Cerebral Palsy

	Topic Overview
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits
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What is cerebral palsy?

Cerebral palsy is a group of problems that affects body movement and posture. It is related to a brain injury or to problems with brain growth. It 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. Mental retardation, seizures, and vision and hearing problems can occur in people with cerebral palsy.

Learning that your child has cerebral palsy is not easy, and raising a child who has it can be very hard. But the more you know, the better you can care for and provide for your child.

What causes cerebral palsy?

Cerebral palsy is caused by a brain injury or problem that occurs during pregnancy, birth, or within the first 2 to 3 years of a child’s life. Cerebral palsy can be caused by:

• Problems from being born too early (premature birth).
• Not getting enough blood, oxygen, or other nutrients before or during birth.
• A serious head injury.
• A serious infection that can affect the brain, such as meningitis.
• Some problems passed from parent to child (genetic conditions) that affect brain development.

In many cases, the exact cause of cerebral palsy is not known.

What are the symptoms?

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 with cerebral palsy have only 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 with severe forms of cerebral palsy are more likely to have other problems, such as seizures or mental retardation.

Babies with severe cerebral palsy often have problems with their posture. Their bodies may be either very floppy or very stiff. Birth defects, such as a spine that doesn't have the normal shape, a small jawbone, or a small head, sometimes occur along with cerebral palsy.

The brain injury or problem that causes cerebral palsy does not 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 do not show clear signs of it right away.

How is cerebral palsy diagnosed?

Most of the time, doctors will diagnose cerebral palsy based on a child's medical history. Your doctor will ask about your child’s growth and about any problems you may have noticed. You may be asked to answer questions about your child’s development. The doctor may also do a physical exam.

Other tests, such as a CT scan or an MRI of your child’s head, may be done. Or the doctor may look at ultrasound pictures of the brain. These tests can help the doctor find out the cause of cerebral palsy.

It can take several months to several years to find out if a child has cerebral palsy. Some of the time, a doctor can find out if a child has cerebral palsy by the time the child is 18 months old. If 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. These developmental delays can be early signs of cerebral palsy.

How is it treated?

Cerebral palsy can't be cured, so your child will probably need lifelong treatment. But treatments can 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.

What can you do to cope?

Meeting the daily needs of a family member with cerebral palsy can be very hard. If your child has cerebral palsy, seek family and community support. It may help to join a support group or to 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 that you may feel when your child has cerebral palsy. Your child will need help too. Providing emotional support for your child can help him or her deal with having cerebral palsy.

Frequently Asked Questions

Cerebral palsy (CP) is a result of injury to or abnormal development of the brain. In many cases, the exact cause of CP is not known. The damage or abnormality may occur during pregnancy, birth, or within the first 2 to 3 years of life.

• Possible causes of CP during pregnancy or birth can be related to genetic or chromosomal problems, infections or health problems in the mother or fetus during pregnancy, or complications related to labor and delivery. Any of these problems can affect how a fetus grows or deprive a fetus or newborn of needed blood, oxygen, or nutrients. Health problems in a newborn, such as untreated low blood sugar, can also cause brain damage that leads to CP.
• Possible causes of CP related to an early birth (premature birth) are related to the brain's development. Babies born too early are at risk for bleeding in the brain (intraventricular hemorrhage, or IVH). A condition called periventricular leukomalacia, or PVL, which reflects injury to the white matter of the brain, is also more likely in babies born prematurely than in those born at full term. Both IVH and PVL put a baby at risk for cerebral palsy.
• Possible causes of CP within the first 2 or 3 years of life are usually related to brain damage from a serious illness, such as meningitis; a brain injury, such as from an accident or fall; or not enough oxygen getting to the brain tissue, such as from a near-drowning incident.

Even when the condition is present at birth, the signs of cerebral palsy (CP) may not be noticed until a child is between 1 and 3 years of age. This is due to the way children develop and mature. Health professionals and parents may not recognize that a baby's movements are irregular until they become more pronounced as a child grows. These babies and young children may retain newborn reflexes and fail to reach age-appropriate developmental milestones. Parents and caregivers usually are the first to notice that a baby has developmental delays that may be early signs of CP.

When CP is severe, signs are often noticed at birth or shortly thereafter. However, some early signs of severe CP vary according to the specific type of CP present.

Common signs of severe CP that may be noticed shortly after birth include:

• Problems sucking and swallowing.
• A weak or shrill cry.
• Unusual positions. Often the body is either very relaxed and floppy or very stiff. When held, babies may arch their backs and extend their arms and legs. These postures are different from and more extreme than those that sometimes occur in babies with colic.

Some problems related to CP become more evident over time or develop as a child grows. These may include:

• Smaller muscles in affected arms or legs. Nervous system problems prevent movement in affected arms and legs. Inactivity affects muscle growth.
• Abnormal sensations and perceptions. Some people with CP feel pain when touched lightly. Even everyday activities, such as brushing teeth, may hurt. Abnormal sensations can also make it difficult to identify common objects by touch, such as feeling the difference between a soft foam ball and a hard baseball.
• Skin irritation. Drooling is common when facial and throat muscles are affected. Drooling irritates the skin, particularly around the mouth, chin, and chest.
• Dental problems. Children who have difficulty brushing their teeth have increased risk of developing cavities and gum disease (gingivitis). Seizure medications may also contribute toward developing gum disease.
• Accidents. Falls and other accidents are a risk, depending on muscle control, joint stiffness, and general physical strength. In addition, CP-related seizures can cause accidental injuries.
• Infections and long-term illnesses. Severe CP causes problems with eating. If food is inhaled into the lungs, a child's risk of developing pneumonia increases. Adults are at a higher risk for heart and lung disease.

