Cerebral palsy

Overview

Cerebral palsy is a group of conditions that affect movement and posture. It's caused by damage that occurs to the developing brain, most often before birth.

Symptoms appear during infancy or preschool years and vary from very mild to serious. Children with cerebral palsy may have exaggerated reflexes. The arms, legs and trunk may appear floppy. Or they may have stiff muscles, known as spasticity. Symptoms also can include irregular posture, movements that can't be controlled, a walk that's not steady or some combination of these.

Cerebral palsy may make it hard to swallow. It also can cause eye muscle imbalance, in which the eyes don't focus on the same object. People with the condition might have reduced range of motion in their joints due to muscle stiffness.

The cause of cerebral palsy and its effect on function vary from person to person. Some people with cerebral palsy can walk while others need assistance. Some people have intellectual disabilities, but others do not. Epilepsy, blindness or deafness also might affect some people with cerebral palsy. There is no cure, but treatments can help improve function. The symptoms of cerebral palsy may vary during the child's development, but the condition doesn't get worse. The condition generally stays the same over time.

Symptoms

Symptoms of cerebral palsy can vary greatly. In some people, cerebral palsy affects the whole body. In other people, symptoms might only affect one or two limbs or one side of the body. General symptoms include trouble with movement and coordination, speech and eating, development, and other issues.

Movement and coordination

Movement and coordination symptoms may include:

• Stiff muscles and exaggerated reflexes, known as spasticity. This is the most common movement condition related to cerebral palsy.
• Variations in muscle tone, such as being either too stiff or too floppy.
• Stiff muscles with regular reflexes, known as rigidity.
• Lack of balance and muscle coordination, known as ataxia.
• Jerky movements that can't be controlled, known as tremors.
• Slow, writhing movements.
• Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling.
• Trouble walking. People with cerebral palsy may walk on their toes or crouch down when they walk. They also may have a scissors-like walk with their knees crossing. Or they may have a wide gait or a walk that's not steady.
• Trouble with fine motor skills, such as buttoning clothes or picking up utensils.

Speech and eating

These symptoms related to speech and eating may occur:

• Delays in speech development.
• Trouble speaking.
• Trouble with sucking, chewing or eating.
• Drooling or trouble with swallowing.

Development

Some children with cerebral palsy have these symptoms related to development:

• Delays in reaching motor skills milestones, such as sitting up or crawling.
• Learning disabilities.
• Intellectual disabilities.
• Delayed growth, resulting in smaller size than would be expected.

Other symptoms

Damage to the brain can contribute to other neurological symptoms, such as:

• Seizures, which are symptoms of epilepsy. Children with cerebral palsy may be diagnosed with epilepsy.
• Trouble hearing.
• Trouble with vision and changes in eye movements.
• Pain or trouble feeling sensations such as touch.
• Bladder and bowel issues, including constipation and urinary incontinence.
• Mental health conditions, such as emotional conditions and behavior issues.

The brain condition causing cerebral palsy doesn't change with time. Symptoms usually don't worsen with age. However, as the child gets older, some symptoms might become more or less clear. And muscle shortening and muscle rigidity can worsen if not treated aggressively.

When to see a doctor

Contact your child's health care professional and get a prompt diagnosis if your child has symptoms of a movement condition. Also see a health professional if your child has delays in development.

See your child's health care professional if you have concerns about episodes of loss of awareness or of irregular bodily movements or posture. It's also important to contact your child's health care professional if your child has trouble swallowing, poor coordination, eye muscle imbalance or other developmental issues.

Causes

Cerebral palsy is caused by irregular brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. Often the cause isn't known. Many factors can lead to changes in brain development. Some include:

• Gene changes that result in genetic conditions or differences in brain development.
• Maternal infections that affect an unborn baby.
• Stroke, which interrupts blood supply to the developing brain.
• Bleeding into the brain in the womb or as a newborn.
• Infant infections that cause swelling in or around the brain.
• Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical trauma.
• Lack of oxygen to the brain related to a hard labor or delivery, although this cause is less common than previously thought.

Risk factors

A number of factors are associated with an increased risk of cerebral palsy.

Maternal health

Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby's developing brain.

• Cytomegalovirus. This common virus causes flu-like symptoms. If a mother has her first active infection during pregnancy, it can lead to birth defects.
• German measles, known as rubella. This viral infection can be prevented with a vaccine.
• Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
• Syphilis. This is a bacterial infection that's usually spread by sexual contact.
• Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
• Zika virus infection. This infection is spread through mosquito bites and can affect the brain development of an unborn baby.
• Intrauterine infections. This includes infections of the placenta or fetal membranes.
• Exposure to toxins. One example is exposure to methyl mercury.
• Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid conditions, preeclampsia or seizures.

Infant illness

Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:

• Bacterial meningitis. This bacterial infection causes swelling in the membranes surrounding the brain and spinal cord.
• Viral encephalitis. This viral infection also causes swelling in the membranes surrounding the brain and spinal cord.
• Severe or untreated jaundice. Jaundice appears as a yellowing of the skin and eyes. The condition occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.
• Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.

Factors of pregnancy and birth

The potential contribution from each is limited, but these pregnancy and birth factors may increase the risk of cerebral palsy risk:

• Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
• Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors' risk of cerebral palsy increases.
• Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
• Delivery complications. Events during labor and delivery may increase the risk of cerebral palsy.

Complications

Muscle weakness, muscle spasticity and trouble with coordination can contribute to complications in childhood or in adulthood, including:

• Contracture. Contracture is muscle tissue shortening due to severe muscle tightening. This can be the result of spasticity. Contracture can slow bone growth, cause bones to bend, and result in joint changes, dislocation or partial dislocation. These can include a dislocated hip, a curved spine or other bone changes.
• Malnutrition. Trouble with swallowing and feeding can make it hard to get enough nutrition, particularly for an infant. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
• Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavior issues also can occur.
• Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing conditions. Trouble swallowing can result in respiratory issues, such as aspiration pneumonia. Aspiration pneumonia happens when a child inhales food, drink, saliva or vomit into the lungs.
• Osteoarthritis. Pressure on joints or misalignment of joints from muscle spasticity may lead to this painful bone disease.
• Osteoporosis. Fractures due to low bone density can result from lack of mobility, poor nutrition and anti-seizure medicines.
• Other complications. These can include sleep conditions, chronic pain, skin breakdown, intestinal issues and issues with oral health.

Prevention

Often cerebral palsy can't be prevented, but you can reduce risks. If you're pregnant or planning to become pregnant, take these steps to minimize pregnancy complications:

• Make sure you're vaccinated. Getting vaccinated against diseases such as rubella might prevent an infection. It's best to make sure you're fully vaccinated before getting pregnant.
• Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to develop an infection that results in cerebral palsy.
• Seek early and continuous prenatal care. See your health care professional regularly during pregnancy. Proper prenatal care can reduce health risks to you and your unborn baby. Seeing your health care professional regularly can help prevent premature birth, low birth weight and infections.
• Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.

Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.