Cerebral palsy is the most common motor disorder in children. It affects between 1 and 4 out of every 1,000 kids. Identifying cerebral palsy early gives families, physicians, and specialists a better chance to improve a child's outcomes by acting as a team. Together, they can provide evidence-based therapies while the young brain is still developing and most adaptable to change.
The American Academy of Pediatrics (AAP) and the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) provided updated guidance for doctors in the clinical report, "Providing a Primary Care Medical Home for Children and Youth with Cerebral Palsy." The report was published in the December 2022
Coordinating care for kids with cerebral palsy
"As a primary care physician, a critical task is to integrate and orchestrate care across multiple organ systems and health care specialists. At the same time, we provide families with resources and support to help the child or adolescent thrive" said Garey Noritz, MD, FAAP, FACP, lead author of the report and chairperson of the AAP Council on Children With Disabilities.
"Physicians also act as advocates who can help families navigate their relationships with the medical system, therapy providers,
schools, community groups and other resources," he said.
The importance of developmental screening
Children with cerebral palsy may show delays in meeting development milestones, or may have problems with movement and coordination, speech and eating, development or muscle tone.
Some children will be identified as being "at risk" for cerebral palsy or other developmental disorders because of their medical history. This may include
preterm birth and difficulties during and shortly after pregnancy. These children should be followed closely for
motor and other developmental problems.
However, many children with cerebral palsy have no identifiable risks from their birth or medical history. That's why it is important to identify them through screening and surveillance activities in the primary care
The AAP recommends standardized developmental screening for children at ages
18 months and
30 months. Screenings should include a neuromotor examination with particular attention to motor skill milestones and muscle tone.
The AAP and AACPDM also recommend:
Children with cerebral palsy should receive standard primary care visits to promote health and well-being. These should include receiving vaccinations according to the
recommended childhood and adolescent immunization schedule, with additional vaccines for those with chronic pulmonary or other conditions.
Cerebral palsy is more prevalent in Black children and children who come from families with lower socioeconomic status. Because race is a social construct rather than biological construct, these disparities may be attributable to systemic racism within the medical system. It is important that physicians identify implicit biases and barriers to screening, identification, treatment and family support for children with cerebral palsy whose lives are affected by
social determinants of health.
Children with cerebral palsy benefit from a multidisciplinary team approach to care. Teams typically consist of the child and family, the primary care provider and
medical specialists. There are also other vital health professional team members, such as physical, occupational and speech therapists.
Children with cerebral palsy frequently have other associated conditions such as epilepsy, feeding issues, hip abnormalities ,or scoliosis. These may warrant follow up with specialists including neurologists, gastroenterologists, orthopedic surgeons, etc.
Physicians should encourage families to participate in available social, recreational, and community activities based on the child and teen's interests. Pediatricians can assist with locating opportunities for
adaptive sports and recreation when indicated.
When a child has new symptoms or functional declines, these should be investigated fully as new medical problems. It should not be assumed that they are related to their underlying diagnosis of cerebral palsy.
By the time a patient reaches age 12 to 14 years, a health care transition process should begin to shift from pediatric care to adult care
"It really does 'take a village' to help children with cerebral palsy reach their full potential," Dr. Noritz said. "Families and physicians share this goal. We can partner to improve quality of life by focusing on the strengths of the child and family, providing appropriate services and adapting the environment to the needs of each child."