I appreciate the comments of Dr Scheuerle regarding my article1 and growth in cerebral palsy (CP). She raises a very legitimate point regarding the etiologic heterogeneity of children with CP and the possibility that it affects growth, independent of the child's encephalopathy. At our institution, as in most other tertiary care, university settings, all children who are assigned the diagnostic label of CP undergo careful evaluation for evidence of underlying genetic, metabolic, or neurodegenerative disease. The extent of this evaluation varies with the clinical situation, but it generally includes, as a minimum, a careful history and clinical examination, neuroimaging (computed tomography or magnetic resonance imaging), and metabolic or genetic testing, as indicated. Most patients had been followed up for at least 1 year, and the diagnosis is reviewed at each clinic visit. All children with dysmorphic features or evidence of genetic or neurodegenerative disease were excluded from this
Stevenson RD. Heterogeneity of Cerebral Palsy-Reply. Arch Pediatr Adolesc Med. 1996;150(4):443. doi:10.1001/archpedi.1996.02170290109022
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