ARTICLE

Growth and Health in Children With Moderate-toSevere Cerebral Palsy

Richard D. Stevenson, MDa, Mark Conaway, PhDb, W. Cameron Chumlea, PhDc, Peter Rosenbaum, MDd, Ellen B. Fung, RD, PhDe,
Richard C. Henderson, MD, PhDf, Gordon Worley, MDg, Gregory Liptak, MDh, Maureen ODonnell, MDi, Lisa Samson-Fang, MDj,
Virginia A. Stallings, MDk; of the North American Growth in Cerebral Palsy Study
Departments of aPediatrics and bPublic Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia; cDepartment of Community Health and
Pediatrics, Wright State University, Fairborn, Ohio; dDepartment of Pediatrics, McMaster University, Hamilton, Ontario, Canada; eDepartment of Pediatrics, Childrens
Hospital Oakland, Oakland, California; fDepartment of Orthopedics, University of North Carolina, Chapel Hill, North Carolina; gDepartment of Pediatrics, Duke University,
Durham, North Carolina; hDepartment of Pediatrics, University of Rochester, Rochester, New York; iDepartment of Pediatrics, University of British Columbia, Vancouver,
British Columbia, Canada; jDepartment of Pediatrics, University of Utah, Salt Lake City, Utah; kDepartment of Pediatrics, University of Pennsylvania, Philadelphia,
Pennsylvania
The authors have indicated they have no nancial relationships relevant to this article to disclose.

ABSTRACT
BACKGROUND. Children with cerebral palsy frequently grow poorly. The purpose of
this study was to describe observed growth patterns and their relationship to
health and social participation in a representative sample of children with moderate-severe cerebral palsy.
METHODS. In a 6-site, multicentered, region-based cross-sectional study, multiple

sources were used to identify children with moderate or severe cerebral palsy.
There were 273 children enrolled, 58% male, 71% white, with Gross Motor
Function Classification System levels III (22%), IV (25%), or V (53%). Anthropometric measures included: weight, knee height, upper arm length, midupper
arm muscle area, triceps skinfold, and subscapular skinfold. Intraobserver and
interobserver reliability was established. Health care use (days in bed, days in
hospital, and visits to doctor or emergency department) and social participation
(days missed of school or of usual activities for child and family) over the preceding
4 weeks were measured by questionnaire. Growth curves were developed and z
scores calculated for each of the 6 measures. Cluster analysis methodology was
then used to create 3 distinct groups of subjects based on average z scores across
the 6 measures chosen to provide an overview of growth.
RESULTS. Gender-specific growth curves with 10th, 25th, 50th, 75th, and 90th per-

centiles for each of the 6 measurements were created. Cluster analyses identified
3 clusters of subjects based on their average z scores for these measures. The
subjects with the best growth had fewest days of health care use and fewest days
of social participation missed, and the subjects with the worst growth had the most
days of health care use and most days of participation missed.
CONCLUSIONS. Growth patterns in children with cerebral palsy were associated with
their overall health and social participation. The role of these cerebral palsyspecific growth curves in clinical decision-making will require further study.

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STEVENSON et al

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www.pediatrics.org/cgi/doi/10.1542/
peds.2006-0298
doi:10.1542/peds.2006-0298
Key Words
cerebral palsy, health status, growth,
growth and nutrition, growth patterns
Abbreviations
CP cerebral palsy
NAGCPPNorth American Growth in
Cerebral Palsy Project
KH knee height
UAL upper arm length
SUBsubscapular skinfold thickness
TRItriceps skinfold thickness
AMAarm muscle area
GMFCSGross Motor Function
Classication System
CDCCenters for Disease Control and
Prevention
Accepted for publication Mar 31, 2006
Address correspondence to Richard D.
Stevenson, MD, Department of Pediatrics,
University of Virginia School of Medicine,
Kluge Childrens Rehabilitation Center and
Research Institute, 2270 Ivy Rd, Charlottesville,
VA 22903. E-mail: rds8z@virginia.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005;
Online, 1098-4275). Copyright 2006 by the
American Academy of Pediatrics

