Cerebral Palsy in Children

Cerebral palsy (CP) is a group of neurological conditions that affect movement, muscle tone, balance and coordination. It results from an abnormality or injury to the developing brain, usually before birth, around the time of birth, or during early childhood.

Cerebral palsy isn't progressive. That means the brain injury doesn't get worse over time. But that doesn't mean that your child's needs won't change. Muscle stiffness, weakness, abnormal movement and differences in bone and joint development can lead to pain, contractures or difficulty walking as a child gets older.

There is no cure for cerebral palsy, but early intervention and ongoing treatment can help children develop skills, stay active, manage symptoms and participate as fully as possible at home, at school and in their communities.

Types of Cerebral Palsy

Doctors classify cerebral palsy based on the type of movement problems a child has and which parts of the body are affected. Some children have mixed CP, meaning they have characteristics of more than one type.

Spastic Cerebral Palsy

Spastic CP is the most common type. Muscles are stiff or tight because of increased muscle tone, which can make movement difficult.

Spastic CP may affect:

• One side of the body (hemiplegia): The arm and leg on one side are primarily affected.
• The legs more than the arms (diplegia): This is common in children who were born prematurely.
• Both arms and legs (quadriplegia): The trunk and, sometimes, the muscles involved in speaking and swallowing may also be affected.

Dyskinetic Cerebral Palsy

Dyskinetic CP causes involuntary movements that a child cannot fully control. Movements may be twisting, repetitive, jerky or slow and may change depending on the child's position or activity.

Ataxic Cerebral Palsy

Ataxic CP primarily affects balance and coordination. Children may have difficulty walking steadily, controlling precise movements or judging distance.

What Causes Cerebral Palsy?

CP develops when the developing brain is injured or does not develop normally. In many cases, doctors cannot identify one specific cause.

Brain injury or abnormal brain development can occur:

• During pregnancy
• Before or during birth
• Shortly after birth
• During early childhood

In many children, CP develops without a single identifiable cause.

Risk Factors for Cerebral Palsy

Certain factors can increase a child's likelihood of developing CP. The strongest risk factors include problems associated with premature birth and injury to the developing brain.

Risk factors may include:

• Premature birth
• Low birth weight
• Multiple birth, such as twins or triplets
• Stroke or bleeding in the developing brain
• Certain infections during pregnancy
• Complications affecting the placenta or umbilical cord
• Certain genetic or developmental conditions
• Severe newborn jaundice
• Brain injury or infection during infancy or early childhood

Having a risk factor does not mean that a child will develop cerebral palsy. Many premature babies and other children with risk factors do not develop CP.

Symptoms of Cerebral Palsy

Signs of CP usually become noticeable during infancy or early childhood. Some children are diagnosed in the first year or two of life, while milder forms may not be recognized until later.

Early signs can include:

• Delayed motor milestones, such as rolling, sitting, crawling or walking
• Muscle stiffness or unusually tight muscles
• Muscles that seem unusually weak or floppy
• Favoring one side of the body
• Using one hand much more than the other at an early age
• Difficulty standing or walking
• Unusual walking patterns
• Poor balance or coordination
• Tremors or involuntary movements
• Difficulty with precise hand movements
• Difficulty with speech
• Difficulty chewing or swallowing
• Drooling

The severity and combination of symptoms vary greatly. Some children have mild movement difficulties, while others need significant assistance with mobility and daily activities.

Other Conditions Associated With Cerebral Palsy

CP can affect more than movement. Depending on the areas of the brain involved, children may also experience:

• Seizures or epilepsy
• Vision problems
• Hearing problems
• Speech and communication difficulties
• Learning difficulties
• Intellectual disability
• Difficulty swallowing
• Feeding problems
• Gastrointestinal problems
• Problems with bladder or bowel control
• Chronic pain
• Sleep problems
• Low bone density
• Hip problems or dislocation
• Muscle and joint contractures

Not every child with CP will experience these conditions.

Diagnosing Cerebral Palsy

There is no single test that diagnoses cerebral palsy. Doctors diagnose CP by looking at your child's movement, muscle tone, reflexes, development and medical history.

Your child's evaluation may include:

Developmental & Neurological Evaluation

Your child's doctor will assess:

• Motor skills and developmental milestones
• Muscle tone and strength
• Reflexes
• Balance and coordination
• Movement patterns
• Posture
• Ability to use the hands and arms
• Walking and mobility

Standardized developmental and neurological assessments may help identify children who need additional evaluation or early intervention.

Brain MRI

An MRI of the brain is often used to look for abnormalities that may explain your child's movement problems. MRI can show areas of previous brain injury, differences in brain development, stroke, bleeding or other abnormalities.

MRI findings can help doctors understand the possible cause of CP, although a normal MRI does not completely rule it out.

Other Tests

Additional testing depends on your child's symptoms and medical history. Your child's doctor may recommend:

• Genetic testing when a genetic cause is suspected
• Metabolic testing when an underlying metabolic condition is possible
• Vision and hearing evaluations
• EEG if your child has seizures or symptoms that may represent seizures
• Swallowing or feeding evaluations for children with difficulty eating or swallowing
• Hip and bone imaging to monitor musculoskeletal complications

CT scans may occasionally be useful in specific situations, but MRI is generally preferred for evaluating the developing brain.