By: JoJo Yang, MD & Courtney J. Wusthoff MD, MS, FAAP
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 is the most common disability that affects a child's motor control.
How does cerebral palsy affect children?
Cerebral palsy can affect children in many different ways. Some children who have mild cerebral palsy learn to walk and run, but may do so a little later than other kids. Other children with cerebral palsy may learn to walk with the help of devices, such as a walker or leg braces. Still others may use a wheelchair. For some children, cerebral palsy makes it difficult to eat or talk, because it is hard to control the movements needed to do those things.
The type of cerebral palsy a child has may be related to what parts of the brain were injured early in life. If your child is diagnosed with cerebral palsy, it is important to share the diagnosis with doctors, therapists and school staff to help your child get the treatments and support to help them.
While cerebral palsy affects motor control, this is different than intelligence or other brain functions. A child may be very bright even though CP makes it hard for them to control some movements.
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 walk late. If a child has a known risk for cerebral palsy because of an early brain injury, special developmental check-ups are sometimes planned to watch for early signs of the condition. In other cases, families or pediatricians 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 means abnormal tightness in a child's muscles. The tightness may be felt with certain stretches. 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 with trouble bending.
Hypotonia is low muscle tone. This may show up as floppiness in the muscles. Children with hypotonia may have trouble sitting up or holding up the head.
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 or involuntary movements.
What causes cerebral palsy?
There are different reasons a child may develop cerebral palsy, including:
Premature birth. This is the most common cause of cerebral palsy in the United States.
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 or brain infections.
For children with cerebral palsy, an MRI (magnetic resonance image) may be recommended to see if there is brain injury 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 these tests.
How is cerebral palsy treated?
Cerebral palsy is a chronic, long-term 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 brain, helps development, and prevents complications.
Early Intervention. Early intervention programs can help babies who are behind in their development. A team may include behavioral specialists, physical therapists, nurses, and social workers. They teach families exercises and give tips to help a 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 and figuring out ways to work around challenges.
Speech therapy. Speech therapists can help children with learning to talk and other ways to communicate
Assistive devices. Different kinds of equipment may be helpful for children with cerebral palsy. Leg braces can support their legs as the learn to walk. Arm braces can support arms or hands in a normal position. Other types of assistive devices include communication keyboards, special wheelchairs and chairs to help with sitting.
Medications. Medications may help when therapies are not enough. These may include medicines to help with spasticity in the muscles, or injections to relax particular muscles. This can help a child participate in therapies.
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.
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, and hearing loss. Your pediatrician will help you make a plan for your child.
Preventing 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 get stuck in one position. Stretching can help preventing this complication. 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.
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.