Cerebral palsy is a group of problems that affect body movement and posture. It is related to a brain injury or to problems with brain development. It is one of the most common causes of lasting disability in children.
Cerebral palsy causes reflex movements that a person can't control and muscle tightness that may affect parts or all of the body. These problems can range from mild to severe. Intellectual disability, seizures, and vision and hearing problems can occur.
Cerebral palsy is caused by a brain injury or problem that occurs during pregnancy or birth or within the first 2 to 3 years of a child's life. It can be caused by:
In many cases, the exact cause of cerebral palsy is not known.
Everyone with cerebral palsy has problems with body movement and posture. But the physical problems are worse for some people than for others.
Some people who have cerebral palsy have a slight limp or a hard time walking. Other people have little or no control over their arms and legs or other parts of the body, such as the mouth and tongue, which can cause problems with eating and speaking. People who have severe forms of cerebral palsy are more likely to have other problems, such as seizures or intellectual disability.
Babies with severe cerebral palsy often have problems with their posture. Their bodies may be either very floppy or very stiff. Birth defects sometimes occur along with cerebral palsy. Examples of birth defects include a spine that doesn't have the normal shape, a small jawbone, or a small head.
The brain injury or problem that causes cerebral palsy doesn't get worse over time. But new symptoms may appear, or symptoms may change or get worse as your child gets older. This is why some babies born with cerebral palsy don't show clear signs of it right away.
Your child's doctor will do a physical examination and ask you about your child's medical history. He or she will ask about your child's growth and about any problems you may have noticed. The doctor may also ask about your child's development.
Tests, such as a CT scan or an MRI of your child's head, may also be done. Or the doctor may look at ultrasound pictures of the brain. These tests can sometimes help the doctor find the cause of cerebral palsy.
If your child has a severe form of cerebral palsy, a doctor may be able to pinpoint the problem within the first few weeks of your child's life. But parents are often the first to notice that their baby does not have the abilities and skills that are common in other children in the same age group. These developmental delays can be early signs of cerebral palsy.
Even when the condition is present at birth, the signs of cerebral palsy may not be noticed until a child is 1 to 3 years old.
Even though cerebral palsy can't be cured, you and your child can do things to help deal with symptoms, prevent problems, and make the most of your child's abilities. Physiotherapy is one of the most important treatments. Medicines, surgery, and special equipment such as a walker can also help.
Meeting the daily needs of a family member with cerebral palsy isn't easy. If your child has cerebral palsy, seek family and community support. It may help to join a support group or talk with other parents who have a child with special needs, so you don't feel alone.
You may also find counselling useful. It may help you understand and deal with the wide range of emotions you may feel. Your child will need help too. Providing emotional support for your child can help him or her cope with having cerebral palsy.
Learning that your child has cerebral palsy isn't easy, and raising a child who has it can be hard. But the more you know, the better you can care for and provide for your child.
Learning about cerebral palsy:
Living with cerebral palsy:
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Cerebral palsy (CP) is a result of an injury to the brain or abnormal development of the brain. In many cases, the exact cause isn't known. The damage or abnormality may occur during pregnancy or birth or within the first 2 to 3 years of life.
When cerebral palsy (CP) is severe, signs are often noticed at birth or shortly after birth. But some early signs of severe CP vary depending on the specific type of CP.
Common signs of severe CP that may be noticed shortly after birth include:
Even when the condition is present at birth, the signs of cerebral palsy may not be noticed until a child is 1 to 3 years old. Doctors and parents may not see that a baby's movements are unusual until the movements become more obvious as the baby grows.
Some problems related to CP become more clear over time. Or they may develop as a child grows. These may include:
All people who have cerebral palsy (CP) have some problems with body movement and posture. But many babies don't show signs of CP at birth. Parents and caregivers may notice the first signs of CP. For example, the baby may not roll over, sit, crawl, or walk at the expected ages.
Signs of CP may become more obvious as the child grows. Some developmental problems may not appear until after a baby's first year. The brain injury that causes CP doesn't get worse over time. But its effects can appear, change, or become more severe as the child gets older.
How much a child is able to move around and do things depends on the type of CP the child has and how much of his or her body is affected. The way CP affects a child also depends on the child's level of intellectual disability, if any, and whether he or she has other complications or other medical conditions.
Most people who have CP have a type of spastic cerebral palsy. This can affect the whole body but may only affect parts of the body in some children. For example, a child with spastic cerebral palsy may have symptoms mostly in one leg or on one side of the body. Most children usually learn ways to adapt to their movement problems, like using special devices and equipment to move around.
