{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:45:11Z","timestamp":1792082711106,"version":"4.4.0"},"reference-count":64,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,1,1]]},"abstract":"<jats:p>Objective. This report describes the consensus outcome of an interdisciplinary workshop that was held at the National Institutes of Health in April 2001. The purpose of the workshop and this article are to define the terms \u201cspasticity,\u201d \u201cdystonia,\u201d and \u201crigidity\u201d as they are used to describe clinical features of hypertonia in children. The definitions presented here are designed to allow differentiation of clinical features even when more than 1 is present simultaneously.<\/jats:p>\n                  <jats:p>Methods. A consensus agreement was obtained on the best current definitions and their application in clinical situations.<\/jats:p>\n                  <jats:p>Results. \u201cSpasticity\u201d is defined as hypertonia in which 1 or both of the following signs are present: 1) resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement, and\/or 2) resistance to externally imposed movement rises rapidly above a threshold speed or joint angle. \u201cDystonia\u201d is defined as a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. \u201cRigidity\u201d is defined as hypertonia in which all of the following are true: 1) the resistance to externally imposed joint movement is present at very low speeds of movement, does not depend on imposed speed, and does not exhibit a speed or angle threshold; 2) simultaneous co-contraction of agonists and antagonists may occur, and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint; 3) the limb does not tend to return toward a particular fixed posture or extreme joint angle; and 4) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen.<\/jats:p>\n                  <jats:p>Conclusion. We have provided a set of definitions for the purpose of identifying different components of childhood hypertonia. We encourage the development of clinical rating scales that are based on these definitions, and we encourage research to relate the degree of hypertonia to the degree of functional ability, change over time, and societal participation in children with motor disorders.<\/jats:p>","DOI":"10.1542\/peds.111.1.e89","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T20:43:47Z","timestamp":1092429827000},"page":"e89-e97","source":"Crossref","is-referenced-by-count":690,"title":["Classification and Definition of Disorders Causing Hypertonia in Childhood"],"prefix":"10.1542","volume":"111","author":[{"given":"Terence D.","family":"Sanger","sequence":"first","affiliation":[{"name":"Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio R.","family":"Delgado","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosciences, Texas Scottish Rite Hospital for Children, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Gaebler-Spira","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rehabilitation Institute of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hallett","sequence":"additional","affiliation":[{"name":"Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan W.","family":"Mink","sequence":"additional","affiliation":[{"name":"Department of Child Neurology, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Task Force on Childhood Motor Disorders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2003,1,1]]},"reference":[{"key":"2021120821105169400_R1","doi-asserted-by":"crossref","unstructured":"Cans C. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol.2000;42:816\u2013824","DOI":"10.1111\/j.1469-8749.2000.tb00695.x"},{"key":"2021120821105169400_R2","unstructured":"Tardieu C, Lacert P, Lombard M, Truscelli D, Tardieu G. H reflex and recovery cycle in spastic and normal children: intra- and inter-individual and inter-groups comparisons. Arch Phys Med Rehabil.1977;58:561\u2013567"},{"key":"2021120821105169400_R3","unstructured":"Anthoney TR. Neuroanatomy and the Neurologic Exam. Ann Arbor, MI: CRC Press; 1994"},{"key":"2021120821105169400_R4","unstructured":"World Health Organization. ICIDH-2: International Classification of Functioning and Disability. Geneva, Switzerland: World Health Organization; 1999"},{"key":"2021120821105169400_R5","doi-asserted-by":"crossref","unstructured":"Campbell SK, Quantifying the effects of interventions for movement disorders resulting from cerebral palsy. J Child Neurol.1996;11(suppl 1):S61[ens]S70","DOI":"10.1177\/0883073896011001S09"},{"key":"2021120821105169400_R6","unstructured":"Lance JW. Pathophysiology of spasticity and clinical experience with baclofen. In: Feldman RG, Young RR, Koella WP, eds. Spasticity: Disordered Motor Control. Chicago, IL: Year Book Medical Publishers; 1980:185\u2013220"},{"key":"2021120821105169400_R7","unstructured":"Crothers B, Paine R. The natural history of cerebral palsy. In: Mitchell R, ed. Classics in Developmental Medicine. Vol 2. Philadelphia, PA: JB Lippincott; 1959"},{"key":"2021120821105169400_R8","unstructured":"Young R. Spasticity: a review. Neurology.1994;44(suppl 9):S12\u2013S20"},{"key":"2021120821105169400_R9","doi-asserted-by":"crossref","unstructured":"Sinkjaer T, Toft E, Larsen K, Andreassen S, Hansen HJ. Non-reflex and reflex mediated ankle joint stiffness in multiple sclerosis patients with spasticity. Muscle Nerve.1993;16:69\u201376","DOI":"10.1002\/mus.880160112"},{"key":"2021120821105169400_R10","doi-asserted-by":"crossref","unstructured":"Powers RK, Campbell DL, Rymer WZ. Stretch reflex dynamics in spastic elbow flexor muscles. Ann Neurol.1989;25:32\u201342","DOI":"10.1002\/ana.410250106"},{"key":"2021120821105169400_R11","unstructured":"Katz RT, Rymer WZ. Spastic hypertonia: mechanisms and measurement. Arch Phys Med Rehabil.1989;70:144\u2013155"},{"key":"2021120821105169400_R12","doi-asserted-by":"crossref","unstructured":"Levin MF, Feldman AG. The role of stretch reflex threshold regulation in normal and impaired motor control. Brain Res.1994;657(1\u20132):23\u201330","DOI":"10.1016\/0006-8993(94)90949-0"},{"key":"2021120821105169400_R13","doi-asserted-by":"crossref","unstructured":"Jobin A, Levin MF. Regulation of stretch reflex threshold in elbow flexors in children with cerebral palsy: a new measure of spasticity. Dev Med Child Neurol.2000;42:531\u2013540","DOI":"10.1017\/S0012162200001018"},{"key":"2021120821105169400_R14","doi-asserted-by":"crossref","unstructured":"Berger W, Quintern J, Dietz V. Pathophysiology of gait in children with cerebral palsy. Electroencephalogr Clin Neurophysiol.1982;53:538\u2013548","DOI":"10.1016\/0013-4694(82)90066-9"},{"key":"2021120821105169400_R15","doi-asserted-by":"crossref","unstructured":"Dietz V, Trippel M, Berger W. Reflex activity and muscle tone during elbow movements in patients with spastic paresis. Ann Neurol.1991;30:767\u2013779","DOI":"10.1002\/ana.410300605"},{"key":"2021120821105169400_R16","doi-asserted-by":"crossref","unstructured":"Dietz V. Human neuronal control of automatic functional movements: interaction between central programs and afferent input. Physiol Rev.1992;72:33\u201369","DOI":"10.1152\/physrev.1992.72.1.33"},{"key":"2021120821105169400_R17","doi-asserted-by":"crossref","unstructured":"O\u2019Dwyer NJ, Ada L. Reflex hyperexcitability and muscle contracture in relation to spastic hypertonia. Curr Opin Neurol.1996;9:451\u2013455","DOI":"10.1097\/00019052-199612000-00010"},{"key":"2021120821105169400_R18","doi-asserted-by":"crossref","unstructured":"O\u2019Dwyer NJ, Ada L, Neilson PD. Spasticity and muscle contracture following stroke. Brain.1996;119(Pt 5):1737\u20131749","DOI":"10.1093\/brain\/119.5.1737"},{"key":"2021120821105169400_R19","doi-asserted-by":"crossref","unstructured":"Hiersemenzel LP, Curt A, Dietz V. From spinal shock to spasticity: neuronal adaptations to a spinal cord injury. Neurology.2000;54:1574\u20131582","DOI":"10.1212\/WNL.54.8.1574"},{"key":"2021120821105169400_R20","doi-asserted-by":"crossref","unstructured":"Ibrahim IK, Berger W, Trippel M, Dietz V. Stretch-induced electromyographic activity and torque in spastic elbow muscles. Differential modulation of reflex activity in passive and active motor