ROWTH IS A fundamental and integral marker of

health and well-being in children. Normal growth
is an indicator of health, whereas abnormal growth may
indicate illness, malnutrition, or something awry in the
childs environment. Cerebral palsy (CP) is a common
neurologic condition that originates in early childhood
but affects individuals throughout their life span. Children with CP are known to grow poorly compared with
their peers, but it is unclear whether this poor growth is
normal for the population or a marker of some secondary condition that requires further evaluation and
treatment. The basic clinical questions are: (1) does the
observed poor growth negatively impact health and
well-being of children with CP; and (2) if growth is
improved, are health and well-being also improved?
This investigation addresses the first of these questions.
Growth assessment requires reliable measures and
comparison reference data. Reliable alternative measures of growth for children with CP have been widely
adopted.13 However, appropriate reference growth
curves for these children have not been clearly established. The objectives of this study are as follows: (1) to
describe growth status in a region-based sample of children with moderate or severe CP enrolled in the North
American Growth in Cerebral Palsy Project (NAGCPP),
(2) to develop growth curves and calculate z scores, and
(3) to correlate growth with markers of health and social
participation.

METHODS
The NAGCPP is a multicenter study designed to investigate growth, physical development, and nutritional status in children with CP according to an established protocol.4 The University of Virginia, Duke University, the
University of North Carolina, the Childrens Hospital of
Philadelphia, the University of Rochester, McMaster
University, and the University of British Columbia were
the participating sites, with Duke and University of
North Carolina operating as a single site.
Subjects
The details of subject identification, recruitment, and
enrollment were fully described previously.4 The subjects were a sample drawn from the 6 region-based sites,
using multiple sources for identification: clinic samples,
parent organizations, local United Cerebral Palsy Associations, school systems, public service announcements,
physical therapists, local physicians, equipment vendors,
and newspaper advertisements. Each of the sites defined
a geographical region with a population of 500 000
people. All of the children with CP5 between the ages of
2 and 18 years in each region were eligible for recruitment. All of the subjects of moderate or severe impairment defined by Gross Motor Function Classification
System levels III, IV, or V,6 who had clinically diagnosed
CP, were included. Medical history was reviewed. Chil-

dren with a history of genetic, metabolic, or neurodegenerative disease or other medical illnesses known to
influence growth were excluded. However, children
were not excluded on the basis of prematurity or low
birth weight. Informed consent was obtained from the
parent or legal guardian, and assent was obtained when
appropriate. The institutional review boards of each participating site approved the study.
Procedure
Subjects traveled to each study site to participate. At a
single observation, trained observers performed a detailed anthropometric assessment of each child using
standard techniques.1,7 Duplicate measures were obtained, and the average was used for analyses. Measures
included knee height (KH), upper arm length (UAL),
weight, midupper arm circumference, subscapular skinfold thickness (SUB), triceps skinfold thickness (TRI),
and calculated arm muscle area (AMA). Duplicate measures were also used to calculate intraobserver and interobserver reliability, and these are reported in Table 1.
Reliability was comparable with other published reports
in children with CP.1 Sexual maturity ratings (Tanner
stages) and severity of CP were determined after observers were trained for these assessments.8 We have reported previously on sexual maturity ratings in this population.9 Severity of CP was assessed using the Gross
Motor Function Classification System (GMFCS).6 The
GMFCS categorizes severity into 5 levels (I through V)
based on gross motor function, predominantly independent mobility. This study enrolled subjects who were
levels III, IV, and V, the more severe end of the spectrum. Older children who are level III can ambulate
independently with a walker (household ambulators)
but often use wheelchairs in the community; those at
level IV cannot walk independently but can achieve
independent mobility in a motorized wheelchair; and
those at level V have no independent mobility but,
rather, are transported.
Information regarding demographics, medical history, functional abilities, health care use, and social par-

TABLE 1 Reliability of Anthropometric Measures

Variable

Intraobserver
Error
(N 307)a

Weight
Arm circumference
UAL
KH
TRI
SUB

Interobserver Error
(N 18)

TE

CV

TE

CV

0.08
0.18
0.27
0.22
0.60
0.51

0.30
0.92
1.07
0.61
5.93
5.80

0.04
0.32
0.52
0.29
0.55
0.73

0.18
1.66
2.32
0.89
6.98
12.5

TE indicates technical error d2/2n, where d difference between paired measures on

n subjects; CV, coefcient of variation 100 (TE/mean of measures taken).
a Population measured includes some subjects excluded from other analyses in this study.

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ticipation was collected by interview questionnaire.

