Pediatric Cerebral Palsy

Cerebral palsy is a brain (neurological) disorder that causes problems with normal motor function. It's a lifelong condition that affects how the brain and muscles communicate. Cerebral palsy affects body movement, muscle control, coordination, reflexes, posture and balance. These problems are caused by damage to or abnormal development of certain brain areas. But many children with cerebral palsy have normal intelligence. Cerebral palsy can range in severity, but it doesn’t get worse over time. Cerebral palsy doesn't get better over time either. With diagnosis and treatment, children can learn how to manage their condition.

Cerebral palsy occurs when there's abnormal development of or damage to areas of the brain that control motor function. This can happen before or during birth (congenital cerebral palsy). Most cerebral palsy cases are congenital. Less commonly, cerebral palsy can happen after birth. This is called acquired cerebral palsy and usually happens from an infection or head injury.

In many cases, the exact cause of cerebral palsy isn't known. It may be the result of a problem, such as:

• Lack of oxygen to the brain
• Genetic condition
• Infection
• Bleeding in the brain
• Severe jaundice
• Head injury

A child is more at risk for cerebral palsy because of any of the following:

• Preterm birth (before 37 weeks)
• Inflammation of the placenta or amniotic fluid from an infection (chorioamnionitis)
• Blood clotting disorder
• Very low birth weight, especially under 3.3 pounds
• Infection with bacteria or viruses
• Chemical or substance abuse during pregnancy
• Bleeding in the brain
• Complications of labor and delivery, in rare cases

Symptoms can occur a bit differently in each child. A child may have muscle weakness, poor motor control, or shaking (spasticity) of the arms or legs. A child may also have muscle stiffness in the form of stiff legs or clenched fists.

The symptoms depend on what type of cerebral palsy a child has. The types and symptoms include:

• Spastic diplegia. Di means two. This is spasticity of the legs in most cases, but sometimes the arms. Diplegia is also called paraplegia.
• Spastic quadriplegia. This is also called tetraplegia. Quad and tetra mean four. This is spasticity of all arms and legs.
• Spastic hemiplegia. Hemi means half. This is spasticity that affects one side of the body, such as the right arm and right leg.
• Spastic double hemiplegia. This is spasticity on both sides of the body. The amount of spasticity is different on each side.
• Athetoid cerebral palsy. This is also called dyskinetic cerebral palsy. This is movement that can’t be controlled (involuntary). The movement is usually twisting and rigid.
• Ataxic cerebral palsy. This affects balance, leading to unsteady walking. It also affects fine motor coordination. This makes it hard to do things, such as writing.

Babies with cerebral palsy are often slow to reach developmental motor milestones. These may include learning to roll over, sit, crawl or walk. They may also keep certain reflexes that normally disappear in early infancy.

Children with cerebral palsy may have additional problems. But these aren't signs or symptoms of cerebral palsy. Cerebral palsy refers only to the motor dysfunction. The additional problems may include:

• Seizures
• Vision, hearing or speech problems
• Learning disabilities and behavior problems
• Intellectual disability
• Breathing problems
• Bowel and bladder problems
• Bone problems including scoliosis (a sideways curvature of the spine)

The symptoms of cerebral palsy can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

A diagnosis of cerebral palsy isn't usually made until a child is at least age 6 to 12 months. This is when a child should be reaching developmental milestones. These include sitting, standing, walking, and hand and head control. The healthcare provider will ask about your child’s symptoms and health history. They'll give your child a physical exam.

Your child may also have tests, such as:

• Nervous system exam. This checks reflexes and brain and motor function.
• MRI. This imaging test uses large magnets and a computer to make detailed images of organs and tissues in the body. It does not use X-rays. This imaging test is often used to assess cerebral palsy.
• Feeding studies. These tests use X-rays or videos to see what happens from the time food enters your child’s mouth until after your child swallows.
• Electroencephalogram (EEG). This checks electrical activity in the brain.
• Gait lab analysis. This looks at your child’s walking pattern.
• CT scan. This test uses X-rays and a computer to make detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than standard X-rays.
• Genetic studies. These tests look for health conditions that can run in families.
• Metabolic tests. These tests check for the lack of specific enzymes that are needed to maintain the normal function of the body.

Treatment will depend on your child’s symptoms, age and general health. It'll also depend on how severe the condition is. Cerebral palsy is a lifelong condition that has no cure. Because of this, your child’s healthcare providers will work to:

• Prevent or lessen problems
• Make the most of a child's abilities

A child is treated by a healthcare team that may include:

• Pediatrician or family health care provider. This is a child’s primary care provider.
• Orthopedic surgeon. This is a surgeon who treats muscles, ligaments, tendons, and bones.
• Neurologist. This is a provider who treats conditions of the brain, spinal cord, and nerves.
• Neurosurgeon. This is a provider who treats the brain and spinal cord.
• Ophthalmologist. This is a provider who treats eye problems.
• Dentist. This is a provider who treats mouth and teeth problems.
• Nurse. This is a provider who often works with other healthcare providers.
• Physiatrist. This is a provider who specializes in physical medicine and rehabilitation.
• Orthotist. This is a professional who makes braces and splints.
• Rehabilitation team. These include physical, occupational, speech, and audiology therapists.

Management of cerebral palsy may include:

• Rehabilitation
• Positioning aids to help a child sit, lie down or stand
• Braces and splints to prevent deformity and to give support or protection
• Medicines given by mouth or injection to help decrease spasticity in the muscles
• Surgery to treat orthopedic problems, such as curvature in the back, hip dislocation, ankle and foot deformities, and contracted muscles
• Surgery to treat spasticity

Talk with your child’s providers about the risks, benefits and possible side effects of all treatments.

Possible complications vary widely from child to child. Treatment for complications will depend on your child’s symptoms, age and general health. It'll also depend on how serious the condition is. Your child’s healthcare provider will discuss treatment choices with you.

Because healthcare providers don’t know fully what causes congenital cerebral palsy, little can be done to prevent it. Cerebral palsy related to gene problems can’t be prevented. But you can do certain things that might help reduce the risk:

• Be as healthy as possible before and during pregnancy. Get early and regular prenatal care.
• Don't smoke during pregnancy.
• Get vaccinated for certain diseases that can harm a developing baby.

After birth, acquired cerebral palsy is often caused by an infection or injury. Some of these cases can be prevented by helping keep your baby healthy and safe:

• Keep your baby’s vaccines up-to-date.
• Take steps to prevent injuries by always using a car seat, babyproofing your living areas, and watching your young child when in or near water.

Cerebral palsy is a lifelong condition that doesn't have a cure. It can range in severity, but it doesn’t get worse over time. The full extent of cerebral palsy usually isn't fully known right after birth. It can become clearer as a child grows and develops. With diagnosis and treatment, children can learn how to manage their condition.

Your child’s healthcare providers will work to prevent deformities or keep them to a minimum. They'll also work to help your child make the most of their capabilities. You can help your child strengthen their self-esteem and be as independent as possible. Physical and occupational rehabilitation, plus extra support in school, can help a child function as well as possible.

Call the healthcare provider right away if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms