Signs and symptoms

Signs of cerebral palsy may include:

• Delays in development of motor skills
  
  
• Weakness in one or more limbs
  
  
• Standing and walking on tiptoe
  
  
• Abnormal walking gait, with one foot or leg dragging
  
  
• Excessive drooling or difficulties swallowing
  
  
• Poor control over hand and arm movement

Causes

Cerebral palsy results from an abnormality in or injury to areas of the brain that control motor function. Although cerebral palsy affects movement, the underlying problem originates in the brain, not in the muscles themselves.

In some children with cerebral palsy, doctors can pinpoint a specific reason for the neurologic problem. For example, cerebral palsy can develop following meningitis — an infection and inflammation of the membranes and fluid surrounding the brain and spinal cord. However, for many children with cerebral palsy, doctors can't find a specific cause.

For many years doctors and researchers believed that cerebral palsy was closely linked with events occurring during labor and birth. Now they believe this is less frequently the reason. The many possible causes of cerebral palsy now identified include:

• Abnormal brain development
  
  
• Insufficient circulation to areas of the brain either before or after birth
  
  
• Infection in or beside the brain
  
  
• Bleeding in the brain
  
  
• Biochemical or genetic factors
  
  
• Other unknown causes

Researchers believe that some cases of cerebral palsy might occur as an indirect result of an infection before birth. It appears that the brain of a fetus might be affected by the mother's immune response as it fights an infection, not directly by the infection itself.

Meningitis Pregnancy Center

Risk factors

Cerebral palsy is more prevalent among low-birth-weight babies, with the highest risk in the tiniest newborns.

These factors also increase the risk of cerebral palsy:

• Vaginal bleeding during pregnancy
  
  
• Breech presentation — when a fetus doesn't turn to the usual head-first position for birth
  
  
• Maternal infection
  
  
• Meconium staining of amniotic fluid — caused by stool passed by the fetus in utero

When to seek medical advice

If your baby seems to display weakness or paralysis in a limb or isn't developing motor skills at the expected times, see your doctor to determine if cerebral palsy is present.

Screening and diagnosis

Your doctor may make a diagnosis based on your child's physical and behavioral signs and on the degree of severity. Additional tests may rule out other disorders. Your doctor may also order these diagnostic procedures:

• Computerized tomography (CT) scan. This procedure creates a more detailed image than a conventional X-ray, allowing your doctor to see many soft-tissue structures. A CT scan may show the presence and extent of any damage to your child's brain.
  
  
• Magnetic resonance imaging (MRI) scan. The cylinder-shaped MRI scanner uses no X-rays. Instead, a computer creates tissue-slice images from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane.

Computerized tomography MRI

Complications

Besides difficulty with movement and posture, cerebral palsy may result in these health problems for your child:

• Joint deformities or dislocation, if there is considerable spasticity
  
  
• Nutrition problems, if there are swallowing or feeding difficulties

Some children with cerebral palsy will have multiple handicaps and may require long-term care. Some of the associated problems may include:

• Difficulty with vision, hearing and speech
  
  
• Mental retardation
  
  
• Dental problems
  
  
• Seizures

Treatment

The brain abnormality or damage that underlies cerebral palsy isn't progressive, but children with cerebral palsy usually require long-term care. The type and amount of treatment depends on how many problems your child has and how severe they are.

The goal of treatment is to develop your child's maximum level of independence. Treatments may include:

• Physical therapy. Muscle training and exercises may help your child's strength, balance and mobility and lead to greater independence.
  
  
• Occupational therapy. This therapy usually focuses on developing your child's hand function, hand skills and self-care skills. It may also involve working with feeding problems.
  
  
• Speech therapy. A speech therapist may be able not only to help your child speak better, but also to improve eating skills.
  
  
• Hearing aid. This could correct your child's hearing problems.
  
  
• Eyeglasses or eye surgery. Depending on how severely your child's eyes are affected, he or she may need surgery to correct a condition such as cross-eye or other inability of the eyes to focus together properly (strabismus).
  
  
• Joint surgery. Your child may need surgery on muscles, tendons, nerves or joints to place his or her arms and legs in their correct positions. This can help your child better use a walker, braces or crutches.
  
  
• Medications. These may include muscle relaxants to ease muscle stiffness and anticonvulsants to reduce seizures.

Children with cerebral palsy should benefit from educational and therapy services, which are available from birth in most states.

Prevention

For more than a century, doctors have hoped that by somehow improving labor and birth practices, they could reduce the incidence of cerebral palsy. But these rates have remained fairly constant, despite increased prenatal care, electronic fetal monitoring, prenatal ultrasound and increased use of Caesarean section delivery over the past 25 years.

Fewer babies now develop cerebral palsy as a consequence of birth injury. However, larger numbers of extremely premature babies survive, and some will develop cerebral palsy.

For now, the most helpful prevention is likely to be avoiding premature birth. But there are other steps you can take:

• Make sure you're immunized. Immunization against such diseases as rubella may prevent an infection that could cause fetal brain damage.
  
  
• Keep yourself healthy. The more healthy you are heading into a pregnancy, the less likely you'll be to develop an infection that may result in cerebral palsy.
  
  
• Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks both to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight, and infections.

Premature birth Rubella Office visits throughout your pregnancy

Coping skills

A circle of support both for you as a parent and for your child with cerebral palsy can make a big difference in helping you cope with the condition and its effects.

As a parent, you may feel grief and guilt over your child's disability. Your doctor can help you locate support groups, organizations and counseling services in your community.

Your child may benefit from family support programs, school programs and counseling. Also, to reach his or her full potential, your child will benefit from interacting with other children.

Support groups: Finding one that's right for you

— December 5, 2002 —