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Cerebral palsy is a physical disability where the person with the diagnosis has trouble controlling their muscles. It's possibly the most apparent motor disability at birth. There are multiple kinds of cerebral palsy affecting different muscle groups.

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Rutgers University :: Department of Kinesiology and Health

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The Department of Kinesiology and Health at The School of Arts and Sciences, Rutgers, The State University of New Jersey

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There are a plethora of symptoms for those diagnosed with CP. Incontinence, hearing loss, seizures, and painful touch or the loss of sensation are some general symptoms. Some may experience difficulty in developing speech, growth, and mental and physical milestones. They may struggle with chewing, sucking, swallowing and keeping saliva in their mouths. The main symptoms of CP are all involved in the muscles, such as stiff muscles and exaggerated reflexes, jerky or slow movements, issues with walking or finer motor movements in general, a lack of balance and variations in muscle tone across the body. CP may range from lower body to upper body or may span across all muscles. People with CP may favor one side of their body, selecting a dominant side to achieve most tasks.

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Learn about this group of conditions that affect movement. It’s caused by damage to the developing brain, usually before birth.

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Cerebral Palsy can develop in the womb. Some risk factors for congenital CP include a low birth weight, premature births, infections the mother may have had during pregnancy and other various birth complications. Babies can develop it as early as 48 hours after birth; a telltale sign being jaundice, which can cause damage to the newborn's brain if not treated and is severe enough. Head injuries can also cause CP.

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Centers for Disease Control and Prevention

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Cerebral palsy (CP) is caused by abnormal development of the brain or damage to the developing brain that affects a child's ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The brain damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child's life, while the brain is still developing.

Congenital CP

CP related to brain damage that happened before or during birth is called congenital CP. The majority of CP (85%-90%) is congenital. In many cases, the specific cause is not known.

Risk Factors for Congenital CP

Some things increase the chance that a child will have CP. These are called risk factors. It is important to remember that having a risk factor does not mean that a child will have CP. Some of the risk factors for congenital CP are:

Low birthweight―Children who weigh less than 5 1/2 pounds (2,500 grams) at birth, and especially those who weigh less than 3 pounds, 5 ounces (1,500 grams) have a greater chance of having CP.

Premature birth―Children who were born before the 37th week of pregnancy, especially if they were born before the 32nd week of pregnancy, have a greater chance of having CP. Intensive care for premature infants has improved a lot over the past several decades. Babies born very early are more likely to live now, but many have medical problems that can put them at risk for CP.

Multiple births―Twins, triplets, and other multiple births have a higher risk for CP, especially if a baby's twin or triplet dies before birth or shortly after birth. Some, but not all of this increased risk is due to the fact that children born from multiple pregnancies often are born early or with low birthweight, or both.

Assisted reproductive technology (ART) infertility treatments―Children born from pregnancies resulting from the use of some infertility treatments have a greater chance of having CP. Most of the increased risk is explained by preterm delivery or multiple births, or both; both preterm delivery and multiple births are increased among children conceived with ART infertility treatments.

Infections during pregnancy―Infections can lead to increases in certain proteins called cytokines that circulate in the brain and blood of the baby during pregnancy. Cytokines cause inflammation, which can lead to brain damage in the baby. Fever in the mother during pregnancy or delivery also can cause this problem. Some types of infection that have been linked with CP include viruses such as chickenpox, rubella (german measles), and cytomegalovirus (CMV), and bacterial infections such as infections of the placenta or fetal membranes, or maternal pelvic infections.

Jaundice and kernicterus― Jaundice is the yellow color seen in the skin of many newborns. Jaundice happens when a chemical called bilirubin builds up in the baby's blood. When too much bilirubin builds up in a new baby's body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice. When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. This can cause CP and other conditions. Sometimes, kernicterus results from ABO or Rh blood type difference between the mother and baby. This causes the red blood cells in the baby to break down too fast, resulting in severe jaundice.

Medical conditions of the mother―Mothers with thyroid problems, intellectual disability, or seizures have a slightly higher risk of having a child with CP.

Birth complications―Detachment of the placenta, uterine rupture, or problems with the umbilical cord during birth can disrupt oxygen supply to the baby and result in CP.

Acquired CP

A small percentage of CP is caused by brain damage that occurs more than 28 days after birth. This is called acquired CP, and usually is associated with an infection (such as meningitis) or head injury.

Causes

Some causes of acquired CP are:

Infection―Infections of the brain, for example, meningitis or encephalitis during infancy.

Injury―Injuries to the brain, for example, head injuries caused by motor vehicle crashes or child abuse.

