologne (15-241).

Additional information

Communicated by Peter de Winter

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Egenolf, P., Duran, I., Stark, C. et al. Development of disorder-specific normative data for growth in children with cerebral palsy. Eur J Pediatr 178, 811–822 (2019). https://doi.org/10.1007/s00431-019-03360-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-019-03360-5

Keywords

Search

Navigation