New growth charts can help identify Scottish children with CP in need of extra help
Prof Charlotte Wright, Paediatrician with an interest in nutrition
As a paediatrician with an interest in nutrition I have always been interested in growth charts and led the group that redesigned the UK charts a few years back. However charts designed for healthy children can be misleading when you plot children with disability on them. Children with severe cerebral palsy (CP) often have feeding difficulties so it is important to monitor their weight and growth, which may be affected by undernutrition. However it has been known for some time that children with severe CP also grow slowly compared to children without CP, even when well nourished.
I was pleased to see the new charts had been published in the US that allowed a child with CP to be compared to other children with the same severity of CP. The only problem was that these charts were not laid out like UK charts and couldn’t be easily processed on the computer, so it was hard to tell whether they would work as well for UK children. I thus got in contact with the team who designed the US charts and with a statistician in London and we were soon able to produce UK-style charts. Then, with a fellow consultant paediatrician in Glasgow, we found growth data for around half the children with CP being looked after in Glasgow and plotted these on the new charts. Actually we did this statistically using Z scores – but it amounts to the same thing.
This showed that children with CP from Glasgow fit the new charts quite well, but are actually a bit taller than US children with CP. This is in contrast to plotting them on the standard UK chart where they look exceptionally small. Using the new charts in future should make it easier to pick out those children with CP in need of extra help from those who are just naturally small.
Cerebral palsy is a developmental disorder, caused by the brain being deprived of oxygen in the womb or soon after birth. It causes stiffness and weakness of the limbs and may also cause difficulty with speech as well eating and swallowing. There is wider range of severity from a child with just a slight limp though to being in wheelchair and needing help with all daily activities.
Z scores are a way of standardising and comparing growth measures. A Z score of zero is equivalent to the 50th centile on a chart while +2 = 98th centile and -2 = 2nd.
Read the full article here:
Validation of US cerebral palsy growth charts using a UK cohort. Dev Med Child Neurol.
WRIGHT, C. M., REYNOLDS, L., INGRAM, E., COLE, T. J. & BROOKS, J. 2017.
Featured image: Elvis Kennedy [CC BY-NC-ND 2.0] via Flickr
Charlotte Wright is a paediatrician and epidemiologist at Glasgow University who is internationally recognised for her programme of research into growth, nutrition and screening in early childhood. Her interest in nutrition began with the study failure to thrive but now extends to all aspects of growth and feeding in preschool children and obesity in older children. She is a consultant at the Royal Hospital for Sick Children in Glasgow, where she specialises in nutritional problems and works with NHS greater Glasgow on planning children’s services related to Nutrition. She is also a member of SACN, the committee that advises the UK government on scientific aspects of nutrition.