Problem with blood flow to the brain―Cerebrovascular accidents, for example, stroke or bleeding in the brain associated with a blood clotting problem, blood vessels that didn't form properly, a heart defect that was present at birth, or sickle cell disease.

Risk Factors

Some things increase the chance that a child will have CP. These are called risk factors. It is important to remember that having a risk factor does not mean that a child will have CP. Some risk factors for acquired CP are:

Infancy―Infants are at greater risk of a brain-damaging event than older children.

Preterm or low birthweight―Children born preterm or at low birthweight are at greater risk for acquired CP.

Brain infections―Not getting certain vaccinations increases the risk of brain infections that can result in CP.

Injury―Inadequate safety measures or lack of adult supervision can increase the risk of injury that can result in CP.

Preventing CP

In many cases, the cause or causes of congenital CP aren't fully known, which means that currently little can be done to prevent it. CP related to genetics is not preventable. However, there are actions people can take before and during pregnancy, as well as after birth that might help reduce the risk of developmental problems, including CP.

Taking steps to help ensure a healthy pregnancy can help prevent developmental problems, including CP. Acquired CP often is related to an infection or injury, and some of these cases can be prevented.

Before Pregnancy

Be as healthy as possible before pregnancy. Make sure that any infections in the mother are treated and health conditions are in control, ideally before pregnancy occurs.

Get vaccinated for certain diseases (such as chickenpox and rubella) that could harm a developing baby. It is important to have many of these vaccinations before becoming pregnant.

If assistive reproductive technology (ART) infertility treatments are used to get pregnant, consider ways to reduce the chance of a multiple pregnancy (twins, triplets, or more), such as transferring only one embryo at a time.

During Pregnancy

Learn how to have a healthy pregnancy.

Get early and regular prenatal care, both for your health and for that of your developing baby.

Wash your hands often with soap and water to help reduce the risk of infections that might harm your developing baby.

Contact your health care provider if you get sick, have a fever, or have other signs of infection during pregnancy.

A flu shot is your best protection against serious illness from the flu. A flu shot can protect pregnant women and their unborn babies, both before and after birth. Flu shots have not been shown to cause harm to pregnant women or their babies.

If there is a difference in the blood type or Rh incompatibility between mother and baby it can cause Jaundice and kernicterus. Women should know their blood type and talk to their doctor about ways to prevent problems. Doctors can treat the mother with Rh immune globulin ("Rhogam") when she is 28 weeks pregnant and again shortly after giving birth to prevent kernicterus from occurring.

Talk to your doctor about ways to prevent problems if you are at risk for preterm delivery. Research has shown that taking magnesium sulfate before anticipated early preterm birth reduces the risk of CP among surviving infants.

After the Baby is Born

Learn how to help keep your baby healthy and safe after birth.

Any baby can get jaundice. Severe jaundice that is not treated can cause brain damage, called kernicterus. Kernicterus is a cause of CP that potentially can be prevented. Your baby should be checked for jaundice in the hospital and again within 48 hours after leaving the hospital. Ask your doctor or nurse about a jaundice bilirubin test. In addition, steps can be taken to prevent kernicterus that is caused by Rh blood type incompatibility between the mother and baby.

Make sure your child is vaccinated against infections that can cause meningitis and encephalitis, including Haemophilus influenzae type B (HiB vaccine) and Streptococcus pneumoniae (pneumococcal vaccine).

Take steps to prevent injuries:

Buckle your child in the car using an infant or child car seat, booster seat, or seat belt (according to the child's height, weight, and age).

Make living areas safer for children by using window guards to keep young children from falling out of open windows and using safety gates at the top and bottom of stairs.

Make sure the surface on your child's playground is made of a shock-absorbing material, such as hardwood mulch or sand.

Carefully watch young children at all times around bathtubs, swimming or wading pools, and natural bodies of water. Adults watching kids near water should avoid distracting activities like using a computer or handheld device, reading, or talking on the phone.

Make sure your child wears a helmet for activities like riding a bike.

Never hit, throw, shake, or hurt a child.

For More Information

References

1. Doyle LW, Crowther CA, Middleton P, Marret S. Antenatal magnesium sulfate and neurologic outcome in preterm infants: a systematic review. Obstet Gynecol. 2009 Jun;113(6):1327-33.

2. Magnesium sulfate before anticipated preterm birth for neuroprotection. Committee Opinion No. 455. American College of Obstetricians and Gynecologists. Obstet Gynecol 2010;115:669-71.

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Causes and Risk Factors | Cerebral Palsy | NCBDDD | CDC

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Cerebral palsy (CP) is caused by abnormal development of the brain or damage to the developing brain that affects a child's ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process.