Some children with CP often also display a group of behavioral symptoms, such as excessive sleepiness, irritability, and little interest in their environment.¹

All people with cerebral palsy (CP) have some problems with body movement and posture, but many babies do not show signs of CP at birth. Parents and caregivers may notice the first signs of CP, such as the baby not rolling over, sitting, crawling, or walking 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 does not get worse over time, but its effects can appear, change, or become more severe as the child gets older.

The specific effects of CP depend on its type and severity, the level of mental impairment, and whether other complications develop or other medical conditions are present.

• The type of CP present and how much of the body that is affected will determine a child's mobility.
  • Most people with CP have forms 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 develop symptoms mostly in one leg or one side of the body. Most children usually learn ways to accommodate for their handicaps. Some people can live on their own, and others live and work in situations that provide some level of assistance. When both legs are affected, children can move around with the help of a scooter board (a device used to self-propel while lying down), modified stroller, wheelchair, or other special equipment.
  • Total body cerebral palsy causes the most severe problems. Severe spastic CP and athetoid (dyskinetic) CP are types of total body CP. Many of those affected are not able to take care of themselves, either because of severe physical disabilities or mental retardation. However, some people can live on their own with the help of family members and/or health care aides.
• Complications, such as seizures, and other long-term physical effects of CP can be difficult to predict until a child is between 1 and 3 years of age. Sometimes, however, such predictions are not possible until a child reaches school age when learning, communication skills, and other abilities can be measured. The amount of help and supervision needed depends on the number and severity of problems.
• The severity of mental impairment, if any, is a strong predictor of daily functioning. Approximately 75% of people with CP have some degree of cognitive impairment.² About 60% of these people are mentally retarded (ranging from mildly to severely), and the remainder often function normally but have some type of learning disability.²
• Other medical conditions, such as vision or hearing problems, are often associated with CP. Sometimes these conditions are known right away, and in other cases they are not detected until a child gets older.

Also, just like people with normal physical development, people with CP have social and emotional concerns throughout their lives. Because their physical limitations may add to these concerns, people with CP need the awareness and consideration of others.

Of all children diagnosed with cerebral palsy, 90% live to adulthood (beyond 20 years old).³ A more precise life expectancy can be estimated by evaluating the type of CP present, its severity, and the impact of any conditions that are often related to CP. Most adults with the mild or moderate form—and some with the severe form—live independently and have jobs. Opportunities for independent living and employment for adults with CP have improved. These opportunities are a result of better home support services and advances in technology, such as computers to assist with speech, powered wheelchairs, and other devices.⁴

Premature birth and low birth weight

Between 40% and 50% of all children who develop cerebral palsy (CP) are born prematurely.¹ In addition, 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.

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. It is estimated that 70% to 80% of children with CP experienced a disruption in the normal development of parts of their brain during fetal growth.⁵ 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 full term.

Risk factors before birth

A fetus's risk for developing a brain abnormality or injury that leads to CP increases when the mother has certain problems during her pregnancy, which may include:

• Infections, such as German measles (rubella), cytomegalovirus infection (CMV), and toxoplasmosis. When these infections occur during the first 6 months of pregnancy, the fetus is especially at risk.
• Infections in the mother's uterus or birth canal (vagina). These infections may cause inflammation in the placenta (chorioamnionitis), which can disrupt the normal growth of a fetus's brain and may contribute to getting periventricular leukomalacia (PVL).^{5, 6}
• Exposure to certain medications, such as thyroid hormones or estrogen.
• Use of alcohol, illegal drugs, and some prescription medicines (such as methotrexate).
• Other problems, such as bleeding in the uterus between the sixth to ninth month of pregnancy, large amounts of protein in the urine (proteinuria), or high blood sugar levels.

Risk factors for cerebral palsy at birth

Although rare, some babies develop CP as a result of complications during the mother's pregnancy or at birth. Risk factors include:

• Premature birth. Premature babies are at increased risk for developing bleeding in the brain (intraventricular hemorrhage, or IVH), which may result in CP.
• Difficult or prolonged labor. Brain infection or physical trauma (such as from the use of forceps or other instruments, which is rare) are all risks associated with a problem birth that can increase a baby's risk of developing CP. A lack of oxygen, although it occurs less commonly, also increases a baby's risk. But CP can itself cause a baby to have a difficult birth because of body movement and posture problems related to the condition.
• Placenta abruptio. The placenta usually separates from the wall of the uterus several minutes after the birth of the baby. If it separates before the baby is born, the baby loses the blood and oxygen supply from the mother, which increases the risk of developing CP.
• Infections in the mother's uterus or vagina, such as strep infections, that transfer to the baby during birth. Cerebral palsy can result if the infection reaches the baby's brain.

Risk factor after birth

Risk factors for developing CP just after birth or within the first 2 or 3 years of life are related to brain damage and include:

• A serious illness, such as severe jaundice, meningitis, or lead poisoning (very rare). Early signs of concern include breathing problems, low levels of thyroid hormone (thyroxine), seizures, and low blood sugar levels (hypoglycemia). Babies born prematurely or with a low birth weight are susceptible to these illnesses.
• Serious head injury from an accident or fall. This includes injury to a baby from shaking, throwing, or other force (shaken baby syndrome, also called intentional head injury or IHI).
• Lack of oxygen to brain tissues, such as the result of a brain tumor or a near-drowning incident.

