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

  • Philipp Egenolf
  • Ibrahim Duran
  • Christina Stark
  • Kyriakos Martakis
  • Stefanie Hamacher
  • Eckhard Schoenau
  • Oliver SemlerEmail author
Original Article


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.


Cerebral palsy Growth retardation Body height Reference data 



Cerebral palsy


Insulin-like growth factor


Life Expectancy Project


Gross motor function classification system


Authors' 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.


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.

Compliance with ethical standards

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).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medicine and University Hospital Cologne, Department of PediatricsUniversity of CologneCologneGermany
  2. 2.Faculty of Medicine and University Hospital Cologne, Center for Prevention and RehabilitationUniversity of CologneCologneGermany
  3. 3.Department of International Health, CAPHRI, FHMLMaastricht UniversityMaastrichtThe Netherlands
  4. 4.Institute of Medical Statistics and Computational BiologyUniversity of CologneCologneGermany
  5. 5.Children’s and Adolescent’s HospitalUniversity of CologneCologneGermany

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