Anthropometric Nutritional Assessment in Children with Severe Neurological Impairment and Intellectual Disability

  • Corine Penning
  • Heleen M. Evenhuis


This chapter discusses the current evidence and best practices of anthropometric measurements in children with severe neurological impairment and intellectual disability, who both have a severe motor impairment and moderate to profound intellectual disability due to congenital or acquired neurological damage. First the target population is described in detail, with regard to the etiology of the disorder, frequent concomitant medical problems and life expectancy. The necessity of regularly measuring the nutritional state is underlined in the light of these children’s nutrition-related problems, such as dysphagia and gastro-esophageal reflux, which are potential causes of malnutrition. In contrast, a subgroup of these children is at risk of developing obesity due to tube feeding. An overview of the feasibility of commonly used anthropometric measurements in the target population, such as weight, height and skinfold measurements, is presented and where possible, alternative methods are described, such as the use of segmental measures when accurate measurement of standing height is not possible. Outcome of body composition measurement is interpreted by means of specific equations. An overview of frequently applied and, if available, group-specific norm values and equations for interpretation of the outcome is presented, followed by suggestions for future research needed for further improvement of the reliability and interpretation of anthropometric measurements in these children. Based on the current knowledge, practical recommendations are given for applying anthropometry in children with severe neurological impairment and ID.


Cerebral Palsy Intellectual Disability Intellectual Disability Nutritional Assessment Skinfold Thickness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Bioelectric impedance analysis