Other risk factors

• Babies born to teen mothers or to mothers age 35 and older have a higher risk for cerebral palsy.
• Having a genetic or chromosomal problem, such as thrombophilia, a blood-clotting disorder, raises the risk for CP.

Call 911 or other emergency services if your child with cerebral palsy (CP):

• Is having problems breathing.
• Chokes during feeding and you are not able to dislodge the food.

Call a health professional immediately if:

• You are pregnant and you get or suspect you have German measles (rubella) or signs of some other infection; have been exposed to harmful substances, such as strong chemicals or radiation; or you have consumed alcohol or used drugs.
• Your child has a seizure for the first time.

If you have a child diagnosed with CP, call your doctor if your child has:

• A seizure (if it is the first time, call your doctor or seek care immediately)
• Constipation that is not relieved by home treatment.
• Skin irritation that is not getting better, starts to bleed or weep fluid, or causes pain.
• Feeding problems that are not relieved by home treatment, such as:
  • A pattern of coughing and choking during feeding. If food is inhaled into the lungs, it increases the risk of developing pneumonia.
  • Chewing difficulty along with weight loss or complaints of being hungry.
• Frequent accidents that threaten your child's safety.
• Other signs of complications, such as bladder control problems, bleeding gums, or an increase in joint stiffness.

Watchful Waiting

Pay attention to whether your child is reaching early developmental milestones. Report your observations to your health professional at regularly scheduled well child visits or any time you have concerns.

Watchful waiting is not appropriate if your child has been diagnosed with cerebral palsy and develops complications. See your child's health professional.

If you have cerebral palsy and you are pregnant, talk with a health professional about how the disorder can affect your pregnancy and delivery.

Who To See

Health professionals who can diagnose and treat people with cerebral palsy (CP) include:

• Pediatricians (some pediatricians specialize in developmental disabilities).
• Family medicine doctors.
• Nurse practitioners.
• Physician assistants.
• Internal medicine doctors.
• Neurologists.
• Neurological surgeons.
• Physiatrists, physical medicine and rehabilitative physicians, and other doctors who specialize in therapeutic and long-term treatment issues.

Other specialists who may be involved in the care of people with CP include:

• Ophthalmologists.
• Orthopedic surgeons.
• Psychiatrists, psychologists, social workers, and psychiatric nurses.

Other health professionals who may be involved in the care of people with CP include:

• Occupational therapists.
• Physical therapists.
• Dentists or orthodontists.
• Hearing specialists (audiologists).
• Speech therapists (speech-language pathologists).
• Registered dietitians.

Some health care clinics specialize in treating children with CP. Call your local health department for the nearest clinic in your area.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Diagnosing cerebral palsy

Signs of cerebral palsy (CP) may not be present or detected at birth. 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.

Health professionals use caution in diagnosing CP too early because some babies who have motor skill abnormalities soon after birth never develop CP.

Sometimes symptoms may not appear until the nervous system matures with the continual growth of the brain, nerves, and muscles. It can take up to a few years before doctors determine whether a baby with body movement and posture (motor) problems has CP.

Cerebral palsy is diagnosed based on observations of a baby's or young child's physical development delays or irregularities, medical history, a physical examination, screening tests, and other tests, such as MRI. Specifically, these tests include:

• Asking questions about the child's medical history, including details about the mother's pregnancy. Developmental delays are often reported by parents or observed by a health professional during routine well baby checks. These visits are also an opportunity for health professionals to watch your baby and ask details about his or her sensory and motor skills, especially those that are expected to occur during the first year or second year.
• A physical examination to look for signs of CP. During a physical exam, a health professional evaluates whether a child retains newborn reflexes longer than normal, which can be an indication of CP. Postures and basic muscle function, hearing, and vision are usually also assessed.
• Screening tests. Your health professional will recommend developmental questionnaires and other tests to help determine the extent of developmental delays and whether they should be further evaluated.
• Magnetic resonance imaging (MRI) of the head, which may be done to identify brain abnormalities.

Taken together, results of these tests can point toward a diagnosis of CP.⁷

If diagnosis is unclear, additional tests may be done to evaluate the brain and possibly rule out other conditions. Sometimes, results from these tests can also be useful in evaluating the severity of CP. Tests may include:

• Additional developmental questionnaires.
• Computed tomography (CT) scan of the head.
• Ultrasound of the brain.

Evaluating and monitoring cerebral palsy

After CP is diagnosed, a child will also be screened for other medical conditions that can occur with cerebral palsy, such as:

• Other developmental delays in addition to those that have already been identified. Developmental abilities will be assessed periodically to determine whether new symptoms, such as speech and language delay, appear as a child's nervous system matures.
• Intelligence testing, to identify below-normal intelligence (mental retardation).
• Seizures. An electroencephalography (EEG) is used to check for abnormal activity in the brain if a child has a history of seizures.
• Problems with feeding and swallowing.
• Vision or hearing problems.
• Psychological evaluation, for any behavioral problems.

Most of the time, a health professional can predict many of the long-term physical effects of CP when a child is between 1 and 3 years of age. Sometimes, however, such predictions are not possible until a child reaches school age when learning, communication skills, and other abilities can be measured. The amount of help and supervision needed depends on the number of problems and how bad the problems are.

Some children need repeated testing that may include:

• X-rays, to check for loose or dislocated hips. Children with CP are usually X-rayed several times between ages 2 and 5. A child will also have an X-ray any time he or she complains of hip pain or has other signs of dislocated hips, such as unusual leg or knee movements. Spinal X-rays also are done to look for curves in the child's spine (scoliosis).
• Gait analysis, which helps identify problems and guide treatment decisions.