tasks. Brain.1993;116(Pt 4):971\u2013989","DOI":"10.1093\/brain\/116.4.971"},{"key":"2021120821105169400_R21","doi-asserted-by":"crossref","unstructured":"Dietz V. Supraspinal pathways and the development of muscle-tone dysregulation. Dev Med Child Neurol.1999;41:708\u2013715","DOI":"10.1017\/S0012162299001449"},{"key":"2021120821105169400_R22","unstructured":"Wagley PF. A study of spasticity and paralysis. Bull Johns Hopkins Hosp.1945;77:218\u2013273"},{"key":"2021120821105169400_R23","doi-asserted-by":"crossref","unstructured":"Myklebust BM, Gottlieb GL, Penn RD, Agarwal GC. Reciprocal excitation of antagonistic muscles as a differentiating feature in spasticity. Ann Neurol.1982;12:367\u2013374","DOI":"10.1002\/ana.410120409"},{"key":"2021120821105169400_R24","doi-asserted-by":"crossref","unstructured":"Leonard CT, Hirschfeld H, Moritani T, Forssberg H. Myotatic reflex development in normal children and children with cerebral palsy. Exp Neurol.1991;111:379\u2013382","DOI":"10.1016\/0014-4886(91)90106-M"},{"key":"2021120821105169400_R25","unstructured":"Burke D. Spasticity as an adaptation to pyramidal tract injury. Adv Neurol.1988;47:401\u2013423"},{"key":"2021120821105169400_R26","unstructured":"Wiesendanger M Corboz M, Palmeri A, Chen DF, Palmer CI. Noradrenergic mechanisms involved in muscle relaxation: significance for the treatment of spasticity. Schweiz Arch Neurol Psychiatry.1991;142:132\u2013134"},{"key":"2021120821105169400_R27","doi-asserted-by":"crossref","unstructured":"Mayer NH. Clinicophysiologic concepts of spasticity and motor dysfunction in adults with an upper motoneuron lesion. Muscle Nerve Suppl.1997;6:S1\u201313","DOI":"10.1002\/(SICI)1097-4598(1997)6+<1::AID-MUS2>3.0.CO;2-D"},{"key":"2021120821105169400_R28","doi-asserted-by":"crossref","unstructured":"Myklebust BM, Gottlieb GL. Development of the stretch reflex in the newborn: reciprocal excitation and reflex irradiation. Child Dev.1993;64:1036\u20131045","DOI":"10.1111\/j.1467-8624.1993.tb04186.x"},{"key":"2021120821105169400_R29","doi-asserted-by":"crossref","unstructured":"Leonard CT, Hirschfeld H. Myotatic reflex responses of non-disabled children and children with spastic cerebral palsy. Dev Med Child Neurol.1995;37:783\u2013799","DOI":"10.1111\/j.1469-8749.1995.tb12062.x"},{"key":"2021120821105169400_R30","unstructured":"Fahn S, Marsden CD, Calne DB. Classification and investigation of dystonia. In: Marsden CD, Fahn S, eds. Movement Disorders. Vol 2. London, UK: Butterworths; 1987:332\u2013358"},{"key":"2021120821105169400_R31","doi-asserted-by":"crossref","unstructured":"Fahn S. Concept and classification of dystonia. Adv Neurol.1988;50:1\u20138","DOI":"10.1136\/jnnp.50.1.117"},{"key":"2021120821105169400_R32","unstructured":"Fahn S, Bressman SB, Marsden CD. Classification of dystonia. In: Fahn S, Marsden CD, DeLong M, eds. Dystonia. Vol 3. Philadelphia, PA: Lippincott-Raven; 1998:1\u201310"},{"key":"2021120821105169400_R33","doi-asserted-by":"crossref","unstructured":"Fowler EG, Nwigwe AI, Ho TW. Sensitivity of the pendulum test for assessing spasticity in persons with cerebral palsy. Dev Med Child Neurol.2000;42:182\u2013189","DOI":"10.1017\/S0012162200000323"},{"key":"2021120821105169400_R34","unstructured":"Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner.1964;192:540\u2013542"},{"key":"2021120821105169400_R35","doi-asserted-by":"crossref","unstructured":"Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther.1987;67:206\u2013207","DOI":"10.1093\/ptj\/67.2.206"},{"key":"2021120821105169400_R36","doi-asserted-by":"crossref","unstructured":"Haas BM, Bergstrom E, Jamous A, Bennie A. The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury. Spinal Cord.1996;34:560\u2013564","DOI":"10.1038\/sc.1996.100"},{"key":"2021120821105169400_R37","doi-asserted-by":"crossref","unstructured":"Gregson JM, Leathley M, Moore AP, Sharma AK, Smith TL, Watkins CL. Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil.1999;80:1013\u20131016","DOI":"10.1016\/S0003-9993(99)90053-9"},{"key":"2021120821105169400_R38","doi-asserted-by":"crossref","unstructured":"Lin JP, Brown JK, Brotherstone R. Assessment of spasticity in hemiplegic cerebral palsy. II: Distal lower-limb reflex excitability and function. Dev Med Child Neurol.1994;36:290\u2013303","DOI":"10.1111\/j.1469-8749.1994.tb11849.x"},{"key":"2021120821105169400_R39","unstructured":"Fahn S. Assessment of the primary dystonias. In: Munsat TL, ed. Quantification of Neurologic Deficit. Boston, MA: Butterworths; 1989:241\u2013245"},{"key":"2021120821105169400_R40","doi-asserted-by":"crossref","unstructured":"Katz RT, Rovai GP, Brait C, Rymer WZ. Objective quantification of spastic hypertonia: correlation with clinical findings. Arch Phys Med Rehabil.1992;73:339\u2013347","DOI":"10.1016\/0003-9993(92)90007-J"},{"key":"2021120821105169400_R41","doi-asserted-by":"crossref","unstructured":"Skold C, Harms-Ringdahl K, Hultling C, Levi R, Seiger A. Simultaneous Ashworth measurements and electromyographic recordings in tetraplegic patients. Arch Phys Med Rehabil.1998;79:959\u2013965","DOI":"10.1016\/S0003-9993(98)90095-8"},{"key":"2021120821105169400_R42","doi-asserted-by":"crossref","unstructured":"Pisano F, Miscio G, Del Conte C, Pianca D, Candeloro E, Colombo R. Quantitative measures of spasticity in post-stroke patients. Clin Neurophysiol.2000;111:1015\u20131022","DOI":"10.1016\/S1388-2457(00)00289-3"},{"key":"2021120821105169400_R43","doi-asserted-by":"crossref","unstructured":"Ramos E, Latash MP, Hurvitz EA, Brown SH. Quantification of upper extremity function using kinematic analysis. Arch Phys Med Rehabil.1997;78:491\u2013496","DOI":"10.1016\/S0003-9993(97)90162-3"},{"key":"2021120821105169400_R44","doi-asserted-by":"crossref","unstructured":"Hurvitz EA, Conti GE, Flansburg EL, Brown SH. Motor control testing of upper limb function after botulinum toxin injection: a case study. Arch Phys Med Rehabil.2000;81:1408\u20131415","DOI":"10.1053\/apmr.2000.6293"},{"key":"2021120821105169400_R45","doi-asserted-by":"crossref","unstructured":"Nichols DS, Case-Smith J. Reliability and validity of the Pediatric Evaluation of Disability Inventory. Pediatr Phys Ther.1996;8:15\u201324","DOI":"10.1097\/00001577-199600810-00004"},{"key":"2021120821105169400_R46","doi-asserted-by":"crossref","unstructured":"Stokes NA, Deitz JL, Crowe TK. The Peabody Developmental Fine Motor Scale: an interrater reliability study. Am J Occup Ther.1990;44:334\u2013340","DOI":"10.5014\/ajot.44.4.334"},{"key":"2021120821105169400_R47","doi-asserted-by":"crossref","unstructured":"Schmidt LS, Westcott SL, Crowe TK. Inter-rater reliability of the Gross Motor Scale of the Peabody Developmental Motor Scales with 4- and 5-year-old children. Pediatr Phys Ther.1993;5:169\u2013175","DOI":"10.1097\/00001577-199305040-00002"},{"key":"2021120821105169400_R48","doi-asserted-by":"crossref","unstructured":"Palisano RJ, Kolobe TH, Haley SM, Lowes LP, Jones SL. Validity of the Peabody Developmental Gross Motor Scale as an evaluative measure of infants receiving physical therapy [discussion 948\u2013951]. Phys Ther.1995;75:939\u2013948","DOI":"10.1093\/ptj\/75.11.939"},{"key":"2021120821105169400_R49","doi-asserted-by":"crossref","unstructured":"Provost B, Crowe TK, McClain C. Concurrent validity of the Bayley Scales of Infant Development II Motor Scale and the Peabody Developmental Motor Scales in two-year-old children. Phys Occup Ther Pediatr.2000;20:5\u201318","DOI":"10.1080\/J006v20n01_02"},{"key":"2021120821105169400_R50","doi-asserted-by":"crossref","unstructured":"Msall ME, diGaudio KM, Duffy LC. Use of functional assessment in children with developmental disabilities. In: Granger CV, Gresham GE, eds. New Developments in Functional Assessment. Philadelphia, PA: WB Saunders; 1993:517\u2013527","DOI":"10.1016\/S1047-9651(18)30567-9"},{"key":"2021120821105169400_R51","doi-asserted-by":"crossref","unstructured":"Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol.1997;39:214\u2013223","DOI":"10.1111\/j.1469-8749.1997.tb07414.x"},{"key":"2021120821105169400_R52","doi-asserted-by":"crossref","unstructured":"Campbell SK, Kolobe TH, Osten ET, Lenke M, Girolami GL. Construct validity of the