Cerebral palsy

Cerebral palsy (also called CP) is a group of conditions that affects the parts of your brain that control your muscles. This can cause problems with movement, posture (standing up straight) and balance. 

Some but not all children with CP also may have other conditions, like intellectual and developmental disabilities. These are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others.

About 1 in 300 children (less than 1 percent) has CP. Most children are diagnosed by the time they’re 2 years old. 

CP is the most common cause of movement problems in childhood. There are four kinds of CP that are based on the type of movement problems a child has. 

What is spastic CP?

Spastic means tight or stiff muscles, or muscles that get tight (spasm). This is the most common kind of CP. About 4 in 5 children (80 percent) with CP have spastic CP. These children have stiff muscles and may have awkward body movements. 

Signs and symptoms of spastic CP include:

• Tight muscles that do not stretch
• Trouble walking, crossing knees, having a scissor-like walk or walking on toes
• Tight joints
• Weak muscles or no movement in a group of muscles 

There are three kinds of spastic CP: 

1. Spastic diplegia. Children with this kind have muscle stiffness mostly in the legs. They may have trouble walking because tight muscles in the hips and legs cause their legs to turn inward and cross at the knees (also called scissoring). These children may need a walker or leg braces to help them move from place to place. 
2. Spastic hemiplegia. This kind usually affects one side of the body. The arm and leg on the affected side may be shorter and thinner than the other side of the body. These children often walk later than others and may walk on tip-toe. Some have a curved spine (scoliosis), seizures or speech problems.
3. Spastic quadriplegia. This is the most serious kind of spastic cerebral palsy. It affects most of the body, including all arms and legs, the torso (the body’s midsection) and the face. These children usually can’t walk and they often have intellectual disabilities, trouble speaking and seizures. 

What are the other kinds of CP?

Other kinds of CP include:  

• Dyskinetic CP (includes athetoid CP, choreoathetoid CP and dystonic CP). Children with this kind of CP have muscle tone that ranges from being too tight to too loose. This can cause uncontrolled movements that can be slow and twisting or quick and jerky. Children with dyskinetic CP may have problems controlling the movements of their hands, arms, feet and legs. This makes it hard to sit and walk. Some of these children also have trouble speaking. Problems in their face and tongue muscles may make them frown or drool. 
• Ataxic CP. This type of CP is rare. These children have problems with balance and coordination. They may be unsteady when they walk. They also may have tremors (shaking muscles) when they make quick movements or movements that need a lot of control, like writing. 
• Mixed CP. This is when a child shows symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

How do you know if your baby has CP?

CP can be different in each child. Some children have mild CP. They may have some awkward body movements and need little or no special help. Other children have more serious CP. They may need a lot of special care their whole lives. CP doesn’t get worse over time, but its symptoms can change.

Some but not all babies with CP often have developmental delays. This means your child doesn't reach developmental milestones when expected. A developmental milestone is a skill or activity that most children can do at a certain age. Milestones include sitting, walking, talking, having social skills and having thinking skills. Tell your child’s health care provider if you notice any of these signs in your baby at these ages: 

Younger than 6 months

• Their head falls back when you pick them up from lying on their back.
• They feel stiff or floppy.
• They seem to push away when you hold them.
• Their legs get stiff legs and cross or “scissor” when you pick them up. 

Older than 6 months

• They don't roll over.
• They can’t bring their hands together.
• They have trouble bringing their hands to their mouth.
• They reach with only one hand while keeping the other hand in a fist. 

Older than 10 months

• They crawl by pushing off with one hand and one leg while dragging the other hand and leg.
• They scoot around on their bottom or hop on their knees, but do not crawl on all fours. 

Older than 1 year

• They can’t crawl.
• They can’t stand up with support.

If you think your baby has developmental delays or other signs of CP, talk to her provider. Diagnosing CP usually happens in three steps. 

1. Developmental monitoring. Your baby’s provider checks their growth and development over time. If your baby shows signs and symptoms of CP, their provider recommends developmental screening.
2. Developmental screening. These tests check for developmental delays, like problems with movement. The American Academy of Pediatrics recommends that all children have developmental screening tests during their well-baby visits at 9 months, 18 months and 24 or 30 months.
3. Developmental and medical evaluations. If results of your baby’s screening tests aren't normal, your baby’s provider recommends developmental and medical evaluations. These can be done by your baby’s provider or by a child neurologist. This is doctor with special training in treating brain conditions in babies and children.

Your baby’s provider also may recommend these tests for your baby:  

• Blood tests
• Magnetic resonance imaging (also called MRI). MRI is a medical test that makes a detailed picture of the inside of your body.
• Computed tomography (also called CT scan). This test uses special X-rays to make a picture of your baby’s brain. 
• Electroencephalogram (also called EEG). This test records electrical activity in your baby’s brain. It can help diagnose epilepsy, which sometimes happens in children with CP. Epilepsy is a seizure disorder that affects how the nerve cells in your brain work.
• Ultrasound. This test uses sound waves and a computer screen to show a picture of your baby inside the womb. 

What causes CP?

CP happens when your baby has brain damage or there are problems in how your baby’s brain develops. Most children with CP have congenital CP. This means they have CP at birth. In many of these children, we don’t know the exact cause of CP. 

Changes in genes that affect brain development may play a role in causing CP. Genes are a part of your body's cells that stores instructions for the way your body grows and works. Genes are passed from parents to children. A gene change (also called mutation) is a change to the instructions that are stored in a gene. 