Additional tests may be needed, depending on the child's symptoms or other conditions that are present.

Cerebral palsy (CP) cannot be cured. But a variety of treatments can help people with CP to maximize their abilities and physical strength, prevent complications, and improve their quality of life. The brain injury or problem that causes CP does not get worse over time. New symptoms can appear or become worse over time, however, because of how a child grows and develops.

Specific treatment varies by individual and changes as needed if new issues develop. In general, treatment focuses on measures that maintain or improve a person's quality of life and overall health.

Initial treatment

Physical therapy is an important treatment that begins soon after a child is diagnosed and often continues throughout his or her life. This therapy also may begin before a definite diagnosis is made, depending on the child's symptoms.

Medications can help control some of the symptoms of CP and prevent complications. This treatment may include injectable antispasmodics to help relax tight muscles and improve range of motion. Other medications may be used for common problems related to cerebral palsy, such as anticonvulsant medications for seizures.

In some cases, orthopedic surgery (for muscles, tendons, and joints) or selective posterior rhizotomy (cutting nerves of affected limbs) for contracture or other mobility problems is performed soon after diagnosis on a baby or very young child with severe problems.

Often the biggest problem for parents is fear of the unknown. Learning about CP can help you to understand the condition and be familiar with some of the challenges and joys of raising a child with cerebral palsy. Being informed can help give you a sense of control about how best to help your child. For more information, talk to your health professional or see the Other Places to Get Help section of this topic.

Ongoing treatment

Ongoing treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatments and adding new treatments as necessary. Although the brain injury that causes CP does not get worse over time, some of its effects can appear for the first time, change, or become more severe as a child gets older.

Regular visits with your child's health professional and specialists are important for monitoring your child's condition. These visits may include tests, such as questionnaires to evaluate whether new developmental milestones are being achieved as expected, or periodic blood tests to find out about the effects of medication your child may be taking. Your child should also have regular eye, hearing, and speech evaluations.

Other tests may be done to determine whether common problems related to cerebral palsy have developed. These problems can then be treated as they appear.

Ongoing treatment for cerebral palsy may include:

• Physical therapy. This is usually an important part of ongoing treatment for CP and can help your child become as mobile as possible. It may also help prevent the need for surgery. If a child has surgery, intense physical therapy may be needed for 6 months or more.
• Monitoring of any medications being taken to help control symptoms and prevent complications. Medications may include antispasmodics or injectable antispasmodics to help relax muscles and reduce spasms, anticonvulsants to help treat seizures, or anticholinergics to help manage uncontrollable body movements (dystonic cerebral palsy) or frequent drooling.
• Orthopedic surgery (for muscles, tendons, and joints) or selective posterior rhizotomy (cutting nerves of affected limbs) to try and prevent problems with bones and related muscles, ligaments, and tendons.
• Special devices and equipment, such as braces, casts, and splints. The specific types used depend on a child's needs. For example, a child may get a cast after surgery or as a means to restrict movement in one area to strengthen muscles and tendons in another part of the body.

Ongoing treatment for CP may also include:

• Biofeedback. This therapy may be useful as part of physical therapy or on its own. During biofeedback sessions, people with CP learn ways to control their affected muscles. Some people find this technique helpful in reducing muscle tension. Biofeedback does not help everyone with CP.
• Massage therapy and hatha yoga. These therapies are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP.
• Therapies to stimulate learning and sensory development. Babies and young children may benefit from these stimulation or neurodevelopmental therapies. Some of these therapies also help people of other ages. These therapies cannot repair damaged parts of the brain. However, they may be able to stimulate undamaged parts of the brain.

You may hear about a wide range of controversial treatments. Some of these may cause harm. Do not be afraid to talk to your health professional about any type of treatment you are considering for your child.

Each person with CP has unique strengths and areas of difficulty. However, most people with CP need ongoing help with:

• Feeding and eating. Cerebral palsy can affect jaw control and interfere with the ability to chew, suck, and swallow. Special utensils, such as plates that stick to a surface; properly positioning your child at meals; and serving soft or semi-solid foods, such as oatmeal, may be helpful.
• Using the toilet. Some people with cerebral palsy have stiff hip joints or similar problems that make using a toilet difficult. Others do not have dependable bladder control. Training from an occupational therapist and special undergarments are common ways to help treat this condition.
• Bowel elimination. People with CP often become constipated, making stools difficult to pass. Stool softeners and mild laxatives are frequently used for this problem. For more information, see the topics Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
• Bathing and grooming. People with cerebral palsy who do not have control of their hands or arms usually are unable to groom themselves. Others can be taught some level of self-grooming through regular practice.
• Dressing. Provide clothing and shoes that are easy to put on and take off, such as those that zip or button in the front (not the back) or that have large buttons, ties, or Velcro fasteners.
• Dental care. Cerebral palsy can affect the jaw muscles, make teeth improperly positioned and prone to decay, and cause sensitivity in the mouth and tongue. Also, many people with CP find it difficult to use a toothbrush. You can help your child by providing special equipment, such as a mechanized teeth-cleaning water spray or electric toothbrush; buying toothpaste for sensitive gums; and making sure he or she has regular dental cleanings.
• Skin care. Drooling is common in people with CP, and it can cause skin irritation around the chin, mouth, and chest. You can help protect skin by blotting rather than wiping drool, using absorbent cloths to cover the chest, and applying lotions or cornstarch to areas that are prone to irritation.
• Speaking. Some people with CP have problems with the muscles in their jaws and mouth as well as hearing loss. These problems, alone or in combination, can make it difficult for them to form words. You can make better communication possible by speaking slowly, looking directly at your child during conversations, and using pictures or objects as you talk. Reading to your child is also important, and using books with bright pictures may be most effective.
• Safety. People with CP are prone to falls and other accidents, especially if they are affected by seizures. You can take general safety measures at home—such as having heavy, sturdy furniture or not polishing floors—to help your child avoid accidents. Also, use common sense and care around sharp objects and never leave a person with CP alone while he or she is bathing.

