Cerebral palsy refers to a group of conditions that affect movement, balance and posture. Affected children have abnormalities in one or more parts of the brain that affect the ability to control muscles. Symptoms range from mild to severe but do not get worse as the child gets older. With treatment, most children can significantly improve their abilities.
Many children with cerebral palsy have other conditions that require treatment. These include intellectual disabilities, learning disabilities, seizures, abnormal physical sensations (difficulties with sense of touch), and problems with vision, hearing and speech.
Cerebral palsy usually is diagnosed by 3 years of age. About 2 to 3 children in 1,000 are affected (1). About 800,000 children and adults of all ages in the United States have cerebral palsy (2).
There are three major types of cerebral palsy. Some individuals may have symptoms of more than one type.
Cerebral palsy usually is caused by factors that disrupt normal development of the brain before birth. In some cases, genetic defects may contribute to brain malformations and “miswiring” of nerve cell connections in the brain, resulting in cerebral palsy (2). Other cases are caused by injuries to the developing brain, such as a fetal stroke. Contrary to common belief, few cases of cerebral palsy are caused by a lack of oxygen reaching the fetus during labor and delivery (2).
A small number of babies develop brain injuries in the first months or years of life that can result in cerebral palsy (2). These injuries may be caused by brain infection (such as meningitis) and head injuries. In many cases, the cause of cerebral palsy in a child is not known.
Certain risk factors make it more likely that a baby will develop cerebral palsy. However, most babies with one of these risk factors do not develop cerebral palsy. Risk factors for cerebral palsy include:
Some children with cerebral palsy may have delays in learning to roll over, sit, crawl or walk. The Centers for Disease Control and Prevention (CDC) recommends that parents contact their child's provider if they see any of the following signs (5):
A child more than 2 months old who:
A child more than 6 months old who:
A child more than 10 months old who:
A child more than 12 months old who:
Cerebral palsy is diagnosed mainly by evaluating how a baby or young child moves. The provider evaluates the child's muscle tone; children with cerebral palsy may appear floppy or stiff. Some may have variable muscle tone (too loose at times and too tight at other times).
The provider checks the child's reflexes and look to see if the baby has developed a preference for using his right or left hand. While most babies do not develop a hand preference (become right- or left-handed) until at least 12 months of age, some babies with cerebral palsy do so before 6 months of age.
Another important sign of cerebral palsy is the persistence of certain reflexes, called primitive reflexes. These reflexes are normal in younger infants but generally disappear by 6 to 12 months of age. The provider also takes a careful medical history and attempts to rule out any other disorders that could be causing the symptoms.
The provider may suggest brain imaging tests, such as magnetic resonance imaging (MRI), computed tomography (CT scan) or ultrasound. These tests sometimes can help identify the cause of cerebral palsy. Ultrasound often is recommended in premature babies who are considered at risk for cerebral palsy to help diagnose brain abnormalities that are frequently associated with cerebral palsy. In some children with cerebral palsy, especially those who are mildly affected, brain imaging tests show no abnormalities, suggesting that microscopically small areas of brain damage can cause symptoms.
About half of babies who are suspected to be at higher risk for cerebral palsy at 12 months of age appear to outgrow their symptoms by age 2 (6).
A team of health care professionals works with the child and family to identify the child's needs and create an individualized treatment plan to help the child reach his or her maximum potential. The team is generally coordinated by one health care professional and may include pediatricians, physical medicine and rehabilitation physicians, orthopedic surgeons, physical and occupational therapists, ophthalmologists (eye doctors), speech/language pathologists, social workers and psychologists.
The child usually begins physical therapy soon after diagnosis. Therapy improves motor skills (such as sitting and walking) and muscle strength and helps prevent contractures (shortening of muscles that limits joint movement). Sometimes braces, splints or casts are used along with physical therapy to help prevent contractures and to improve function of the hands or legs. If contractures are severe, surgery may be recommended to lengthen affected muscles.
Drugs sometimes are recommended to ease spasticity or to reduce abnormal movement. Unfortunately, oral drug treatment often is not very helpful. Sometimes injection of drugs, such as Botox (botulinum toxin), directly into spastic muscles is helpful. The effects may last several months.
A new type of drug treatment is showing promise in children with moderate to severe spasticity. During a surgical procedure, a pump is implanted under the skin that continuously delivers the anti-spasmodic drug baclofen.
For some children with spastic cerebral palsy, a surgical technique called selective dorsal rhizotomy may permanently reduce spasticity and improve the ability to sit, stand and walk. In this procedure, doctors identify and cut some of the nerve fibers at the base of the spine that are contributing most to spasticity. This procedure usually is recommended only for children with severe spasticity who have not responded well to other treatments (2).
Occupational therapists work with the child on skills required for daily living, including feeding and dressing. Children with speech problems work with a speech therapist or, in more severe cases, learn to use a computerized voice synthesizer that can speak for them. Computers have become an important tool for children and adults with cerebral palsy in terms of therapy, education, recreation and employment.
Some children with cerebral palsy may benefit from the many mechanical aids available today, including walkers, positioning devices (to allow a child with abnormal posture to stand correctly), customized wheelchairs, and specially adapted scooters and tricycles.
In many cases, the cause of cerebral palsy is not known, so there is nothing that can be done to prevent it. However, some causes of cerebral palsy can be prevented by eliminating or managing certain risk factors.