The brain damage that leads to CP can happen before birth, during labor and birth or after birth, while the brain is still developing. Your baby may be more likely than other babies to develop CP before birth if: 

• You’re pregnant with multiples (twins, triplets or more). The more babies you’re pregnant with, the greater the risk of CP.
• You have certain infections during pregnancy. Infections that can lead to CP include chickenpox, rubella (also called German measles), cytomegalovirus (CMV), toxoplasmosis, chorioamnionitis (an infection in the amniotic fluid - the liquid that surround your baby - or uterus or womb), syphilis, Zika virus and infections in the placenta. The placenta grows in your uterus and supplies your baby with food and oxygen through the umbilical cord.
• You have a health condition, like seizures or a thyroid condition. The thyroid is a gland in your neck that makes hormones that help your body store and use energy from food. 
• Your blood and your baby’s blood are incompatible (can’t be together). This puts your baby at risk of Rh disease, which can cause serious problems — even death — for your baby. You can get a blood test during pregnancy to see if your blood and your baby’s blood are incompatible.
• You come in contact with a harmful substance, like mercury. During pregnancy, don’t eat fish with high levels of mercury, like swordfish, king mackerel, shark and tilefish. 
• Your baby doesn't get enough oxygen in the womb. This can happen if the placenta isn't working properly or it tears away from the wall of the uterus before birth. 
• Your baby has bleeding in the brain. Sometimes a baby has a stroke in the womb that causes bleeding in her brain. Stroke happens when a blood clot (a mass or clump of blood) blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open. Blood clots in the placenta, weak blood vessels and high blood pressure during pregnancy can cause a baby to have a stroke in the womb. 
• You don’t have access to prenatal care. Because people who don’t have many financial resources or health insurance may not be able to afford health care while pregnant, their babies may be at higher risk of developing CP.
• You drink alcohol or smoke cigarettes while pregnant. Both of these activities can raise your baby’s risk of having CP. If you’re pregnant, not drinking alcohol or smoking can make you and your baby safer.

Your baby may be more likely than other babies to develop CP during labor and birth if:

• They’re in the breech position at the start of labor. This is when your baby’s bottom or feet are facing down right before birth.
• They don't get enough oxygen during labor and birth. This can happen if there are problems with the umbilical cord or you have a health condition, like uterine rupture. Uterine rupture is when the uterus tears during labor. This happens very rarely.
• They’re born preterm. This is when a baby is born too early, before 37 weeks of pregnancy.
• They’re born with low birthweight or they’re born small for gestational age (also called SGA). Low birthweight means a baby weighs less than 5 pounds, 8 ounces at birth. SGA means a baby is smaller than normal based on the number of weeks he’s been in the womb.  

Babies who have certain health conditions after birth are more likely than others to develop CP. These conditions include: 

• Severe jaundice, especially if it’s not treated early. Jaundice is when your baby’s eyes and skin look yellow. A baby has jaundice when the liver isn’t fully developed or isn’t working well. Some blood diseases, like Rh disease, can cause severe jaundice and brain damage in babies. 
• Head injuries. A baby may get a head injury from being in a car accident or falling and hitting their head.  
• Brain infections, like encephalitis and meningitis. Encephalitis is swelling of the brain; it’s usually caused by a virus. Meningitis is an infection that causes swelling in the brain and spinal cord.
• Seizures

How is CP treated?

You can work with a team of health care providers to figure out your child’s needs and come up with a treatment plan. Members of the team can include:

• Pediatrician. This is a doctor who has special training to take care of babies and children.
• Child neurologist. This is a doctor who has special training in treating brain conditions in babies and children.
• Social worker. This is a person with special training to help people solve problems and make their lives better.
• Psychologist. This is a person with special training to take care of people with emotional or mental health problems, like depression.
• Orthopedic surgeon. This is a doctor with special training to do surgery on bones and muscles.
• Physical therapist. This is a person with special training to create exercise programs for your child.
• Occupational therapist. This is a person who can teach your child how to do everyday things, like eating, getting dressed and writing.
• Speech and language pathologist. This professional can help your child speak more clearly or communicate in other ways.
• Special education teacher. This person has special training to help your child with learning.
• Family support group. Can include other parents, psychologists and family therapists to assist you sharing ways to understand and develop skill to assist your child.

Your child’s treatment plan may include special equipment to help with movement and getting around. These can include a walker, leg or arm braces, a wheelchair or a scooter. Your child may also need a special computer to help with communication.

Your child may need medicines to help relax muscle spasms, including:

• Diazepam (Valium®), baclofen (Ozobax®), dantrolene (Dantrium®) and tizanidine (Zanaflex®). Your child takes these by mouth.
• Baclofen, a medicine that your child gets through a pump placed under his skin. The pump releases the medicine into the fluid that surrounds the spinal cord.
• Botox® (also called botulinum toxin). Your child gets this through a needle.

If your child has severe spasms and medicines don’t help, your provider may recommend surgery called selective dorsal rhizotomy. This is when a surgeon cuts some of the nerves at the base of the spine. It may help with muscle spasms and help your child sit, stand, walk or move around more easily.

What health problems are common for people with CP?

People with CP may have these health problems:

• Constipation, difficulty with having bowel movements, including painful gas
• Drooling
• Feeling pain, especially in adults, commonly in the hips, knees, ankles and back
• Problems urinating
• Seizures
• Throwing up
• Trouble breathing
• Trouble swallowing, sucking or eating
• Trouble talking, seeing or hearing
• Trouble sitting, standing or walking

Last reviewed: January, 2024