Behavioral therapy, in which a counselor helps a child learn better ways to communicate, may be a part of ongoing treatment. It is most often used to help school-age children with CP learn better ways to interact with others, especially their peers.

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 ongoing treatment for people with cerebral palsy. Specifically, these strategies include:

• Researching and understanding your child's educational rights. In the United States, disabled children are eligible for free early treatment programs and equal access to public education. You also have the right to be fully informed about educational decisions concerning your child. Contact your state and local education departments for detailed information about these accommodations. In addition, vocational training may benefit some teens and young adults.
• Working with your child's teachers, school administrators, special learning consultants, and school boards to develop the best educational plan for your child. A cooperative team approach helps your child realize his or her potential.
• Supporting your child emotionally. Your child's needs will change over time. As children grow and become more aware of their physical limitations, they need to be able to talk about their feelings and how they are treated. It is sometimes easier for them to talk with someone who is not a family member. Ask your health professional about whether emotional counseling might benefit your child. In addition, involve your child as much as possible when making decisions about his or her health care.
• Getting proper rest, eating well, exercising, and learning ways to cope with the challenges of raising a child with CP. You will be better equipped to help your child when you have physical energy and emotional strength.
• Working together as a family. The entire family is affected when one member has CP. Helping family members cope with this situation is important, especially for siblings. You can help prevent other children from developing unrealistic fears and concerns, feeling left out, or becoming overwhelmed.

Of all children diagnosed with cerebral palsy, 90% live to adulthood (beyond 20 years old).³ Most adults with CP are employed, despite moderate to severe physical disability. As your child with CP approaches this stage of life, consider enrolling him or her in occupational therapy as part of a gradual preparation for independent living. Helping your child be independent requires patience and resourcefulness on your part. Expect some frustrating setbacks or obstacles. Your child may need extra help and encouragement to prepare for additional expectations and responsibilities.

Treatment if the condition gets worse

Although the brain injury that causes cerebral palsy (CP) does not get worse over time, some of its effects can appear for the first time, change, or become more severe as a child's nervous system grows and develops.

Common problems related to cerebral palsy may develop, become more severe, or lead to complications. Treatment varies by the individual and type of problem but generally can include medication, surgery, specialized therapies, and orthopedic equipment.

Medication

Medications can help treat effects that some people experience with CP, such as muscle spasms or seizures.

If severe muscle spasms develop, antispasmodic pills may be given. These pills include diazepam (Valium), dantrolene (Dantrium), and baclofen (Lioresal). Or, less commonly, intrathecal baclofen (ITB) may be given. For this, a small pump is placed under the skin of the abdomen. This pump releases baclofen into the fluid around the spinal cord. ITB may be more helpful than the pill at relieving spasms, but it is harder to do than pills and has some risks (such as infection where the pump is implanted).

Injectable antispasmodics, such as botulinum toxin (Botox), are sometimes used. This medicine can be given with a needle directly into an affected muscle. Botulinum toxin may be more useful than antispasmodic pills for the treatment of CP. But in rare cases, severe side effects can occur.

If seizures become a problem, anticonvulsants such as carbamazepine (Tegretol) are used. Anticholinergics, such as glycopyrrolate (Robinul) help a minority of people with CP who have uncontrollable body movements (dystonic cerebral palsy) or drool frequently.

Surgery Types of surgery include:

• Orthopedic surgery to loosen tight muscles, tendons, and joints, particularly on the hips, knees, and ankles.
• Selective posterior rhizotomy to cut nerves on the limbs that are most affected by movements and spasms to allow more flexibility and control.

A doctor evaluates symptoms, age, and the person's general state of health when considering whether to recommend surgery. A thorough checkup is needed to help the doctor determine which muscles and nerves are affected and what type of surgery would best treat the condition. A gait analysis may be included, which evaluates the person's walking patterns.

Physical therapyPhysical therapy is often used as part of ongoing treatment, 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. Biofeedback may be useful as part of physical therapy or on its own. Although biofeedback does not help everyone with CP, some people who use the technique learn how to control their affected muscles or reduce muscle tension.

Special devices and equipment Many people with CP benefit from using materials to maintain or improve joint mobility, help strengthen muscles and relax overactive (spastic) muscles, and assist with daily activities. Such devices and equipment may include orthotics, casts, standers, special seats, walkers, wheelchairs, special shoes, and other individualized materials to help with specific problems.

Individualized therapies may also be needed depending on the specific need that develops.

• Occupational therapy helps adults adapt to their limitations and live as independently as possible.
• Speech therapy helps control the mouth muscles. This therapy can be of great benefit to children with speech or eating problems. Speech therapy often starts before the child begins school and continues throughout the school years.
• Nutritional counseling may help when dietary needs are not met because of problems with eating certain foods.
• Both massage therapy and hatha yoga are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP.
• Therapies to stimulate learning and sensory development may benefit babies and young children. Some also help people of other ages. These therapies cannot repair damaged parts of the brain. But they may be able to stimulate undamaged parts of the brain.
• Behavioral therapy helps some school-age children with CP learn better ways to communicate with others.

