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.
seizures, and vision and hearing problems can
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
In many cases, the exact cause of cerebral palsy is not
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 exam 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.
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.
developmental delays can be early signs of cerebral
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. Physical therapy 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 counseling 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
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:
Health Tools help you make wise health decisions or take action to improve your health.
(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.
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
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.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
5.5 lb (2.5 kg). 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.
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
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:
Call 911 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. Health professionals who can diagnose and treat people
who have cerebral palsy include:
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 department for the nearest clinic in your
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Developmental delays are often reported by parents or
observed by a doctor during routine
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
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.
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
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
Treatment for CP includes:
therapy 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
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.
Physical therapy 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.
Physical therapy 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 physical therapy 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
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
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
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
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:
child approaches the teen years and young adulthood, be aware of his or her
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.
with CP may need extra help preparing for retirement.
Medicines can help control some of the
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:
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:
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 exam.
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
Sometimes medicine or
physical therapy 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 physical therapy after
general, post-surgical physical therapy usually starts as soon as possible and
may continue for as long as 6 months.
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
NCBDDD aims to find the cause of and prevent birth
defects and developmental disabilities. This agency works to help people of all
ages with disabilities live to the fullest. The website has information on
many topics, including genetics, autism, ADHD, fetal alcohol spectrum
disorders, diabetes and pregnancy, blood disorders, and hearing loss.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The March of Dimes tries to improve the health of babies
by preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's website has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care.
The National Dissemination Center for Children with
Disabilities (NICHCY) is the national information and referral center that
provides information on disabilities and disability-related issues for
families and professionals. The focus is on children and
youth, birth to age 22.
United Cerebral Palsy (UCP) offers family support for people with cerebral palsy. UCP publishes
newsletters, brochures, pamphlets, scientific reports, and books. UCP also
works for the rights of people with cerebral palsy. There are chapters in every
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September 20, 2012
Susan C. Kim, MD - Pediatrics & Louis Pellegrino, MD - Developmental Pediatrics
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