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Treatment and Inclusion in the Classroom

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Treatment and Inclusion in the Classroom

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There is no cure for cerebral palsy unfortunately, but there are treatment plans that can assist a person with any form of CP throughout their entire life. Physical, speech and occupational therapy can all greatly assist a person with CP. Assistive devices such as arm and/or leg braces may aid in their journey to walking without these. Special chairs for sitting, vocal keyboards and special wheelchairs may also help depending on the severity. Medication and medical interventions may help if none of the other options do. Depending on the severity of the condition, this child may bring an abundance of challenges to the classroom. Giving them enough space to safely maneuver may be tough as class sizes continue to grow. They most likely will need an IEP and/or an IFSP throughout their education. Having the appropriate technology to assist in any speech difficulties is crucial. They would bring some valuable discussions to the classroom and would help teach other children about disabilities. Patience and kindness are needed for every child, but for a friend who may struggle to quickly maneuver tight spaces or may take a little extra time saying their thoughts is absolutely needed, and it's a great thing to give kids this idea and experience early on.

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​​By: JoJo Yang, MD & Courtney J. Wusthoff MD, MS, FAAP

Children with cerebral palsy have trouble controlling their movement. The condition is the most common disability that affects a child's motor control.

Cerebral palsy usually is caused by a brain injury or abnormal brain development before birth or early in life. Genetic causes, although less common, can also play a role.

Here is what families need to know about cerebral palsy and how to help children who have it reach their full potential.

How does cerebral palsy affect children?

Cerebral palsy can affect children in many ways. Some children who have cerebral palsy will learn to walk and run, but may do so a little later than other kids. Other children with cerebral palsy may need devices, such as a walker or leg braces to walk. Still others may use a wheelchair as their best way to move around. For some children, cerebral palsy makes it difficult to eat or talk, because it is hard for them to control the necessary movements.

The type of cerebral palsy a child has is related to what parts of the brain developed abnormally or were injured early in life.

While cerebral palsy affects motor control, this is different than intelligence or other brain functions. A child may be very bright even though cerebral palsy makes it hard for them to control some movements.

If your child is diagnosed with cerebral palsy, it is important to share their diagnosis with doctors, therapists and school staff. This will help your child get treatments and support to help them.

What are some signs of cerebral palsy in children?

The first clue a child might have cerebral palsy is usually motor delay, such as learning to sit or to walk late. If a child has a known risk for cerebral palsy, special developmental check-ups are sometimes planned to watch for early concerning signs. Sometimes, a child's family or pediatrician might be the first to notice motor delay in a child. If you have any concerns about your child's development, talk to your pediatrician.

Cerebral palsy can show up in a number of ways:

Spasticity is increased muscle tone. This is the abnormal tightness in a child's muscles. The tightness is there even when the muscles are resting. Spasticity can make arms stay tight and close to the body, or make legs stiff and difficult to bend.

Hypotonia is low muscle tone. This may appear as floppiness in the muscles. Children with hypotonia may have trouble sitting up or holding up their head. Hypotonia is different from muscle weakness, which is also common in some children with cerebral palsy.

Diplegia is trouble controlling both legs. In some cases, this may make walking difficult.

Hemiplegia is trouble moving one side of the body. Children with hemiplegic cerebral palsy may have trouble using their arm and leg on either the left or right side.

Dystonia is when muscles contract in an uncontrolled way. This can cause muscle spasms, involuntary movements, or "getting stuck".

What causes cerebral palsy?

Many children diagnosed with cerebral palsy may not have any known risk factors. There are different reasons a child may develop cerebral palsy, including:

Premature birth. Nearly half of people with cerebral palsy are born prematurely. This is the most common cause of cerebral palsy in the United States. However, children born at term may also develop cerebral palsy.

Medical problems during pregnancy or around the time a baby is born.

Illnesses or injuries as a newborn or infant, such as very severe jaundice, strokes, brain infections, and bleeding into brain structures.

Genetic conditions. Recent research suggests that underlying genetic abnormalities may be related to cerebral palsy.

For children with cerebral palsy, an MRI (magnetic resonance image) may be recommended to see if a brain injury is present. Other times, genetic testing may be helpful. Your pediatrician may work with a specialist, such as a developmental pediatrician or pediatric neurologist, to help families plan for these or other tests.

How is cerebral palsy treated?

Cerebral palsy is a chronic, life-long medical problem. There is no cure that can make it go away completely, but there are ways to help a child with cerebral palsy do their best.