You may hear about a wide range of controversial treatments, some of which may cause harm. Do not be afraid to talk to your health professional about any type of treatment you are considering for your child.

The cause of cerebral palsy (CP) sometimes is not known. But links have been identified between CP and certain conditions during pregnancy, birth, and early childhood. Some of these can be prevented, and some cannot.

You can help prevent CP before and during your pregnancy by adopting and maintaining healthy habits.

• Eat nutritious foods.
• Do not smoke.
• Avoid exposure to harmful substances.
• See your health professional regularly.

Also, help prevent CP in your young child by minimizing your child's risk for sustaining a brain injury.

• Take measures to prevent accidents.
• Make sure you are familiar with the signs of jaundice in newborns.
• Know how to prevent lead poisoning.
• Keep your child away from people who have serious contagious illnesses, such as meningitis.
• Make sure your child's immunizations are up-to-date. For more information, see the topic Immunizations.

Family members working together with health professionals can use home treatment to provide the best possible care for a baby or young child with cerebral palsy (CP).

Education and support for parents and family members

• Learn about the condition. Often the biggest problem for parents is fear of the unknown. Learn about the condition so you are best able to help your child. You may find local or national cerebral palsy organizations helpful, especially in dealing with the impact of daily emotional and lifestyle issues. Talk with your health professional or call your local hospital for suggestions. For more information, see the Other Places to Get Help section of this topic.
• Learn about your child's educational rights.Educational rights for disabled children are mandated by law in the United States. These laws include free early treatment programs, equal access to public education, and protection of the parents' rights to be fully informed about or disagree with educational decisions concerning their child. Contact your state and local education departments for specific information about these accommodations. In addition, vocational training may benefit some teens and young adults.
• Work with teachers and school officials. Work with your child's teachers, school administrators, special learning consultants, and school boards to develop the best educational plan for your child. A cooperative team approach helps your child realize his or her potential.
• Provide emotional support. The needs of a child with CP change over time. As children grow and become more aware of their physical limitations, they need to be able to talk about their feelings and how they are treated. It is sometimes easier for them to talk with someone who is not a family member. Ask your health professional about whether emotional counseling would benefit your child. In addition, include your child when making decisions about his or her health care.
• Take care of yourself. Get proper rest, eat well, exercise, and learn ways to cope with the challenges of raising a child with CP. You will be better equipped to help your child when you have physical energy and emotional strength.
• Help each other. The entire family is affected when one member has CP. Helping family members cope with this situation is important, especially for siblings. You can help prevent other children from developing unrealistic fears and concerns, feeling left out, or becoming overwhelmed.

Helping with daily routines

Each person with CP has unique strengths and areas of difficulty. However, most people with CP need ongoing help with:

• Feeding and eating. Cerebral palsy can affect jaw control and interfere with the ability to chew, suck, and swallow. Special utensils, such as plates that stick to a surface; properly positioning your child at meals; and serving soft or semi-solid foods, such as oatmeal, may be helpful.
• Using the toilet. Some people with cerebral palsy have stiff hip joints or similar problems that make using a toilet difficult. Others do not have dependable bladder control. Training from an occupational therapist and special undergarments are common ways to help treat this condition.
• Bowel elimination. People with CP often become constipated, making stools difficult to pass. Stool softeners and mild laxatives are frequently used for this problem. For information about preventing and treating constipation, see the topics Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
• Bathing and grooming. People with cerebral palsy who do not have control of their hands or arms usually are unable to groom themselves. Others can be taught some level of self-grooming through regular practice.
• Dressing. Provide clothing and shoes that are easy to put on and take off, such as those that zip or button in the front (not the back) or that have large buttons, ties, or Velcro fasteners.
• Dental care. Cerebral palsy can affect the jaw muscles, make teeth improperly positioned and prone to decay, and cause sensitivity in the mouth and tongue. Also, many people with CP find it difficult to use a toothbrush. You can help your child by providing special equipment, such as a mechanized teeth-cleaning water spray or electric toothbrush; buying toothpaste for sensitive gums; and making sure he or she has regular dental cleanings.
• Skin care. Drooling is common in people with CP, which can cause skin irritation around the chin, mouth, and chest. You can help prevent skin irritations and protect your child's skin by blotting rather than wiping drool, using absorbant cloths to cover the chest, and applying lotions or corn starch to areas that are prone to irritation.
• Speaking. Some people with CP have problems with the muscles in their jaws and mouth as well as hearing loss. These problems, alone or in combination, can make it difficult to form words. You can make better communication possible by speaking slowly, looking directly at your child during conversations, and using pictures or objects as you talk. Reading to your child is also important, and using books with bright pictures may be most effective.
• Safety. People with CP are prone to falls and other accidents, especially if they are affected by seizures. You can take general safety measures at home—such as having heavy, sturdy furniture or not polishing floors—to help your child avoid accidents. Also, use common sense and care around sharp objects, and never leave a person with CP alone while he or she is bathing.

Preparing for independence

Parents and other caregivers can help children with CP develop to their highest potential. One of the most important things is to help them learn to do as much for themselves as they can. A recent study found that most adults with CP (84%) feel that their parents overprotected them as children.⁴

Teenage years

As your child approaches the teenage years and young adulthood, be aware of his or her changing needs.

