Cerebral Palsy

Pediatric Basics

Children with cerebral palsy may need a walker or wheelchair to help them get around.
Children with cerebral palsy may need a walker or wheelchair to help them get around. Photo by Andres Balcazar

Children with cerebral palsy have problems with muscle tone, affecting their ability to keep their balance, posture, and to walk and move.

Unlike other medical conditions that can affect a child's ability to move or walk, with cerebral palsy, the problem isn't in the child's muscles or nerves. Instead, damage to the child's brain itself affects his ability to control his muscles.

What Causes Cerebral Palsy?

The brain injury that causes cerebral palsy sometimes occurs early in pregnancy, while a baby's brain is still developing.

On the other hand, it can also occur much later in pregnancy, during delivery, or less commonly, early in a baby's life.

Some common causes of cerebral palsy include:

  • genetic conditions
  • metabolic disorders
  • bacterial meningitis
  • prenatal infections (toxoplasmosis, human parvovirus (Fifth Disease), rubella, cytomegalovirus, herpes, syphilis, etc.)
  • bleeding in the brain
  • lack of oxygen due to problems with the placenta
  • kernicterus (severe jaundice)
  • head injury
  • stroke
  • child abuse and shaken baby syndrome

Prematurity, while it does not cause cerebral palsy, is often associated with the condition, as premature babies are typically at risk for many of the problems that do.

Keep in mind that most experts now believe that very few cases of cerebral palsy are actually caused by a lack of oxygen during labor and delivery.

Symptoms of Cerebral Palsy

Although most children are born with cerebral palsy, the symptoms may not be noticeable for many months.

In fact, mild cerebral palsy symptoms may not be detected until your child is several years old.

Cerebral palsy symptoms that you may notice, and that you should look for if you are concerned that your baby may have cerebral palsy, include:

  • stiff or tight muscles (hypertonia)
  • exaggerated reflexes
  • uncontrolled body movements
  • low muscle tone (hypotonia)
  • toe walking (can be normal before age 3 years, especially if a child doesn't walk on their toes all of the time)
  • limping or dragging a foot while walking
  • walking with a scissored gait, turning in their legs as they walk
  • excessive drooling
  • difficulty swallowing, sucking, or speaking
  • tremors
  • trouble with fine motor skills, such as fastening buttons or holding a pencil

Cerebral palsy symptoms don't worsen with age, but symptoms can range from mild to severe. For example, a child with very mild cerebral palsy may just have problems running, while another with more severe symptoms may need a wheelchair.

Children with cerebral palsy can also have feeding problems, mental retardation, seizures, learning disabilities, and problems with their vision and hearing.

Diagnosing Cerebral Palsy

The diagnosis of cerebral palsy is usually made when a parent or pediatrician notices that a child isn't meeting his physical and/or behavioral developmental milestones. Your pediatrician may also notice, during physical exam, that a child with cerebral palsy has problems with his muscle tone or reflexes.

Early signs of cerebral palsy might be a baby who:

  • still has poor head control after he is two months old
  • always reaches with just one hand after he is six months old, keeping the other in a fist (keep in mind that many infants don't show a hand preference in their first year)
  • can't crawl or stand with support by his first birthday

In addition to a physical exam, tests that are sometimes helpful when evaluating a child for cerebral palsy include a computerized tomography (CT) scan and/or magnetic resonance imaging (MRI) scan of the child's brain. Other tests may also be done if a genetic, metabolic, or infectious cause of cerebral palsy is suspected.

Treatments for Cerebral Palsy

Although there is no cure for cerebral palsy, treatments usually include:

  • physical therapy
  • occupational therapy
  • speech therapy
  • medications, which can sometimes help more severe symptoms, such as muscle spasticity (baclofen, Botox), seizures, and even drooling (Robinul).
  • surgery on stiff tendons or joints

In addition to therapy, children with moderate or severe cerebral palsy might need assistive devices to get around, such as orthotics, a walker, or a wheelchair. Other types of assistive technology can also help kids with severe cerebral palsy communicate (high-tech communication devices) and perform daily tasks.

What To Know About Cerebral Palsy

Other things to know about cerebral palsy include that:

  • The latest statistics show that cerebral palsy affects about 3.1 per 1,000 children, or about 1 in 323 children in the United States.
  • The prevalence of cerebral palsy has been unchanged since 1985.
  • Children with cerebral palsy don't worsen over time and may in fact get better with treatment.
  • Children with cerebral palsy may have vision and hearing problems. They may need eyeglasses or even surgery, to correct strabismus, as well as hearing aids.

An evaluation by a pediatric neurologist and/or developmental pediatrician can also be helpful when a child is thought to have cerebral palsy.

Sources:

Behrman: Nelson Textbook of Pediatrics, 17th ed.

Christensen et al. Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning - Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev Med Child Neurol. 2014 Jan;56(1):59-65.

Marshalyn Yeargin-Allsopp, MD. Prevalence of Cerebral Palsy in 8-Year-Old Children in Three Areas of the United States in 2002: A Multisite Collaboration. PEDIATRICS Vol. 121 No. 3 March 2008, pp. 547-554

Van Naarden Braun et al. Birth prevalence of cerebral palsy: A population-based study. Pediatrics. Volume 137, number 1, January 2016.

Continue Reading