Total body cerebral palsy causes the most severe problems. Many of those affected are not able to take care of themselves, either because of severe physical disabilities or intellectual disability. But some people can live on their own with the help of family members, health care aides, or both.
Some children with CP may have complications, such as seizures. Other medical conditions, such as vision or hearing problems, are often associated with CP. Sometimes these conditions are known right away. In other cases, they aren't found until a child gets older.
Adults with CP are at risk for heart and lung disease. For example, severe CP causes problems with eating. If food is inhaled into the lungs, the risk of lung infection (pneumonia) increases.
Just like people who have normal physical development, people who have CP have social and emotional concerns throughout their lives. Because their physical limitations may add to these concerns, people who have CP need the awareness and consideration of others.
Most adults with the mild or moderate form-and some with the severe form-live independently and have jobs. Others live and work with some level of assistance. Opportunities for independent living and employment for adults with CP have improved, thanks to better home support services and advances in technology, such as computers to assist with speech, powered wheelchairs, and other devices.
Babies born to teen mothers or to mothers age 35 and older have a higher risk for cerebral palsy (CP).
Also, a baby's risk for developing a brain abnormality or injury that leads to CP increases when the mother has certain problems during her pregnancy. These problems may include:
About half of all children who have cerebral palsy (CP) are born prematurely.footnote 1 The risk of a baby having CP increases as the birth weight decreases.
A baby who is born prematurely usually has a low birth weight, less than 2.5 kg (5.5 lb). But full-term babies can also have low birth weights. Multiple-birth babies are more likely than single-birth babies to be born early or with a low birth weight.
Most children with CP had a disruption in the normal development of parts of their brain during fetal growth. Low-birth-weight, premature babies are more likely than full-term, normal-weight babies to have had developmental problems during fetal growth that can injure the brain. For example, a condition called periventricular leukomalacia, or PVL, which reflects injury to the white matter of the brain, is more likely in babies born prematurely than in those born at full term.
In rare cases, some babies develop CP as a result of complications during the mother's pregnancy or at birth. Risk factors include:
Risk factors for developing CP just after birth or within the first 2 or 3 years of life are related to brain damage. They include:
or other emergency services if your child with cerebral palsy (CP):
Call a doctor right away if:
If you have a child diagnosed with CP, call your doctor if your child has:
If you have cerebral palsy and you are pregnant, talk with a doctor about how CP can affect your pregnancy and delivery.
A team of health care providers will be involved in your child's care. Your family doctor or general practitioner can diagnose and treat cerebral palsy. You may also be referred to specialists, such as:
Other specialists who may be involved in the care of people who have CP include:
Other health professionals who may be involved in the care of people who have CP include:
Some health care clinics specialize in treating children with CP. Call your local health unit for the nearest clinic in your area.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
are often reported by parents or observed by a doctor during routine well-baby checks.
A doctor diagnoses CP based on:
If the diagnosis is unclear, more tests may be done. Sometimes these tests can help find out the severity of CP.
A doctor may closely monitor a newborn or child for signs of CP if he or she has known risk factors. These factors may be related to problems during pregnancy or birth, being born early (premature birth), or problems that occur within the first 2 or 3 years of life.
Doctors are careful not to diagnose CP too early, because some babies who have motor skill problems soon after birth never get CP.
Sometimes symptoms may not appear until the nervous system matures. It can take up to a few years before doctors can tell if a baby with body movement and posture (motor) problems has CP.
After CP is diagnosed, a child will also be checked for other medical conditions that can occur with cerebral palsy, such as:
Most of the time, a doctor can predict many of the long-term physical effects of CP when a child is 1 to 3 years old. But sometimes such predictions aren't possible until a child reaches school age. That's when learning, communication skills, and other abilities can be checked.
Some children need repeated testing that may include:
Other tests may be needed, depending on a child's symptoms, other conditions, or medicines he or she takes.
Even though CP can't be cured, a variety of treatments can help people who have CP to make the most of their abilities and physical strength, prevent complications, and improve their quality of life.
Specific treatment varies by individual and changes as needed if new issues develop. In general, treatment focuses on ways to maintain or improve a person's quality of life and overall health.
Regular visits with your child's doctor and specialists are important for monitoring your child's condition.