• Teens and adults with CP need emotional support and understanding. Family members and other supportive friends and family can help them deal with the daily challenges of having CP.
• Gradually prepare your child with CP for independent living. Usually teens have learned to use their talents and strengths. But they may need extra help and encouragement to prepare for additional expectations and responsibilities.
• Teens and young adults with CP may also need more guidance than other people their age in developing intimate relationships.

Parents must also recognize that they will need to change their own routines as their child with CP grows and develops. For example, parents may not be able to continue caring for a severely affected child who is growing tall and heavy. Parents also need to plan ahead for the time when their grown child with CP is not under their care. For more information, see the Other Places to Get Help section of this topic.

Adulthood

Of all children diagnosed with cerebral palsy, 90% live to adulthood (beyond 20 years old).³ Preparing your child for adulthood takes careful planning. It also requires patience and resourcefulness on your part. Do not abandon your efforts because of frustrating setbacks or obstacles.

• Encourage independent living skills. A time may come when you or other family members can no longer assist your child with CP at the accustomed level.
• Complications of cerebral palsy may develop and affect quality of life. In addition, some forms of CP are more severe and require special assistance. For these reasons, planning for an adult's current and future health care needs is important.
• Occupational therapy and similar programs may be helpful. Most adults with CP are employed, despite moderate to severe physical disability. In the United States, laws protect the rights of disabled people to find and hold employment (among other rights). Learn about the provisions of the Americans with Disabilities Act (ADA) of 1990. For more information about the ADA, see the Other Places to Get Help section.
• Older adults with CP may need extra help preparing for retirement.

Medications can help control some of the symptoms of cerebral palsy (CP), prevent or minimize complications, and treat other medical conditions related to CP.

Medication Choices

Antispasmodics are the most common medications used for people with CP. Antispasmodics can help relax tight muscles and reduce muscle spasms. Most antispasmodics are taken orally and include:

• Diazepam (such as Valium).
• Baclofen (Lioresal).
• Dantrolene sodium (Dantrium).

Although these medications are given as a pill to swallow (oral medication), baclofen can also be given using a method called intrathecal baclofen (ITB). For this, a small pump is placed under the skin of the abdomen. This pump releases baclofen into the fluid around the spinal cord. ITB may be more helpful than taking a pill at relieving severe spasms. But it is harder to do than pills, and has some risks (such as infection where the pump is implanted).

Injectable antispasmodics, which are injected directly into stiff or spasmatic muscles, are occasionally used to help them relax. These medications typically remain effective for about 3 to 8 months, depending on the type used. Injectable antispasmodics used for treating CP include:

• Phenol or alcohol "washes."
• Botulinum toxin (Botox).

Anticonvulsants are used as treatment for people with CP who have seizures. Most commonly used anticonvulsants include:

• Gabapentin (Neurontin).
• Lamotrigine (Lamictal).
• Oxcarbazepine (Trileptal).
• Topiramate (Topamax).
• Zonisamide (Zonegran).

Anticholinergics help a minority of people with CP who have uncontrollable body movements (dystonic cerebral palsy) or who drool frequently. These include:

• Benztropine mesylate (Cogentin).
• Carbidopa-levodopa (Sinemet).
• Glycopyrrolate (Robinul).
• Procyclidine hydrochloride (Kemadrin).
• Trihexyphenidyl hydrochloride (Artane).

Stool softeners and mild laxatives may help treat constipation, which is a common complaint of people with CP.

What To Think About

Medication for cerebral palsy (CP) targets individual needs. Unfortunately, medication has had limited success in treating CP, especially the types that involve involuntary movements (athetoid type of dyskinetic cerebral palsy).

Botulinum toxin may be more useful than antispasmodic pills for treating CP.

Some medications used to treat CP have serious side effects. For example, dantrolene sodium (Dantrium) can cause liver damage, so frequent blood tests are needed while taking this medication. And in rare cases, the use of botulinum toxin is related to severe side effects, such as trouble breathing or swallowing.

Some health professionals believe that the most commonly used medications to treat CP (diazepam [such as Valium], baclofen [Lioresal], and dantrolene [Dantrium]) should not be given to growing children. They are concerned that the side effects from these medications can cause problems for children that are more severe than the tight muscles and muscle spasms related to CP. For example, one side effect of these medications is drowsiness. Drowsiness may interfere with a child's ability to concentrate and learn in school. Other health professionals believe that the benefits of these medications outweigh the risk of side effects.

Ask your doctor the following questions about any medication prescribed for your child:

• How successful is the medication in treating your child's problem?
• What are the short-term and long-term side effects of the medication?
• What are the chances that the medication will stop working? Discuss what options are available if this happens.
• How might the medication affect your child's growth and development?

Surgery for people with cerebral palsy (CP) usually involves either:

• Loosening tight muscles and releasing fixed joints, most often performed on the hips, knees, and ankles. In rare cases, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers.
• Cutting nerves on the limbs most affected by movements and tightness (spasticity). This procedure reduces spasms and allows more flexibility and control of the affected limbs and joints.

A doctor evaluates the person's symptoms, age, and general state of health when considering whether to recommend surgery.

A thorough checkup is needed to help the doctor determine which muscles and nerves are affected and what type of surgery would best treat the condition. A gait analysis is part of the examination if the person is able to walk.

For young children, surgery may be postponed if doing so will likely prevent the need for additional surgery in the future.