Body mass index


Cerebral Palsy


Doubly labeled water


Dual-energy X-ray Absorptiometry


Fat-free mass


Gastro-Esophageal Reflux


Gross motor function classification scale


Intellectual disability


Knee height


Percutaneous endoscopic gastrostomy


Tibia length


Upper-arm length


  1. van den Berg-Emons RJ, van Baak MA, Westerterp KR. Are skinfold measurements suitable to compare body fat between children with spastic cerebral palsy and healthy controls? Dev Med Child Neurol. 1998 May;40(5):335–9. PubMed PMID: 9630261.PubMedGoogle Scholar
  2. Day SM, Strauss DJ, Vachon PJ, Rosenbloom L, Shavelle RM, Wu YW. Growth patterns in a population of children and adolescents with cerebral palsy. Dev Med Child Neurol. 2007 Mar;49(3):167-71. PubMed PMID: 17355471.PubMedCrossRefGoogle Scholar
  3. Durnin JV, Rahaman MM. The assessment of the amount of fat in the human body from measurements of skinfold thickness. Br J Nutr. 1967 Aug;21(3):681–9. PubMed PMID: 6052883.PubMedCrossRefGoogle Scholar
  4. Eyman RK, Grossman HJ, Chaney RH, Call TL. The life expectancy of profoundly handicapped people with mental retardation. N Engl J Med. 1990 Aug 30;323(9):584–9. PubMed PMID: 2143270.PubMedCrossRefGoogle Scholar
  5. Gurka MJ, Kuperminc MN, Busby MG, Bennis JA, Grossberg RI, Houlihan CM, Stevenson RD, Henderson RC. Assessment and correction of skinfold thickness equations in estimating body fat in children with cerebral palsy. Dev Med Child Neurol. 2010 Feb;52(2):e35–41. Epub 2009 Oct 7. PubMed PMID: 19811518; PubMed Central PMCID: PMC2859115.Google Scholar
  6. Krick J, Murphy-Miller P, Zeger S, Wright E. Pattern of growth in children with cerebral palsy. J Am Diet Assoc. 1996 Jul;96(7):680–5. PubMed PMID: 8675911.PubMedCrossRefGoogle Scholar
  7. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, M W J Schols A, Pichard C; ESPEN. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr. 2004 Dec;23(6):1430–53. PubMed PMID: 15556267.CrossRefGoogle Scholar
  8. Liu LF, Roberts R, Moyer-Mileur L, Samson-Fang L. Determination of body composition in children with cerebral palsy: bioelectrical impedance analysis and anthropometry vs dual-energy x-ray absorptiometry. J Am Diet Assoc. 2005 May;105(5):794–7. PubMed PMID: 15883558.PubMedCrossRefGoogle Scholar
  9. McRae MP. Educating chiropractic students about intraobserver and interobserver variability through the use of skinfold measurement. J Chiropr Educ. 2009 Fall;23(2):147-50. PubMed PMID: 19826542; PubMed Central PMCID: PMC2759992.PubMedGoogle Scholar
  10. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997 Apr;39(4):214–23. PubMed PMID: 9183258..PubMedCrossRefGoogle Scholar
  11. Pencharz PB, Azcue M. Use of bioelectrical impedance analysis measurements in the clinical management of malnutrition. Am J Clin Nutr. 1996 Sep;64(3 Suppl):485S–488S. PubMed PMID: 8780368.PubMedGoogle Scholar
  12. Penning C, Rieken R van Knijff-Raeven AGM, Evenhuis HM. 2010;Submitted.Google Scholar
  13. Rieken R, Calis EA, Tibboel D, Evenhuis HM, Penning C. Validation of skinfold measurements and bioelectrical impedance analysis in children with severe cerebral palsy: a review. Clin Nutr. 2010 Apr;29(2):217–21. Epub 2009 Aug 14. Review. PubMed PMID: 19683370.Google Scholar
  14. Rieken R, van Goudoever JB, Schierbeek H, Willemsen SP, Calis EA, Tibboel D, Evenhuis HM, Penning C. Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability. Am J Clin Nutr. 2011 Sep;94(3):759–66. Epub 2011 Jul 27. PubMed PMID: 21795444.Google Scholar
  15. Sakate T. Relationship between body composition of school children and their growth. Ann Physiol Anthropol. 1984 Apr;3(2):142–3. PubMed PMID: 6537169.PubMedCrossRefGoogle Scholar
  16. Siri WE. Body composition from fluid spaces and density: analysis of methods. In: Brozek J, Henschel A, editors. Techniques for measuring body composition. Washington DC: National Academy of Science; 1961. P. 223–44.Google Scholar
  17. Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD, Bemben DA. Skinfold equations for estimation of body fatness in children and youth. Hum Biol. 1988 Oct;60(5):709–23. PubMed PMID: 3224965.PubMedGoogle Scholar
  18. Spender QW, Cronk CE, Stallings VA, Hediger ML. Fat distribution in children with cerebral palsy. Ann Hum Biol. 1988 May-Jun;15(3):191–6. PubMed PMID: 3389727.PubMedCrossRefGoogle Scholar
  19. Stevenson RD. Use of segmental measures to estimate stature in children with cerebral palsy. Arch Pediatr Adolesc Med. 1995 Jun;149(6):658–62. PubMed PMID: 7767422.PubMedCrossRefGoogle Scholar
  20. Stevenson RD, Conaway M, Chumlea WC, Rosenbaum P, Fung EB, Henderson RC, Worley G, Liptak G, O’Donnell M, Samson-Fang L, Stallings VA; North American Growth in Cerebral Palsy Study. Growth and health in children with moderate-to-severe cerebral palsy. Pediatrics. 2006 Sep;118(3):1010-8. PubMed PMID: 16950992.PubMedCrossRefGoogle Scholar
  21. Strauss D, Shavelle R, Reynolds R, Rosenbloom L, Day S. Survival in cerebral palsy in the last 20 years: signs of improvement? Dev Med Child Neurol. 2007 Feb;49(2):86–92. PubMed PMID: 17253993.PubMedCrossRefGoogle Scholar
  22. Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P. Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study. Dev Med Child Neurol. 2000 Oct;42(10):674–80. PubMed PMID: 11085295.PubMedCrossRefGoogle Scholar
  23. Sullivan PB, Alder N, Bachlet AM, Grant H, Juszczak E, Henry J, Vernon-Roberts A, Warner J, Wells J. Gastrostomy feeding in cerebral palsy: too much of a good thing? Dev Med Child Neurol. 2006 Nov;48(11):877–82. PubMed PMID: 17044953..PubMedCrossRefGoogle Scholar
  24. Veugelers R, Penning C, van Gulik ME, Tibboel D, Evenhuis HM. Feasibility of bioelectrical impedance analysis in children with a severe generalized cerebral palsy. Nutrition. 2006 Jan;22(1):16–22. PubMed PMID: 16455444.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Intellectual Disability Medicine, Department of General PracticeErasmus University Medical CenterRotterdamThe Netherlands

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