A higher proportion of adipose tissue (AT) beneath the deep fascial layer in the mid-thigh is associated with a higher risk for metabolic disease. Individuals with quadriplegic cerebral palsy (QCP) could be more susceptible to metabolic disease due to decreased mobility and decreased muscular development. PURPOSE: The purpose of this study was to determine if the proportion of subfascial AT in the mid-thigh is higher in children with QCP than typically developing children. METHODS: Eight children with QCP and eight typically developing children between the 10th and 90th percentiles for age-based height, weight and BMI were studied. Pubertal development was assessed by Tanner Staging. Magnetic resonance images of the entire thigh were collected using a GE 1.5 T scanner (TR = 750, TE =14, FOV =16-20, 1 NEX, 512×512 matrix). Images representing the mid-thigh (i.e., level of the mid-third of the femur) were identified and analyzed for subfascial and subcutaneous AT. RESULTS: Children with QCP were not different (P >0.05) from controls in age (11 ± 2 vs. 10 ±1y), pubertal development (1.3 ±0.5 vs. 1.3 ±0.7 for pubic hair; 1.3 ±0.5 vs. 1.1 ± 0.4 for breast/testicular), height (128 ± 12 vs. 138 ± 7 cm), mass (27 ± 10vs32±3 kg) and BMI (16 ± 3 vs. 17 ± 1 kg/m2). For total, subfascial and subcutaneous AT in the mid-thigh, there were no statistically significant group differences (P >0.05). However, children with QCP had a higher ratio of subfascial to total AT (0.12 ± 0.05 vs 0.05 ± 0.01), a lower ratio of subcutaneous to total AT (0.88 ± 0.05 vs 0.95 ± 0.01), and a higher ratio of subfascial to subcutaneous AT (0.13 ± 0.06 vs 0.05 ± 0.01) in the mid-thigh (P <0.001). CONCLUSIONS: The results suggest that although children with QCP and typically developing children have a similar quantity of total and subcutaneous AT in the mid-thigh, children with QCP have a greater proportion of AT stored beneath the deep fascial layer. Fat storage in this manner has been linked to an increased risk for metabolic disease. Supported by the United Cerebral Palsy Research and Educational Foundation.