Treatment for CP includes:
Physiotherapy and special equipment may be used together, such as for constraint-induced movement therapy, also called shaping. This encourages a child to increase movements by presenting interesting activities or objects and giving praise and rewards when a child attempts to use the less-functioning muscles.
Ongoing treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatments and adding new treatments as needed.
Working with others involved with your child's care, understanding your child's needs and rights, and taking care of yourself and other family members are all important parts of treatment. For more information, see Home Treatment.
Physiotherapy is an important treatment that begins soon after a child is diagnosed. It often continues throughout the child's life. It may begin before a definite diagnosis is made, depending on the child's symptoms.
Physiotherapy may help prevent the need for surgery. But its focus may change after surgery or for problems that are new or getting worse. After surgery, specialized physiotherapy may be needed for 6 months or longer.
Many people who have CP benefit from using something to maintain or improve joint mobility, help strengthen muscles and relax overactive (spastic) muscles, and assist with daily activities. These devices and equipment may include special crutches, orthotics, casts, standers, special seats, walkers, wheelchairs, special shoes, and other methods to help with specific problems.
The specific types of devices used depend on a child's needs. For example, a child may get a cast after surgery or to restrict movement in one area to strengthen muscles and tendons in another part of the body. If both legs are affected by CP, a child can learn to move around with the help of a scooter board (a device used to self-propel while lying down), a modified stroller, a wheelchair, or other special equipment.
Other therapies may also be needed, depending on specific needs.
You may hear about a wide range of controversial treatments, some of which may cause harm. Several controversial treatments exist for CP, such as electrical stimulation and special diets. Be sure to talk to your doctor about any type of treatment you are considering for your child.
Many adults with CP get jobs if they have good support from their family and community. You can enroll your teen in occupational therapy as part of a gradual preparation for independent living. Your child may need extra help and encouragement to prepare for added expectations and responsibilities.
The cause of cerebral palsy (CP) sometimes isn't known. But links have been identified between CP and certain conditions during pregnancy, birth, and early childhood. Some of these can be prevented. Some cannot.
Doing all you can before and during pregnancy can help lower the risk that a brain injury will occur in a developing baby. Here are some tips for healthy habits before and during pregnancy.
Help prevent CP in your young child by minimizing your child's risk for getting a brain injury.
If your child has not been diagnosed with CP, pay attention to whether your child is reaching early developmental milestones. Report anything you notice to your doctor at regularly scheduled well-child visits or anytime you have concerns.
Family members working together with doctors can use home treatment to provide the best possible care for a child with cerebral palsy (CP).
You and your family and friends can help your child reach his or her highest potential. Focus on your child's strengths. And build self-esteem by helping your child learn to do things by himself or herself.
Each person with CP has unique strengths and areas of difficulty. But most people who have CP need ongoing help with:
As your child approaches the teen years and young adulthood, be aware of his or her changing needs.
Learn to change your routines as your child with CP grows and develops. For example, you may not be able to continue caring for a severely affected child who is growing tall and heavy. Try to plan ahead for the time when your grown child with CP is not under your care.
Preparing your child for adulthood takes careful planning. It also requires patience and resourcefulness on your part.
Older adults with CP may need extra help preparing for retirement.
Medicines can help control some of the symptoms of cerebral palsy (CP), prevent or minimize complications, and treat other medical conditions related to CP.
Muscle relaxants (antispasmodics) are the most common medicines used for people who have CP. They can help relax tight muscles and reduce muscle spasms. Most antispasmodics are taken by mouth. Some are injected directly into stiff or spastic muscles. Examples include:
Anticonvulsants help prevent or control seizures. These include:
Anticholinergics help some people who have CP who have uncontrollable body movements (dystonic cerebral palsy) or who drool often. These include:
Stool softeners and mild laxatives may help treat constipation, which is a common complaint of people who have CP.
Some doctors believe that oral antispasmodic medicines should not be given to growing children. They are concerned that side effects from these medicines can cause problems for children that are worse than the tight muscles and muscle spasms related to CP. For example, drowsiness is a side effect that may interfere with a child's ability to concentrate and learn in school. Other doctors believe that the benefits of these medicines outweigh the risk of side effects.
Ask your doctor the following questions about any medicine prescribed for your child:
See the new medicine information form(What is a PDF document?) for more questions to ask.
Surgery for people who have cerebral palsy (CP) may help reduce muscle stiffness or spasms and allow more flexibility and control of the affected limbs and joints.