Physical and occupational therapy, medications, and assistive devices such as braces can help a child reach their best potential. Treatment supports the child's overall development, improves their functional ability to participate in family and community activities, and minimize complications. Talk to your pediatrician about different therapy options for your child with cerebral palsy. These may include:

Early intervention. Early intervention programs can help babies who are behind in their development. A team may include behavioral specialists, physical therapists, nurses, social workers, and early childhood educators. Early intervention programs may include feeding therapy as well, however the type of provider (speech language pathologist, occupational therapist), may vary depending on location. The team teaches families strategies and gives them tips to help their baby learn new skills.

Physical therapy. Physical therapists are specialists who work with children on stretching and strengthening exercises. They help a child learn new movements, such as rolling over, sitting, or walking.

Occupational therapy. These specialists help children learn to do day-to-day tasks. They use a combination of exercises, modifying items the child uses every day and figuring out ways to successfully work around challenges to the child's abilities.

Speech therapy. Speech therapists can help children with learning to talk and other ways to communicate.

Assistive devices. Different kinds of equipment may help children with cerebral palsy. Leg braces can support their legs as they learn to walk. Arm braces can support arms or hands in a more functional position. Other types of assistive devices include communication keyboards, special wheelchairs, and chairs to help with sitting.

Medications & medical interventions. These may be recommended when therapies are not enough. They may include medicines to help with general muscle spasticity, or injections to relax particular muscles. This can help a child participate in therapies. In some situations, surgery may also be recommended as part of the child's treatment plan.

Because so many different causes may result in a diagnosis of cerebral palsy, different children may benefit from different treatments. It is important for parents to talk with their team about the benefits of different traditional and complementary treatments, their frequency, and models of care.

Keeping kids with cerebral palsy healthy

Your pediatrician and care team will also help keep your child healthy by watching out for any medical problems that sometimes go along with cerebral palsy. Ongoing care can also help prevent complications.

Routine preventive care. Children with cerebral palsy should receive the same routine preventive care that all children receive, including immunizations, hearing/vision screening, etc.

Specific problems associated with cerebral palsy. Every child is different. For some children with cerebral palsy, extra check-ups may be needed to look out for problems that can happen along with cerebral palsy. These may include learning problems, seizures/epilepsy, vision difficulties, hearing loss and feeding difficulties. Your pediatrician will help you make a plan for your child.

Minimizing joint and bone complications. Children who do not move much, especially who spend a lot of time in the same position, may develop "contractures." This is when the joints become limited in how much they can move. Stretching can help prevent contractures. Children who do not stand or walk also are at risk of having low bone density (osteopenia) and scoliosis (too much curving of the spine). Your pediatrician and other care team members will help watch for any early problems and help with plans to avoid or treat these complications.

Oral hygiene. As with any other child, dental hygiene is very important. Patients with cerebral palsy might be at higher risk of poor oral hygiene due to oral aversion. This is particularly important in patients with a feeding tube as they are at increased risk for cavities. Make sure to discuss these topics with your child's Pediatrician to ensure he/she is receiving appropriate dental care.

Reproductive health. Youth with cerebral palsy, like all youth, have the right to healthy sexuality​. Children with cerebral palsy are at greater risk for early or late onset puberty, so engaging in early conversations with your pediatrician about puberty and sexuality are encouraged.

Like all children, kids with cerebral palsy live in dynamic communities and require a combination of medical, environmental and social supports to thrive. Talk to your pediatrician about your child's diagnosis and its impact on the child's function, family, fitness, fun, friends and future.

More information

About Dr. Yang

Qian-Zhou (JoJo) Yang, MD is a pediatric epilepsy specialist and Assistant Professor Neurology at the University of North Carolina, Chapel Hill. She specializes in the care of children with complex epilepsy and incorporating integrative medicine approaches to common neurologic issues. She is a member of the AAP Section on Neurology.

About Dr. Wusthoff

Courtney J. Wusthoff, MD, MS, FAAP is a pediatric neurologist practicing at Stanford Children's Health. She is an Associate Professor of Neurology and Pediatrics (Neonatal Medicine) at the Stanford School of Medicine. Her work focuses on caring for babies with neurologic conditions. She serves on the AAP Section on Neurology, and has enjoyed the opportunity to speak at AAP CME events.

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American Academy of Pediatrics Section on Neurology ＆ Council on Children With Disabilities (Copyright © 2023)

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cerebral palsy~ impairment~ brain~ control movement~ muscle tone~ normal intelligence~ motor control~ hypotonia~ hypertonia~ hemiparesis~ signs of cerebral palsy~ problems associated with cerebral palsy~ cerebral palsy treatment~ children~ pediatrics

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Children with cerebral palsy have trouble controlling their movement. This is because of a brain injury or abnormal brain development early in life or before birth. It affects different children in many different ways. Learn more here.

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What is Cerebral palsy? || Cerebral Palsy Patient Education ||