Questions regarding health and participation were
adapted from the National Health Interview Survey of
the Centers for Disease Control and Prevention (CDC)10
and referred to the 4 weeks preceding the measurements. These questions asked how many days over the
previous 4 weeks were spent with the child at the emergency department, at the doctors office, overnight in the
hospital, home from school, home in bed, home from
usual activities, or with a family member home and
missing usual activities. No attempt was made to validate
the caregivers recall. The original questions from National Health Interview Survey asked similar questions
but over the preceding 12 months. Other analyses of the
NAGCPP population regarding general health status, nutritional status, bone mineral status, fracture rate, and
health and participation have been published elsewhere.4,1113
Data Analysis
Cross-sectional data analysis was performed by the second author (M. C.) at the coordinating center using
GAUSS 5.014 and SAS 9.1 (SAS Institute, Cary, NC)15
software. The development of growth curves used methods that were similar to those used for the current CDC
growth charts for healthy U.S. children.16,17 These CPspecific curves were used to calculate CP-based z scores
or SD scores for further analysis. To relate body size and
health, K-means cluster analysis18 was used to group
children according to their CP z scores for each of 6
measures of growth and body composition. These 6
measures were chosen a priori as a way to describe each
childs growth in a comprehensive fashion using KH
(lower extremity linear growth), UAL (upper extremity
linear growth), weight (body mass), TRI (extremity fat
stores), SUB (truncal fat stores), and midupper AMA
(skeletal muscle mass). The number of clusters (3) was
chosen empirically as a way to discriminate the sample,
and the cluster analysis program assigned subjects to the
appropriate cluster based on the z scores on the 6 measures. Thus, the technique created a single 3-level composite categorical variable of 6 separate continuous variables with each subject assigned to only 1 of the 3
clusters.
RESULTS
The population is described in Table 2 and consisted of
273 children, with 58% male and 71% white subjects.
Gender-specific growth curves were constructed for all
of the anthropometric data, and 4 illustrative curves are
reproduced in the figures. Because a direct measure of
recumbent length or stature could not be obtained in
these children, KH was used as a proxy for linear
growth. Figures 1 and 2 show the KH curves for boys
and girls with CP, superimposed on a comparison KH
curve generated for healthy children. KH estimates for
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STEVENSON et al

TABLE 2 Demographics of Enrolled Subjects (N 273)

Age, y

Gender
Race

GMFCS level

Birth weight, g

Maternal height, percentile

Characteristic

Enrolled,
n (%)

25
612
1319
Male
Female
White
Black
Other
III
IV
V, no gastrostomy
V, with gastrostomy
1500
15002400
24013300
3300
25th
25th to 75th
75th

72 (26)
107 (39)
94 (34)
157 (58)
116 (42)
192 (70)
63 (23)
18 (7)
56 (23)
64 (25)
73 (29)
62 (24)
52 (24)
53 (24)
61 (28)
53 (24)
49 (26)
91 (47)
52 (27)

Numbers may not add to 273 because of missing values.

the healthy children were based on converting the CDC

height charts16 to KH estimates using the formulas in
Chumlea et al.19 Figures 3 and 4 show the weight curves
for boys and girls with CP superimposed on the weight
curves for healthy children. All of these growth curves
include the 10th, 25th, 50th, 75th, and 90th percentiles.
The cluster analysis discriminated 3 groups of children based on their CP z scores for each of 6 anthropometric assessments: KH, UAL, weight, TRI, SUB, and
midupper AMA. Each child is represented in only 1
group. Figure 5 depicts these 3 groups, with the y-axis
representing the average CP z score for each of the 6
measures. For discussion, these groups will be referred to
as: Z, the smaller group (bottom line in Fig 5; on
average 1 SD below the mean); Z, the middle group
(middle line in Fig 5; on average at about the mean); and
Z, the larger group (top line in Fig 5; on average 1
SD above the mean). Of these children, 90 (35%) were
in the Z group, 106 (42%) were in the Z group, and
58 (23%) were in the Z group.
These 3 groups were then correlated with markers of
health and social participation over the preceding 4
weeks (Fig 6 and Table 3). The x-axis in Fig 6 and the
numbers in Table 3 represent number of days, so higher
numbers indicate more days with health care use and
more days missed of school or usual activities. These
analyses demonstrate that the Z group had fewest days
of health care and fewest days missed of usual activities,
and the Z group had the most days of health care and
most activities days missed, with the Z group falling in
between. Although these results did not reach statistical
significance (at the P .05 level; see Table 3), their
order, relative to each other, was consistent.
The 3 groups from cluster analysis did correlate with

