ICF-CY International Classification of Functioning, Disability and Health Children and Youth Version

Introduction[edit | edit source]

The children and youth version of the International Classification of Functioning, Disability and Health (ICF) was developed and published as the ICF-CY. The purpose of developing this version was to provide a holistic perspective on barriers and facilitators that affect a child’s functioning.[1] It was designed to “record the characteristics of the developing child and the influence of its surrounding environment.”[2] This article provides an overview of the ICF-CY and its application in clinical practice when treating a child diagnosed with cerebral palsy.

ICF-CY Components and Domains[edit | edit source]

The International Classification of Functioning, Children and Youth (ICF-CY) version is derived from the original ICF framework (2001). The ICF is used to classify health and health-related domains. Like the ICF model, the ICF-CY uses language and terminology to record problems involving body functions and body structures, activity limitations and participation restrictions. It also incorporates the environmental factors that are important for children and young people.

It uses standardised language to allow communication between disciplines, sciences and, indeed, across the globe.[2] The "ICF-CY expands the coverage of the main volume through the addition of content and greater detail to encompass the body functions and structures, activities, participation and environments specific to infants, toddlers, children and adolescents."[2]

The need for a specific children and youth version of the ICF becomes apparent when we consider the following:[2]

  • the health manifestations of children and young people differ in nature, intensity and impact compared to adults
  • development in these populations is strongly influenced by environmental factors, physical and social characteristics unique to children and youth:[3]
    • environmental and social factors include 'the child in the context of the family' and the need to consider the unique involvement of children in life situations - moving from total dependence to independence
    • physical factors include aspects such as developmental delay
      • with developmental delay, limitations in structure or function may not be permanent, or they may change through the ageing and development process
  • we must support the human rights of children and youth in healthcare
    • The ICF-CY model incorporates the human rights of children and young people as defined by the UN Convention on the Rights of Persons with Disabilities[4]
    • The ICF-CY is designed so that the growth and health of children and adolescents are promoted across a range of situations and environments[2]

ICF-CY Components[edit | edit source]

The ICF-CY uses the following alphanumeric coding system:

  • “s” for Body Structures
  • “b” for Body Function
  • “d” for Activities/Participation
  • “e” for Environmental Factors

Component example: Body Function (b)

ICF-CY Domains[edit | edit source]

A numeric code is entered after the letter. It starts with a one-digit chapter number. This is followed by two digits, which are the second level heading, and then one digit each for the third and fourth level headings:

Domain example:

  • b7: Chapter 7: Neuromusculoskeletal and movement-related functions
  • b710: Mobility of joint functions (functions of the range and ease of movement of a joint)
  • b7101: Mobility of several joints

ICF-CY Qualifiers[edit | edit source]

ICF-CY qualifiers help to document the "extent of functioning or disability in a domain or category, or the extent to which an environmental factor is a facilitator or barrier."[5]

Generic qualifiers are used to identify the severity of the 'problem' in relation to an impairment, participation restriction etc.[5] The first qualifier identifies the extent of the impairment and is scored as follows:[2]

  • 0 = no problem
  • 1 = mild problem
  • 2 = moderate problem
  • 3 = severe problem
  • 4 = complete problem
  • 8 = not specified
  • 9 = not applicable

The second qualifier identifies the nature of the impairment and the third qualifier indicates the location of the impairment.[2] In the numeric code, the first digit after the decimal point indicates the first qualifier, the second digit is the second qualifier and the third digit is the third qualifier. For more information on ICF-CY qualifiers and the scoring for the second and third qualifiers, please see: International Classification of Function, Disability and Health- Children and Youth Version.

