Growth Attenuation for the Child with Cerebral Palsy

Abstract

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.