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FIGURE 1
KH centiles for Boys with CP versus healthy boys. A, KHs and estimated centiles for boys
with CP (n 156). B, Estimated KH centiles for boys with CP () and healthy boys ().
KH estimates for the general population were based on converting the CDC height charts
using the formulas in Chumlea et al.19

functional severity. Table 4 displays GMFCS and feeding

tube status by group. There are significant (P .001)
differences among the groups with respect to the GMFCS classifications, with the Z and Z groups tending
to have fewer GMFCS level V children (most severely
impaired) and more GMFCS level 3 children (least severely impaired) than the Z group. Negative binomial
regression models were fit to the health and participation measures to assess the effect of group membership
on these measures, adjusting for age, gender, and GMFCS/feeding tube status. The results of these analyses are
displayed in Fig 7. These 2 figures display the estimated
ratio of the health and participation measures from the
Z group, relative to the Z and Z groups, respectively, adjusting for age, gender, and GMFCS/feeding
tube status. As in the unadjusted analyses, children in
the Z group consistently had greater health care use
and lower social participation than children in the Z
and Z groups. Moreover, for 2 of the health and par-

FIGURE 2
KH centiles for girls with CP versus healthy girls. A, KHs and estimated centiles for girls
with CP (n 114). B, Estimated KH centiles for girls with CP () and healthy girls (). KH
estimates for the general population were based on converting the CDC height charts
using the formulas in Chumlea et al.19

ticipation measures (days missed at school and days of

usual activity missed by family members) in the adjusted
analyses (see Fig 7B), these differences were statistically
significant (P .05).
DISCUSSION
In pediatric practice, poor or subnormal growth is
equated with poor health. Poor growth is determined by
careful measurement (anthropometry) and comparison
of the results to appropriate reference standards. The
anthropometric assessment of children with CP has been
difficult because of difficulty acquiring reliable measurements of stature (height or length) and lack of appropriate reference data for comparison.2 Although the measurement problem has been overcome through the use
of alternative measures (eg, UAL, lower leg length, and
skinfold thickness),1,3 the reference standard problem
remains. The use of general population standards for a
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1013

FIGURE 3
Weight centiles for boys with CP versus healthy boys. A, Weights and estimated centiles
for boys with CP (n 153). B, Estimated weight percentiles for boys with CP () and
healthy boys (). Weight centile estimates for the general population were based on the
CDC weight charts.16

group of nonambulatory, severely impaired children is

questionable.20
Most reference standards were established by measuring a representative cross-section of the healthy population and creating growth charts.16 Such growth charts
are intended to encompass individual variability because
of genetic potential. The primary measures used are
stature (height or length), body mass (weight), and often
some measure of body proportion (body mass index
[BMI] or weight for height). An important feature of
most growth charts is that they are intended to be descriptive of a population (how they grew) and are used
to monitor normal growth and screen for abnormal
growth. They are not intended to be prescriptive for
health (how they should grow).21 Growth charts help
clinicians determine the body size (stature and weight)
and relative proportions (BMI) of an individual child
compared with reference data from healthy children.
This is usually described in terms of the childs growth
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STEVENSON et al

FIGURE 4
Weight centiles for girls with CP versus healthy girls. A, Weights and estimated centiles for
girls with CP (n 113). B, Estimated weight centiles for girls with CP () and healthy girls
(). Weight centile estimates for the general population were based on the CDC weight
charts.16

percentile (50th percentile being average) or in SDs

(z score) from the mean. However, a child at the 10th
percentile weight for stature, for example, is not necessarily less healthy than a child at the 50th percentile,
although clearly thinner. Although clinicians often consider the 50th percentile weight for a particular height as
ideal (implying ideal for health), it is simply no more
than a statistical average for the population. Relatively
few data exist that actually link patterns of growth to
clinically meaningful health indicators.
Diagnosis-specific growth curves have been developed for other health conditions, such as Down syndrome and Turner syndrome,2224 conditions in which
malnutrition is uncommon and the genetic abnormality
directly influences stature. Having a reference growth
curve for children with CP may be helpful to clinicians
and beneficial to children. However, any representative
sample of children with moderate or severe CP is likely
to include many children with differing degrees of acute

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FIGURE 5
Cluster means and SEs of means from 3 clusters (n 254 subjects
observed on all 6 anthropometric measures).