Example: a neuromusculoskeletal and movement-related functions, including multiple joints and bones and presenting with a mild, not specified impairment, will be coded as follows: b 7101.188

Application of the ICF-CY[edit | edit source]

The ICF-CY is used for children from birth to 18 years of age. It belongs to the World Health Organisation's Family of International Classification (WHO-FIC), so it provides a framework for coding information about various health issues.[2] The ICF-CY framework classifies disability and functioning as manifestations of the interaction of body functions and structures, activities and participation, and environmental factors. This classification system can be used by clinicians, educators, policymakers, family members, researchers, and consumers. In fact, this model was created for anyone involved in the health, education and well-being of children and youth.[2] It can be used to:

  • document characteristics of health and functioning in children and adolescents
  • provide a conceptual framework, common language and terminology for recording problems across the spectrum, including infancy, childhood and adolescence
  • record a single problem or create a profile to define a child's health and functioning difficulties

The ICF-CY can be used in clinical, administrative, surveillance, policy and research.

Clinical Application[edit | edit source]

Clinically, the ICF-CY can be used to provide the following:

  • a summary of assessment findings
  • clarification for diagnostic information
  • assistance in planning relevant interventions


  • using ICF-CY codes for interprofessional cleft palate-craniofacial teams to help identify appropriate starting points for assessment, counselling, and therapy and to include the children's environment and familial/societal context when planning interventions.[6][7]
  • documenting functioning limitations in children with disabilities when there is a lack of classifications of static diagnoses in ICD, such as mental functions, attention and memory.[8]
  • using the ICF-CY among children and adolescents within the augmentative and alternative communication (AAC) field.[9]

Administrative Application[edit | edit source]

In administrative areas, information can be recorded using the ICF-CY codes to assist with the following:

  • determining eligibility for service provision
  • obtaining reimbursement for services
  • receiving an appropriate follow-up


  • supporting the funding of augmentative and alternative communication (AAC) devices for children and adolescents based on an assessment of their benefits for children and adolescents and their communication partners in daily communication life.[3]

Surveillance Application[edit | edit source]

Codes can be selected in surveillance programmes "to standardize data collection procedures across instruments and over time to document the prevalence of conditions, project service needs and service utilization patterns."[2]


  • assessing and comparing the knowledge of doctors and allied health professionals working with children with cerebral palsy regarding the use of the ICF-CY.[10]

Policy Application[edit | edit source]

In policy, the conceptual framework of the ICF-CY allows focus on particular topics.


  • Portugal: implementing the ICF-CY in Education
    • using functioning-oriented criteria for special needs assessment and eligibility processes as opposed to the traditional classification of disability, defined by the nature or the severity of biological deficits.[11]

Research Application[edit | edit source]

In research, the careful selection of particular ICF-CY codes assists in the standardisation of participants, selection of assessment measures and definition of outcomes.


  • researchers and clinics using the universal language of the ICF-CY to increase description specificity for certain disorders
  • consolidating the research knowledge of specific instruments used to assess functionality in children with cerebral palsy
  • synthesising outcome measurements used in clinical trials
  • assessing the correlation between outcome measures and concepts related to the ICF-CY
  • identifying which ICF-CY categories are the most relevant for evaluating patients

Considerations in the use of the ICF-CY[edit | edit source]

"The unit of classification in the ICF-CY model is not a diagnosis, but a profile of functioning".[2]

  • The ICF-CY aims to describe the nature and severity of the limitation and identify influencing factors in the environment.[2]
  • The application of the ICF-CY should be constant as it can be used in many different contexts and scenarios. Assignment of codes should be based on direct measurements, observations and interviews, as well as professional judgments.[2] Primary caregivers can serve as proxy respondents for young children and children with limited verbal skills.[2]
  • To use ICF-CY coding, it is important to consider all aspects of development. Accurate coding can only be achieved when clinicians have a good understanding of functioning in relation to growth and development - i.e. differentiating between growth and development, which falls into normal ranges and atypical development. It is highly encouraged that users of the ICF-CY revise the guidelines and receive training.[2]

ICF Core Sets[edit | edit source]

The ICF Core Sets (ICF­CS) are a "selection of essential categories from the full ICF classification that are considered most relevant to describe the functioning of a person with a specific health condition or in a specific healthcare context."[13] Their purpose is to facilitate assessment in clinical practice and research.[14] You can find more information about the ICF Core Sets here.