Other surgeries related to cerebral palsy

Surgery for various orthopedic problems: Surgery for other problems is sometimes needed for children with CP. These surgeries vary depending upon the specific problems involved. For example, some children may need surgery to correct uneven leg length, dislocation of the hip, curves in the spine (scoliosis), or an eye problem.

Medication-related surgery: A small pump is surgically implanted under the skin in the abdomen for some people with CP. This pump is used to deliver medications, such as baclofen (Lioresal), directly into the fluid surrounding the spinal cord. For more information, see antispasmodics.

Surgery Choices

The main surgery choices for people affected by cerebral palsy (CP) are:

Orthopedic surgery (for muscles, tendons, and joints). This type of procedure is done to lengthen a tendon to increase a limb's range of motion by cutting through a muscle or tendon (release) and sometimes reattaching it in a different area.¹

Selective posterior rhizotomy (cutting nerves of affected limbs). This procedure is usually considered only for children with severe muscle tightness in the legs.

What To Think About

Health professionals do not agree about the best age for people with cerebral palsy (CP) to have surgery.

• Some surgeons believe that children less than 2 years old with CP benefit most from orthopedic surgeries because it allows them to grow and develop more like other children.
• Some health professionals believe that all surgery should wait until a child is older than age 2, and some prefer to wait until sometime between ages 6 and 8 years. They believe that more problems can be corrected during the same surgery if orthopedic surgery is postponed until the child is older.

Surgery is not used nearly as often for the arms as for the legs. Surgery on arm deformities carries more risks related to sensory damage; also, surgery has a more limited impact on functional abilities than on the legs.⁸

Sometimes medications or physical therapy are used to postpone or eliminate the need for surgery. Physical therapy is also needed for most children after surgery. The type of therapy and special equipment needed after surgery (such as braces, casts, and splints) depend on the child's specific needs. In general, post-surgical physical therapy usually starts as soon as possible and may continue for as long as 6 months.

Physical therapy is one of the most important treatments for cerebral palsy (CP). It usually begins soon after diagnosis and often continues throughout life. Some people with CP may begin physical therapy before being diagnosed, depending on their symptoms.

Special devices and equipment are needed for some people with CP to help them with specific problems. For example:

• A child who develops uneven leg length may need to wear special shoes with a higher sole and heel on the shorter leg.
• Some people who are not able to walk without assistance may need to use canes, crutches, walkers, or wheelchairs.
• Physical therapy and special equipment may be used together, such as for constraint-induced movement therapy, also called shaping. This approach encourages a child to increase movements by presenting interesting activities or objects and giving praise and rewards when a child makes attempts to use the less-functioning muscles.⁹

Occupational therapy helps adults adapt to their limitations and live as independently as possible.

Speech therapy helps control the mouth muscles. This therapy can be of great benefit to children with speech or eating problems. Speech therapy often starts before the child begins school and continues throughout the school years.

Nutritional counseling may help when dietary needs are not met because of problems with eating certain foods.

Biofeedback may be useful as part of physical therapy or on its own. During a biofeedback session, people with CP learn how to control their affected muscles. Some people learn ways to reduce muscle tension with this technique. Biofeedback does not help everyone with CP.

Both massage therapy and hatha yoga are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP.

Other treatments that vary by age or specific need include:

• Therapies to stimulate learning and sensory development. Babies and young children may benefit from these stimulation or neurodevelopmental therapies. Some of these therapies also help people of other ages. These therapies cannot repair damaged parts of the brain. But they may be able to stimulate undamaged parts of the brain that the person is not currently using.
• Behavioral therapy. This type of therapy helps some school-age children with CP learn better ways to communicate with others.

Several controversial therapies exist for CP, such as electrical stimulation and special diets. If you are considering these types of treatments, talk to your doctor about any related research or where to find more information.

Online Resource

Organizations

• Multiple Pregnancy: Twins or More
• Premature Infant
• Shaken Baby Syndrome

Citations

1. Pellegrino L (2002). Cerebral palsy. In M Batshaw, ed., Children With Disabilities, 5th ed., pp. 443–466. Baltimore: Paul H. Brooks Publishing.

2. Liptak GS (2001). Cerebral palsy. In RA Hoekelman, ed., Primary Pediatric Care, pp. 468–473. St. Louis: Mosby.

3. Rapp CE, Torres MM (2000). The adult with cerebral palsy. Archives of Family Medicine, 9: 466–472.

4. Murphy KP, et al. (2000). Employment and social issues in adults with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 81: 807–111.

5. Wu YW, Colford JM (2000). Chorioamnionitis as a risk factor for cerebral palsy. JAMA, 284(11): 1417–1424.

6. Wu Y (2002). Systematic review of chorioamnionitis and cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews, 8: 25–29.

7. Ashwal S, et al. (2004). Practice parameter: Diagnostic assessment of the child with cerebral palsy. Neurology, 62(6): 851–863.

8. Koman LA, et al. (2004). Cerebral palsy. Lancet, 363(9421): 1619–1631.

9. Taub E, et al. (2004). Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics, 113(2): 305–312.

Other Works Consulted

• Diamond M, Armento M (2005). Cerebral palsy section of Children with disabilities. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 2, pp. 1499–1517. Philadelphia: Lippincott Williams and Wilkins.

• Rapin, I (2005). Cerebral palsy section of Static disorders of brain development. In LP Rowland, ed., Merritt's Neurology, 11th ed., pp. 577–579. Philadelphia: Lippincott Williams and Wilkins.

• Wu YW, et al. (2003). Chorioamnionitis and cerebral palsy in term and near-term infants. JAMA, 290(20): 2677–2684.