FIGURE 6
Anthropometric clusters and health and participation
for children with CP. N 238 children with both anthropometric and outcomes data. There are n 82 children
in the Z smaller cluster (F), n 104 in the Z middle cluster () and n 52 children in the Z larger
cluster ().

and chronic malnutrition and possibly growth hormone

deficiency.25,26 This limits the usefulness of a descriptive
reference growth chart for clinical management. What
would be useful for clinical practice is a prescriptive
growth curve, with statistical and clinically significant
links between body size and proportions and health and
social participation outcomes.
We developed CP-specific growth curves for measures
of linear growth, body mass, and body composition.
These growth curves, illustrated in the sample figures,
are similar in shape to other growth curves, both in

typical children16 and in special populations.23,24 Of note

is a steady increase in growth throughout childhood
followed by a plateau in adolescence. The usual adolescent growth spurt seems blunted in the CP curve percentiles compared with healthy children. On average,
the children with moderate or severe CP were smaller,
thinner, and lighter than their age- and gender-related
peers without CP. The differences are significant and
become more pronounced as children age. For example,
whereas the CP KH percentiles overlap with the percentiles for typical children early in childhood, none of our
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1015

TABLE 3 Summary of Health and Participation Outcomes by Cluster Group

Z Medium (n 104)

Z Small (n 82)

Variable

Doctor visits
Emergency department visits
Hospital overnight
Days in bed
School days missed
Child unable to do usual activities
Family unable to do usual activities

Z Large (n 52)

Mean

SE

Range

Mean

SE

Range

Mean

SE

Range

0.84
0.18
0.39
0.49
1.38
1.01
0.79

0.12
0.08
0.21
0.22
0.40
0.27
0.20

06
04
016
015
025
015
010

0.85
0.06
0.07
0.40
0.95
0.92
0.82

0.16
0.02
0.03
0.27
0.32
0.31
0.32

010
01
02
028
028
021
028

0.65
0.06
0.08
0.06
0.38
0.52
0.25

0.15
0.03
0.06
0.06
0.16
0.19
0.12

04
01
03
03
05
07
05

.35
.67
.22
.14
.08
.46
.11

Data are the number days over the previous 4 weeks. P values from Kruskal-Wallis test.

TABLE 4 Cluster Membership by GMFCS

Variable

Z (Smaller),
n (%)

Z (Middle),
n (%)

Z (Larger),
n (%)

Total

III
IV
V no gastrostomy
V with gastrostomy
Total

9 (11)
21 (25)
37 (44)
17 (20)
84 (100)

29 (30)
21 (21)
22 (22)
26 (27)
95 (100)

17 (31)
15 (27)
11 (20)
12 (22)
55 (100)

55
57
70
55
237

Values displayed are number of subjects and column percentages. Numbers do not add to 254 because of missing values on GMFCS/feeding
tube status. 2 test 19.5; P .0001.

FIGURE 7
Estimated percentage of health care use and participation measures for (A) the Z small cluster relative to the Z cluster and (B) the Z cluster relative to the Z large clusters,
relative to the medium cluster. Values displayed are the estimates and 95% condence intervals based on the negative binomial regression model, adjusting for age, gender, and
GMFCS/feeding tube status.

subjects was above the 5th percentile for their typical

peers by adolescence. These data are consistent with
previous reports that show an apparent worsening or
falling off of growth in children with CP over time
when compared with typical children.25,2729
These CP-specific growth curves could be published
for clinical use, as other diagnosis-specific reference
curves have been,23,24,30 and our group debated this issue
pointedly. However, because the representative sample
of children with CP used to develop the curves likely
included children with confounding secondary condi1016

STEVENSON et al

tions of acute and chronic malnutrition and growth hormone deficiency, we decided against the idea. We were
concerned that clinicians might use these growth curves
as prescriptive for the population. Therefore, we decided to embark on further analyses to link physical
growth to health and participation outcomes. There is
clear precedent for this notion in child health research,
most notably in research related to obesity and cystic
fibrosis.3133 In addition, research in adults supports a
relationship between underweight and excess mortality.34
To link physical growth with markers of health and