The main surgery choices are:
A thorough checkup is needed to help the doctor find out which muscles and nerves are affected and what type of surgery would best treat the condition. A gait analysis may be part of the examination.
Doctors don't agree about the best age for children to have surgery for cerebral palsy. Some may suggest surgery at a young age, while others may suggest other treatments before surgery. Use this surgery information form(What is a PDF document?) to help you decide what's right for your child.
Surgery isn't used nearly as often for the arms as for the legs. Surgery on arm deformities carries more risks related to sensory damage.
Sometimes medicine or physiotherapy is used to postpone or prevent the need for surgery.
The type of therapy and special equipment needed after surgery (such as braces, casts, and splints) depends on the child's specific needs. Most children need physiotherapy after surgery. In general, post-surgical physiotherapy usually starts as soon as possible and may continue for as long as 6 months.
Palmer FB, Hoon AH (2011). Cerebral palsy. In M Augustyn et al., eds., The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed., pp. 164–171. Philadelphia: Lippincott Williams and Wilkins.
Hoon AH Jr, Tolley F (2013). Cerebral palsy. In ML Batshaw et al., eds., Children With Disabilities, 7th ed., pp. 423–450. Baltimore: Paul H Brookes Publishing.
Other Works Consulted
Ade-Hall RA, Moore AP (2000). Botulinum toxin type A in the treatment of lower limb spasticity in cerebral palsy. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
Anttila H, et al. (2008). Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics, 8(14): 1–10.
Ashwal S, et al. (2004). Practice parameter: Diagnostic assessment of the child with cerebral palsy. Neurology, 62(6): 851–863.
Committee on Children with Disabilities, American Academy of Pediatrics (1999, reaffirmed 2010). The treatment of neurologically impaired children using patterning. Pediatrics, 104(5): 1149–1151.
Delgado MR, et al. (2010). Practice parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 74(4): 336–343.
Desch LW (2013). Assistive technology. In ML Batshaw et al., eds., Children With Disabilities, 7th ed., pp. 641–656. Baltimore: Paul H Brookes Publishing.
Diamond M, Armento M (2010). Children with disabilities. In WR Frontera, ed., DeLisa's Physical Medicine and Rehabilitation, vol. 2, pp. 1475–1502. Philadelphia: Lippincott Williams and Wilkins.
Glader L, Tilton A (2009). Cerebral palsy. In WB Carey et al., eds., Developmental-Behavioral Pediatrics, 4th ed., pp. 653–662. Philadelphia: Saunders Elsevier.
Hoare BJ, et al. (2010). Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (Update). Cochrane Database of Systematic Reviews (1).
Kedia S, et al. (2014). Neurologic and muscular disorders. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 776–861. New York: McGraw-Hill.
Magee L, et al. (2011). Magnesium sulphate for fetal neuroprotection. SOGC Clinical Practice Guideline No. 258. Journal of Obstetrics and Gynaecology Canada, 33(5): 516–529. Also available online: http://sogc.org/guidelines/documents/gui258CPG1106E.pdf.
Marchand V, et al. (2009). Nutrition in neurologically impaired children. Paediatrics and Child Health, 14(6): 395–401. Available online: http://www.cps.ca/en/documents/position/nutrition-in-neurologically-impaired-children.
Murphy NA, et al. (2008, reaffirmed 2012). American Academy of Pediatrics clinical report: Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics, 121(5): 1057–1061.
Rapin I (2010). Disorders of motor and mental development. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 568–574. Philadelphia: Lippincott Williams and Wilkins.
Renshaw TS, Deluca PA (2006). Cerebral palsy. In RT Morrissy, SL Weinstein, eds., Lovell and Winter's Pediatric Orthopaedics, 6th ed., vol. 1, pp. 551–603. Philadelphia: Lippincott Williams and Wilkins.
Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (and evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691–1698.
ByHealthwise StaffPrimary Medical ReviewerSusan C. Kim, MD - PediatricsBrian D. O'Brien, MD - Internal MedicineJohn Pope, MD - PediatricsAdam Husney, MD - Family MedicineSpecialist Medical ReviewerLouis Pellegrino, MD - Developmental Pediatrics
Current as ofJuly 26, 2016
Current as of: July 26, 2016
Susan C. Kim, MD - Pediatrics
& Brian D. O'Brien, MD - Internal Medicine & John Pope, MD - Pediatrics & Adam Husney, MD - Family Medicine & Louis Pellegrino, MD - Developmental Pediatrics
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