Rh disease and congenital rubella syndrome used to be common causes of cerebral palsy. Now Rh disease usually can be prevented when an Rh-negative pregnant woman receives appropriate care. Women can be tested for immunity to rubella before pregnancy and vaccinated if they are not immune. A woman can help reduce her risk of preterm delivery when she seeks early (ideally starting with a preconception visit) and regular prenatal care and avoids cigarettes, alcohol and illicit drugs.
Babies with severe jaundice can be treated with special lights (phototherapy) and blood transfusions (exchange transfusions), when indicated. Head injuries in babies and young children often can be prevented when babies ride in car seats properly positioned in the back seat of the car and when children wear helmets when riding bicycles. Routine vaccination of babies (with the Hib vaccine) prevents many cases of meningitis, another cause of brain damage in the early months.
The March of Dimes supports a number of grants on prenatal brain development and factors that may disrupt it.
One grantee is studying how developing nerve cells in the fetal brain respond to prolonged oxygen deprivation. This can improve understanding of how lack of oxygen before or around the time of birth can injure the developing brain and how such brain injuries can be prevented or treated.
Another grantee is investigating how intrauterine infections may contribute to brain injuries that result in cerebral palsy, with the goal of developing drug treatments to help prevent these injuries.
A grantee also is studying specific learning disabilities in young children with cerebral palsy in order to develop improved interventions.
Many other March of Dimes grantees are seeking improved ways of preventing preterm delivery, an important risk factor for cerebral palsy.
Cerebral Palsy, Centers for Disease Control and Prevention (CDC)
Last reviewed December 2007
Dad's exposure to harmful chemicals and substances before conception or during his partner's pregnancy can affect his children. Harmful exposures can include drugs (prescription, over-the-counter and illegal drugs), alcohol, cigarettes, cigarette smoke, chemotherapy and radiation. They also include exposure to lead, mercury and pesticides.
Unlike mom's exposures, dad's exposures do not appear to cause birth defects. They can, however, damage a man's sperm quality, causing fertility problems and miscarriage. Some exposures may cause genetic changes in sperm that may increase the risk of childhood cancer. Cancer treatments, like chemotherapy and radiation, can seriously alter sperm, at least for a few months post treatment. Some men choose to bank their sperm to preserve its integrity before they receive treatment. If you have a question about a specific exposure, contact the Organization of Teratology Information Specialists at www.otispregnancy.org.
The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.
If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.
If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.
A cleft lip or cleft palate that extends into the upper gums (where top teeth develop) can cause your baby to have certain dental problems, including:
Every baby with a cleft lip or palate should get regular dental checkups by a dentist with experience taking care of children with oral clefts. Dental problems caused by cleft lip or palate usually can be fixed. If needed, your baby can get ongoing care by a team of experts, including:
See also: Cleft lip and cleft palate
Cleft lip does not cause ear problems.
Babies with cleft palate, however, are more likely than other babies to have ear infections and, in some cases, hearing loss. This is because cleft palate can cause fluid to build up in your baby’s middle ear. The fluid can become infected and cause fever and earache. If fluid keeps building up with or without infection, it can cause mild to moderate hearing loss.
Without treatment , hearing loss can affect your baby’s language development and may become permanent.
With the right care, this kind of hearing loss is usually temporary. Your baby’s provider may recommend:
See also: Cleft lip and cleft palate
Babies with only a cleft lip usually don’t have trouble breastfeeding. Most of the time, they can breastfeed just fine. But they may need some extra time to get started.
Babies with cleft lip and palate or with isolated cleft palate can have:
Most babies with cleft palate can’t feed from the breast. If your baby has cleft palate, he can still get the health benefits of breastfeeding if you feed him breast milk from a bottle. Your provider can show you how to express (pump) milk from your breasts and store breast milk.
Your baby’s provider can help you start good breastfeeding habits right after your baby is born. She may recommend:
Children with cleft lip generally have normal speech. Children with cleft lip and palate or isolated cleft palate may:
Most children can develop normal speech after having cleft palate repair. However, some children may need speech therapy to help develop normal speech.
See also: Cleft lip and cleft palate
The choroid plexus is the area of the brain that produces the fluid that surrounds the brain and spinal cord. This is not an area of the brain that involves learning or thinking. Occasionally, one or more cysts can form in the choroid plexus. These cysts are made of blood vessels and tissue. They do not cause intellectual disabilities or learning problems. Using ultrasound, a health care provider can see these cysts in about 1 in 120 pregnancies at 15 to 20 weeks gestation. Most disappear during pregnancy or within several months after birth and are no risk to the baby. They aren't a problem by themselves. But if screening tests show other signs of risk, they may indicate a possible genetic defect. In this case, testing with higher-level ultrasound and/or amniocentesis may be recommended to confirm or rule out serious problems.
If you didn’t take folic acid before getting pregnant, it doesn't necessarily mean that your baby will be born with birth defects. If women of childbearing age take 400 micrograms of folic acid every day before and during early pregnancy, it may help reduce their baby’s risk for birth defects of the brain and spin called neural tube defects (NTDs). But it only works if you take it before getting pregnant and during the first few weeks of pregnancy, often before you may even know you’re pregnant.
Because nearly half of all pregnancies in the United States are unplanned, it's important that all women of childbearing age (even if they're not trying to get pregnant) get at least 400 micrograms of folic acid every day. Take a multivitamin with folic acid before pregnancy. During pregnancy, switch to a prenatal vitamin, which should have 600 micrograms of folic acid.
Last reviewed November 2012