Resources[edit | edit source]

  1. ICF-based Documentation Tool - ICF Core Sets in Clinical Practice
  2. ICF Core Sets for Cerebral Palsy in CY
  3. Noten S, Selb M, Troenosemito LAA, Thorpe DE, Rodby-Bousquet E, van der Slot WMA, Roebroeck ME; ICF Core Set for Adults with CP Consensus Group. ICF Core Sets for the assessment of functioning of adults with cerebral palsy. Dev Med Child Neurol. 2022 May;64(5):569-577.
  4. Schiariti V, Longo E, Shoshmin A, Kozhushko L, Besstrashnova Y, Król M, Neri Correia Campos T, Náryma Confessor Ferreira H, Verissimo C, Shaba D, Mwale M, Amado S. Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for Children and Youth with Cerebral Palsy: Global Initiatives Promoting Optimal Functioning. Int J Environ Res Public Health. 2018 Sep 1;15(9):1899.

References[edit | edit source]

  1. Adolfsson M, Sjöman M, Björck-Åkesson E. ICF-CY as a Framework for Understanding Child Engagement in Preschool. Frontiers in Education 2018, 3, 339708.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 World Health Organization. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. World Health Organization; 2007.
  3. 3.0 3.1 Tsai MJ. Using the ICF Framework to Assess Communicative Competence in Dyadic Communication among Children and Adolescents Who Use Augmentative and Alternative Communication Devices in Taiwan. Behav Sci (Basel). 2022 Nov 21;12(11):467.
  4. United Nations Convention on the Rights of Persons with Disabilities. United Nations. Available from https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-persons-disabilities [last access 17.06.2023]
  5. 5.0 5.1 Centers for Disease Control and Prevention. THE ICF: AN OVERVIEW. Available from: https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf (last accessed 11 November 2023).
  6. Neumann S, Romonath R. Application of the International Classification of Functioning, Disability, and Health-Children and Youth Version (ICF-CY) to cleft lip and palate. Cleft Palate Craniofac J. 2012 May;49(3):325-46.
  7. Cronin A, McLeod S, Verdon S. Applying the ICF-CY to Specialist Speech-Language Pathologists' Practice With Toddlers With Cleft Palate Speech. Cleft Palate Craniofac J. 2020 Sep;57(9):1105-1116.
  8. Simeonsson RJ. ICF-CY: A Universal Tool for Documentation of Disability. Journal of Policy and Practice in Intellectual Disabilities 2009; 6(2): 70–72.
  9. Zerbeto AB, Soto G, Chun RYS, Zanolli ML, Rezende ACFA, Clarke M. Use and implementation of the International Classification of Functioning, Disability and Health with Children and Youth within the context of Augmentative and Alternative Communication: an integrative literature review. CEFAC. 2020;22(6):e8020
  10. Azhar H, Maqbool S, Ullah E, Khan T. (2019). Use of ICF-CY in assessing level of knowledge of different professionals working with children having cerebral palsy. Pakistan Armed Forces Medical Journal 2019 ; 69(5):1035-40.
  11. Sanches-Ferreira M, Silveira-Maia M, Alves S, Simeonsson RJ. Conditions for Implementing the ICF-CY in Education: The Experience in Portugal. Frontiers in Education 2018; 3: 350688.
  12. Castro GG de, Nascimento LCG do, Figueiredo GLA. Applicability of the ICF-CY in evaluating children with disabilities and family support: an integrative literature review. Rev CEFAC [Internet]. 2020;22(1):e11518. Available from https://www.scielo.br/j/rcefac/a/XMmJjKpfXHFMzykb6xDFpRr/?lang=en#[last access 18.06.2023]
  13. Selb M, Escorpizo R, Kostanjsek N, Stucki G, Üstün B, Cieza A. A guide on how to develop an International Classification of Functioning, Disability and Health Core Set. Eur J Phys Rehabil Med. 2015 Feb;51(1):105-17.
  14. Karlsson E, Gustafsson J. Validation of the international classification of functioning, disability and health (ICF) core sets from 2001 to 2019–a scoping review. Disability and rehabilitation. 2022 Jul 3;44(14):3736-48.