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participation, cluster analyses were chosen to extract the

most information possible from the anthropometric data
collected. Although we considered using simpler measures of proportion, such as weight for height or BMI,
these children were so varied in body proportions that
overall patterns of growth and body composition would
be misrepresented or not captured entirely. Our intent
was to take a broad snapshot of physical growth. Not
unexpectedly, and as illustrated in Table 4, growth correlated with neurologic severity and the presence of a
feeding gastrostomy. A large proportion of the smallest
growth group (Z) was made up of the most severely
impaired children (GMFCS level V), particularly those
without a gastrostomy. However, every level of severity
was represented in each of the anthropometric groups.
Thus, whereas neurologic severity accounted for a portion of the variance in outcomes, it was only when we
controlled for severity (see Fig 7) that 2 of the analyses
reached statistical significance.
The markers of health that we chose were modified
from the National Health Information Survey by the
CDC.10 Although based on questionnaire responses from
parents, they address the construct of health and wellbeing through the reported use of health services and
reported participation in school and usual activities. The
results of our analyses were consistent in that the best
growth correlated with the least use of health care services and fewest days missed of usual activities, even
when neurologic severity was controlled. The consistency of these results suggests that a larger sample size
would likely demonstrate more statistically significant
results. However, health and participation are influenced by many different factors, only some of which
may be modifiable, and even a larger cross-sectional
sample would not confirm cause and effect relationships.
Understanding the impact of growth on health and participation will require clinical trials in which growth is
modified (eg, nutritionally and/or hormonally) and outcomes are carefully measured. Nevertheless, we feel that
the current data are suggestive and worthy of further
investigation.
What do these results mean, and where do we go
from here? These data and analyses represent the next
step in clarifying the relationship between growth and
health in children with CP. However, these data must be
viewed with caution. Although better health and bigger growth correlated strongly with one another, the
direction of causality is unclear. Children may be healthier because they are bigger, or they could be bigger
because they are in better health. Alternatively, because
the health and participation questions refer to the 4
weeks before measurement, it is conceivable that children who had been ill (and missed school, etc) subsequently lost weight and were smaller. Further studies,
such as those recently published by Sullivan et al,35,36 are
essential to corroborate these findings and to evaluate

whether specific interventions that improve growth result in improved health and social participation. The
clinical goal is to optimize the health and well-being of
children with CP and their families through appropriate
management growth and nutrition.37
CONCLUSIONS
Children with moderate or severe CP have poor growth
compared with typical children. We developed growth
curves for children with moderate or severe CP and
correlated growth with markers of health and social
participation. Bigger children with CP had better health
and social participation than similar smaller children.
Further studies are needed to corroborate these findings
and to evaluate whether specific interventions can improve growth, as well as health and social participation.
Determining the potential role of these growth curves in
clinical decision-making will require further study.
ACKNOWLEDGMENTS
This study was conducted as part of the North American
Growth in Cerebral Palsy Project. It was supported by
the Kluge Research Fund and the Childrens Hospital
Committee of the University of Virginia, the Genentech
Foundation for Growth and Development, the National
Center for Medical Rehabilitation Research (grants 5 R01
HD35739-04, 1 F32 HD08615-01A1, 1 R24 HD39631-01,
and K24-HD041504-01), and the University of Virginia
General Clinical Research Center (M01RR00847). In addition, this study was supported by the University of
North Carolina General Clinical Research Center (M01
RR00046) and the National Institute of Arthritis, Musculoskeletal and Skin Diseases (K24 AR02132); the General Clinical Research Center (M01 RR00240) and the
Nutrition Center at the Childrens Hospital of Philadelphia; the Jones-Guerrero Fund at Duke University, the
Childrens Hospital Fund at the University of British
Columbia, and the General Clinical Research Center at
the University of Rochester (M01 RR00044).
We gratefully acknowledge the help and support of
the children and their families. We also give special
thanks to Vivienne Spauls, Jillian Bumler, Teresa Olsen,
and Candra Gerrick.
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Growth and Health in Children With Moderate-to-Severe Cerebral Palsy

Richard D. Stevenson, Mark Conaway, W. Cameron Chumlea, Peter Rosenbaum,
Ellen B. Fung, Richard C. Henderson, Gordon Worley, Gregory Liptak, Maureen
O'Donnell, Lisa Samson-Fang and Virginia A. Stallings
Pediatrics 2006;118;1010
DOI: 10.1542/peds.2006-0298
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright 2006 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Growth and Health in Children With Moderate-to-Severe Cerebral Palsy

Richard D. Stevenson, Mark Conaway, W. Cameron Chumlea, Peter Rosenbaum,
Ellen B. Fung, Richard C. Henderson, Gordon Worley, Gregory Liptak, Maureen
O'Donnell, Lisa Samson-Fang and Virginia A. Stallings
Pediatrics 2006;118;1010
DOI: 10.1542/peds.2006-0298

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
/content/118/3/1010.full.html

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2006 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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