Growth Attenuation for the Child with Cerebral Palsy

  • Jonathan M. Miller
  • Evan Graber
Living reference work entry


Approximately one-third of children with cerebral palsy have moderate or severe cognitive impairment. When severe cognitive impairment accompanies significant physical limitations in children with CP, the caregivers are required to provide for all of their daily needs. Some of these responsibilities will become more difficult as the child grows larger, including transfer from bed to chair, diapering, dressing, bathing, and transporting. Furthermore, the heightened burden on the family can make it increasingly difficult to care for the child in the home environment. These concerns have led some families of nonambulatory children with profound cognitive impairment to request growth attenuation therapy to mitigate the impact of growth on their ability to care for their children. Estrogen given orally or transdermally can be used for growth attenuation in this population, but the ethics of this therapy continues to be debated in the medical community.


Cerebral palsy Growth attenuation Cognitive impairment Estrogen therapy Ashley treatment 


  1. Allen DB, Kappy M, Diekema D, Fost N (2009) Growth attenuation therapy: principles for practice. Pediatrics 123(6):1556–1561CrossRefGoogle Scholar
  2. Bersani H (2007) Growth attenuation: unjustifiable non-therapy. Arch Pediatr Adolesc Med 161(5):520–521CrossRefGoogle Scholar
  3. de Waal WJ, Torn M, de Muinck Keizer-Schrama SM, Aarsen RS, Drop SL (1995) Long term sequelae of sex steroid treatment in the management of constitutionally tall stature. Arch Dis Child 73(4):311–315CrossRefGoogle Scholar
  4. Drop SL, De Waal WJ, de Muinck Keizer-Schrama SM (1998) Sex steroid treatment of constitutionally tall stature. Endocr Rev 19(5):540–558PubMedGoogle Scholar
  5. Greenwald P, Barlow JJ, Nasca PC, Burnett WS (1971) Vaginal cancer after maternal treatment with synthetic estrogens. N Engl J Med 285(7):390–392CrossRefGoogle Scholar
  6. Gunther DF, Diekema DS (2006) Attenuating growth in children with profound developmental disability: a new approach to an old dilemma. Arch Pediatr Adolesc Med 160(10):1013–1017CrossRefGoogle Scholar
  7. Isaacs D, Tobin B, Hamblin J, Slaytor E, Donaghue KC, Munns C, Kilham HA (2011) Managing ethically questionable parental requests: growth suppression and manipulation of puberty. J Paediatr Child Health 47(9):581–584CrossRefGoogle Scholar
  8. Kerruish N (2016) Growth attenuation therapy. Camb Q Healthc Ethics 25(1):70–83CrossRefGoogle Scholar
  9. Miller F, Bachrach SJ (2017) Cerebral palsy: a complete guide for caregiving, 3rd edn. Johns Hopkins University Press, BaltimoreGoogle Scholar
  10. Mohammed K, Abu Dabrh AM, Benkhadra K, Al Nofal A, Carranza Leon BG, Prokop LJ, Montori VM, Faubion SS, Murad MH (2015) J Clin Endocrinol Metab 11(11):4012–4020CrossRefGoogle Scholar
  11. Pollock AJ, Fost N, Allen DB (2015) Growth attenuation therapy: practice and perspectives of paediatric endocrinologists. Arch Dis Child 100(12):1185CrossRefGoogle Scholar
  12. Shah SK, Rosenberg AR, Diekema DS (2017) Charlie Gard and the limits of best interests. JAMA Pediatr 171(10):937–938CrossRefGoogle Scholar
  13. Smith EP, Boyd J, Frank GR, Takahashi H, Cohen RM, Specker B, Williams TC, Lubahn DB, Korach KS (1994) Estrogen resistance caused by a mutation in the estrogen-receptor gene in a man. N Engl J Med 331(16):1056–1061CrossRefGoogle Scholar
  14. Venn A, Hosmer T, Hosmer D, Bruinsma F, Jones P, Lumley J, Pyett P, Rayner JA, Werther G (2008) Oestrogen treatment for tall stature in girls: estimating the effect on height and the error in height prediction. Clin Endocrinol 68(6):926–929CrossRefGoogle Scholar
  15. Wilfond BS, Miller PS, Korfiatis C, Diekema DS, Dudzinski DM, Goering S (2010) Navigating growth attenuation in children with profound disabilities Children’s interests, family decision-making, and community concerns. Hast Cent Rep 40(6):27–40CrossRefGoogle Scholar
  16. Wrigley R, Kerruish N, Hofman PL, Jefferies C, Pollock AJ, Wheeler BJ (2017) Growth attenuation therapy for children with severe physical and cognitive disability: practice and perspectives of New Zealand paediatricians. J Paediatr Child Health 53(12):1180–1185CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nemours A.I. duPont Hospital for Children and Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

Section editors and affiliations

  • Steven Bachrach
    • 1
  1. 1.Al duPont Hospital for ChildrenWilmingtonUSA

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