Children with cerebral palsy have an impairment in the area of the brain that controls movement and muscle tone. Many of these youngsters have normal intelligence, even though they have difficulty with motor control and movement. The condition causes different types of motor disability, which can vary from quite mild and barely noticeable to very profound. Depending on the severity of the problem, a child with cerebral palsy may simply be a little clumsy or awkward, or he may be unable to walk.
Some children have weakness and poor motor control of one arm and one leg on the same side of the body (called hemiparesis). Many have problems with paralysis of both upper or lower extremities; this is called diplegia. In some children the muscle tone generally is increased (called spasticity or hypertonia), while others are abnormally limp (called hypotonia). While many of these children understand language, their ability to produce speech may be affected.
Cerebral palsy is caused by malformation or damage to the brain, usually during pregnancy, but occasionally during delivery, or immediately after birth. A report by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists concluded that the majority of cerebral palsy cases are not the result of events during labor and delivery, such as an insufficient supply of oxygen (hypoxia).
Premature birth is associated with an increased risk of cerebral palsy. A baby also can get cerebral palsy from very severe jaundice after birth, or later on in infancy from an injury or illness affecting the brain.
Although it may be challenging, it is important to focus your energy on optimizing your child’s development and remember that in many cases a cause cannot be identified.
Signs and Symptoms
The signs and symptoms of cerebral palsy vary tremendously because there are many different types and degrees of disability. The main clue that your child might have cerebral palsy is a delay in achieving the motor milestones. Here are some specific warning signs.
In a Baby Under Six Months
His head lags when you pick him up while he’s lying on his back.
He feels stiff.
He feels floppy.
When held cradled in your arms, he seems to overextend his back and neck—constantly acts as if he is pushing away from you.
When you pick him up, his legs get stiff and they cross or “scissor.”
In a Baby Over Six Months
In a Baby Over Ten Months
He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg.
He scoots around on his buttocks or hops on his knees, but does not crawl on all fours.
If you have any concerns about your child’s development, talk to your pediatrician at your routine visit. Because children’s rates of development vary widely, it is sometimes difficult to make a definite diagnosis of mild cerebral palsy in the first year or two of life. Often a consultation with a developmental pediatrician or pediatric neurologist will assist in the diagnosis.
A CT (computed tomography) or MRI (magnetic resonance imagery) of the head may be recommended to determine whether a brain abnormality exists. Even when a firm diagnosis is made during these early years, it often is difficult to predict how severe the disability will be in the future. However, usually by three to four years of age there is enough information to predict accurately how a child will function in years to come.
If your pediatrician suspects that your child has cerebral palsy, you will be referred to an early intervention program. These programs are staffed by early childhood educators; physical, occupational, and speech and language therapists; nurses; social workers; and medical consultants. In such a program you’ll learn how to become your child’s own teacher and therapist. You will be taught what exercises to do with your infant, what positions are most comfortable and beneficial to him, and how to help with specific problems such as feeding difficulties. You’ll be introduced to some of the newer treatment options, such as the medication baclofen, that may be able to manage the spasticity associated with cerebral palsy, and botulinum toxin type A (called Botox), which is a muscle-relaxing drug that can help relieve the toe-walking that is related to muscle tightening. You’ll receive information about so-called adaptive equipment that can help your child participate in everyday activities despite the physical problems he may have; this equipment includes special utensils to make eating easier, pencils that can be held more easily, wheelchairs, and walkers. Through these programs you also can meet parents of other children with similar disabilities and share experiences, concerns, and solutions.
The most important thing you can do for your child is to help him develop skills, become resilient, and gain positive self-esteem. When he is old enough to ask or understand, explain to him that he has a disability and reassure him that he’ll be able to make adjustments in order to succeed in life. Encourage him to perform the tasks he is ready for, but do not push him to do things at which he might fail. The professionals at early intervention centers can help you evaluate your child’s abilities and teach you how to reach appropriate goals.
Although it may be tempting, be careful about wasting time, energy, and money searching for magical cures or undertaking controversial treatments. Instead, ask your pediatrician, or contact the United Cerebral Palsy Association at www.ucp.org, for information about resources and programs available in your area.
It has been estimated that more than half of children with cerebral palsy have problems with intellectual functioning (thinking, problem solving). Many are classified as mentally retarded (or having intellectual disabilities), while others have average abilities with some learning disorders. Some have perfectly normal intelligence.
One out of every three people with cerebral palsy has or will develop seizures. (Some start having them years after the brain is damaged.) Fortunately, these seizures usually can be controlled with anticonvulsant medications.
Because the injury to the brain often affects eye muscle coordination, more than three out of four children with cerebral palsy have strabismus, a problem with one eye turning in or out. If this problem is not corrected early, the vision in the affected eye will get worse and eventually will be lost permanently. Thus it is extremely important to have your child’s eyes checked regularly by your pediatrician.
Limb Shortening and Scoliosis
Of those children with cerebral palsy affecting only one side of the body, over half will develop a shortening of the involved leg and arm. The difference between the legs is rarely more than two inches (5 cm), but an orthopedic surgeon should be consulted if shortening is noticed. Depending on the degree of difference between the legs, a heel or sole lift may be prescribed to fit into the shoe on the shorter side. This is done to prevent a tilt of the pelvis, which can lead to curvature of the spine (scoliosis) when standing or walking. Sometimes surgery is required to correct a serious degree of scoliosis. Scoliosis also can develop in the other forms of cerebral palsy involving both sides of the body.
Many children with cerebral palsy have a greater risk of developing oral diseases from poor oral hygiene. This means more gingivitis (gum disease) and cavities for these children with special needs. One reason may be that it is difficult for them to brush their teeth. However, they also have more enamel defects than other children, which may make their teeth more susceptible to decay. In addition, some medications such as seizure or asthma drugs may contribute to cavity formation.
Some children with cerebral palsy have a complete or partial hearing loss. This happens most often when the cerebral palsy is a result of severe jaundice or anoxia (a deficiency of oxygen) at birth. If you find that your baby does not blink at loud noises by one month, is not turning his head toward a sound by three to four months, or is not saying words by twelve months, discuss it with your pediatrician.
In children with spastic forms of cerebral palsy, it is often difficult to prevent “contracture,” an extreme stiffening of the joints caused by the unequal pull of one muscle over the other. A physical therapist, developmental pediatrician, or physiatrist (doctor of physical medicine) can teach you how to stretch the muscles to try to prevent the onset of contracture. Sometimes braces, casting, or medication may be used to improve joint mobility and stability.
Problems with Spatial Awareness
Over half the children with cerebral palsy affecting one side of the body cannot sense the position of their arm, leg, or hand on the affected side. (For example, when a child’s hands are relaxed, he cannot tell whether his fingers are pointing up or down without looking at them.) If this problem exists, the child rarely will attempt to use the involved hand, even if the motor disability is minimal. He acts as if it is not there. Physical or occupational therapy can help him learn to use the affected parts of his body, despite this disability.