When Your Child Has Cerebral Palsy (CP)
Cerebral palsy (CP) causes a child to have problems with certain motor skills. This means that he or she may have trouble with coordination, movement, or muscle control. These problems are caused by damage or abnormal development of certain brain areas. Many children with cerebral palsy have normal intelligence. CP can range in severity, but it doesn’t get worse over time. CP does not get better over time either. With diagnosis and treatment, children can learn how to manage their condition.
What are the causes of CP?
Most children with CP are born with it. CP is caused by problems with brain development before birth. Or it is caused by injury to the brain during birth. CP is slightly more common in boys than girls. Babies with low birth weight or who are born before their due date (preterm) are more likely to have CP. Often there is no clear cause of CP.
What are the different types of CP?
CP has different types. These include:
Spastic CP. A child has more muscle tone than normal in the arms, torso, or legs. This causes the muscles to be stiff and jerk or spasm. In some cases, only one side of the body is affected.
Dyskinetic CP. A child has poor muscle control. This causes uncontrolled or sudden movements of the arms, legs, hands, or feet. In some cases, the facial muscles or the tongue is also affected.
Ataxic CP. A child has less muscle tone than normal and more trouble in coordinating movement. This can lead to problems walking or doing certain tasks such as dressing.
What are the symptoms of CP?
CP affects each child differently. Symptoms can range from mild to severe. While CP doesn’t get worse, symptoms can change as the nervous system develops. Most children are diagnosed between 18 to 24 months of age. It is important to watch for symptoms if your child is at risk. Your child may have CP with one or more of these symptoms:
Overly passive or irritable
Poor feeding as a baby
Weak muscles in the face, tongue (which can cause slurred speech), arms, legs, hands, or feet
Poor head control
Frequent clenching of fists
Delayed motor skills
Trouble swallowing that causes drooling
Legs spread far apart when walking (wide gait)
CP and other health problems
Children with CP are more likely to have certain other health problems. These can include:
Vision, hearing, or speech problems
Convulsions or seizures
Learning or reasoning problems including intellectual disability
Trouble with feeding
Bladder or bowel control problems
Abnormal bone development
Psychiatric disorders including anxiety and ADHD
Gastrointestinal disorders such as constipation
Breathing fluids or food into the lungs (aspiration)
Bedwetting and other urinary symptoms
Your child’s healthcare provider will give you more information about any other health problems your child has.
How is CP diagnosed?
CP usually cannot be diagnosed until your child is about 2 years old. It takes time for the healthcare provider to track your child's physical and mental development. Babies with CP are slower to develop certain skills. For example, a child may take longer learning how to roll over, sit up, crawl, or walk. Based on your child's progress by age 2, your child's healthcare provider can then confirm the diagnosis. Usually by age 3 or 4, there is enough information to predict how your child will function in the years to come.
Your child will likely see a pediatric neurologist for diagnosis and treatment. This is a healthcare provider who treats nervous system problems. No single test can diagnose CP. It takes time to figure out this diagnosis. During the process of diagnosis:
The healthcare provider gives your child a physical exam. He or she also asks about your child’s symptoms and health history. This is to check for the timing of possible brain damage or injury to your child.
The healthcare provider may order blood tests or imaging tests for your child. These may help the healthcare provider learn more about your child’s condition.
Your child will be screened for developmental milestones. Failing to meet motor milestones is a sign of cerebral palsy.
How is CP treated?
CP is permanent and cannot be cured. The goals of treating CP are to reduce pain, make it easier to move, and prevent complications from the movement problems. Treatment of CP varies depending on your child's needs. Your child will likely work with a team of teachers, healthcare providers, nurses, and therapists to learn how to manage his or her condition. Treatment may include:
Supportive services. These can include special learning facilities, or physical, occupational, or speech therapy.
Medicines. These may be prescribed to help manage symptoms, such as muscle spasms. These may include newer treatment choices. One is the medicine baclofen, which can help manage the spasticity that comes with cerebral palsy. Baclofen can be given by mouth or through a small pump into the spinal canal (intrathecal pump). Another is botulinum toxin type A, which is a muscle-relaxing medicine that can help relieve the toe-walking that is related to muscle tightening. Other medicines can be used to decrease uncontrollable movements.
Mobility aids. Your child may need aids such as a walker or leg braces to help maintain balance and help with walking. Some children may not walk at all and need a wheelchair.
Surgery. Many children with cerebral palsy will need tendon release surgery later in life in order to improve severe spasticity and reduce pain.
What are the long-term concerns?
CP is an ongoing condition that needs to be managed. With regular medical care and supportive services, your child can learn how to be as active and independent as possible.
Life expectancy depends on many factors, but most people with CP have a normal lifespan. It is important that life-threatening conditions linked to CP are managed. Make sure that your child has healthcare and lifestyle support.
Coping with your child’s condition
A positive outlook helps while supporting your child. Encourage your child to be active and to try new things. Consider counseling. This can help you and your child deal with any worries or concerns. And seek help from friends, community resources, and support groups. The more you learn about your child’s condition, the more in control you may feel. For more information about CP, contact United Cerebral Palsy at www.ucp.org.
July 11, 2018
Bass, Pat F. III, MD, MPH,Jasmin, Luc, MD