test of infant motor performance. Phys Ther.1995;75:585\u2013596","DOI":"10.1093\/ptj\/75.7.585"},{"key":"2021120821105169400_R53","doi-asserted-by":"crossref","unstructured":"Pierson SH. Outcome measures in spasticity management. Muscle Nerve Suppl.1997;6:S36\u2013S60","DOI":"10.1002\/(SICI)1097-4598(1997)6+<36::AID-MUS5>3.0.CO;2-K"},{"key":"2021120821105169400_R54","doi-asserted-by":"crossref","unstructured":"Lollar DJ, Simeonsson RJ, Nanda U. Measures of outcomes for children and youth. Arch Phys Med Rehabil.2000;81(12 suppl 2):S46\u2013S52","DOI":"10.1053\/apmr.2000.20624"},{"key":"2021120821105169400_R55","doi-asserted-by":"crossref","unstructured":"Ottenbacher KJ, Msall ME, Lyon N, et al. Functional assessment and care of children with neurodevelopmental disabilities. Am J Phys Med Rehabil.2000;79:114\u2013123","DOI":"10.1097\/00002060-200003000-00002"},{"key":"2021120821105169400_R56","doi-asserted-by":"crossref","unstructured":"Filiatrault J, Arsenault AB, Dutil E, Bourbonnais D. Motor function and activities of daily living assessments: a study of three tests for persons with hemiplegia. Am J Occup Ther.1991;45:806\u2013810","DOI":"10.5014\/ajot.45.9.806"},{"key":"2021120821105169400_R57","doi-asserted-by":"crossref","unstructured":"Dietz V. Neurophysiology of gait disorders: present and future applications. Electroencephalogr Clin Neurophysiol.1997;103:333\u2013355","DOI":"10.1016\/S0013-4694(97)00047-7"},{"key":"2021120821105169400_R58","doi-asserted-by":"crossref","unstructured":"Lin FM, Sabbahi M. Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia. Arch Phys Med Rehabil.1999;80:526\u2013530","DOI":"10.1016\/S0003-9993(99)90193-4"},{"key":"2021120821105169400_R59","doi-asserted-by":"crossref","unstructured":"Cooper J, Majnemer A, Rosenblatt B, Birnbaum R. The determination of sensory deficits in children with hemiplegic cerebral palsy. J Child Neurol.1995;10:300\u2013309","DOI":"10.1177\/088307389501000412"},{"key":"2021120821105169400_R60","doi-asserted-by":"crossref","unstructured":"Lesny I, Stehlik A, Tomasek J, Tomankova A, Havlicek I. Sensory disorders in cerebral palsy: two-point discrimination. Dev Med Child Neurol.1993;35:402\u2013405","DOI":"10.1111\/j.1469-8749.1993.tb11661.x"},{"key":"2021120821105169400_R61","doi-asserted-by":"crossref","unstructured":"Opila-Lehman JM, Short A, Trombly CA. Kinesthetic recall of children with athetoid and spastic cerebral palsy and of non-handicapped children. Dev Med Child Neurol.1985;27:223\u2013230","DOI":"10.1111\/j.1469-8749.1985.tb03773.x"},{"key":"2021120821105169400_R62","doi-asserted-by":"crossref","unstructured":"Thibault A, Forget R, Lambert J. Evaluation of cutaneous and proprioceptive sensation in children: a reliability study. Dev Med Child Neurol.1994;36:796\u2013812","DOI":"10.1111\/j.1469-8749.1994.tb08190.x"},{"key":"2021120821105169400_R63","doi-asserted-by":"crossref","unstructured":"Van Heest AE, House J, Putnam M. Sensibility deficiencies in the hands of children with spastic hemiplegia. J Hand Surg (Am).1993;18:278\u2013281","DOI":"10.1016\/0363-5023(93)90361-6"},{"key":"2021120821105169400_R64","doi-asserted-by":"crossref","unstructured":"Yekutiel M, Jariwala M, Stretch P. Sensory deficit in the hands of children with cerebral palsy: a new look at assessment and prevalence. Dev Med Child Neurol.1994;36:619\u2013624","DOI":"10.1111\/j.1469-8749.1994.tb11899.x"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/111\/1\/e89\/1006153\/pe0103000e89.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/111\/1\/e89\/1006153\/pe0103000e89.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T20:12:24Z","timestamp":1638994344000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/111\/1\/e89\/28548\/Classification-and-Definition-of-Disorders-Causing"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,1,1]]},"references-count":64,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2003,1,1]]},"published-print":{"date-parts":[[2003,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.111.1.e89","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,1,1]]}}}