Cerebral Palsy in Children: causes, symptoms, treatment

Medically reviewed: 9, December 2023

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Cerebral Palsy in Children: An Overview

Cerebral palsy (CP) is a collection of neurological disorders that impact the ability to move, maintain posture, and maintain balance.

This condition happens when something goes wrong with the brain before a baby is born or soon after they are born. It affects how they can move their body and is the most common kind of disability that kids have. In the United States, about 1.5 to 4 out of every 1, 000 babies are born with this condition.

It is essential to note that CP is a lifelong condition that can vary in severity and type, often being accompanied by additional challenges such as intellectual disability, epilepsy, vision impairment, and speech difficulties. While there is currently no known cure for CP, there are various treatments available that can enhance functionality and improve the overall quality of life for affected children and their families.

Causes of Cerebral Palsy in Children

CP is caused by injury or disruption to the developing brain, which can occur at different stages of fetal, perinatal, or postnatal development. The exact cause of CP is often unknown, but some risk factors have been identified, such as:

  • Premature birth
  • Low birth weight
  • Infection or inflammation of the placenta or amniotic fluid
  • Maternal infection or fever during pregnancy
  • Genetic or metabolic disorders
  • Bleeding or stroke in the fetal or neonatal brain
  • Lack of oxygen or blood supply to the brain
  • Severe jaundice or kernicterus
  • Head trauma or infection in infancy

Symptoms of Cerebral Palsy in Children

The symptoms of cerebral palsy can vary greatly depending on the type, location, and extent of brain damage. The symptoms usually appear in infancy or early childhood, and may change over time as the child grows and develops. Some common symptoms of cerebral palsy include:

  • Abnormal muscle tone, such as spasticity, rigidity, or hypotonia
  • Impaired muscle coordination, balance, and reflexes
  • Involuntary movements, such as tremors, athetosis, or dystonia
  • Difficulty with fine and gross motor skills, such as grasping, reaching, crawling, or walking
  • Abnormal posture or gait, such as scissoring, toe walking, or crouching
  • Favoring one side of the body, such as hemiplegia or hemiparesis
  • Difficulty with speech, swallowing, drooling, or breathing
  • Problems with vision, hearing, sensation, or cognition

Cerebral palsy is a condition that affects how a person moves their body. There are different types of CP based on what parts of the body are affected and how the person’s movements are affected.

Spastic cerebral palsy

This is the most common type of CP, affecting about 80% of children with CP. It is characterized by increased muscle tone and stiffness, resulting in jerky and restricted movements. Spastic CP can affect one limb (monoplegia), one side of the body (hemiplegia), both legs (diplegia), three limbs (triplegia), or all four limbs (quadriplegia).

Dyskinetic cerebral palsy

This type of CP affects about 10% of children with CP. It is characterized by involuntary and fluctuating movements, such as twisting, writhing, or jerking. Dyskinetic CP can affect the whole body or specific parts, such as the face, mouth, tongue, or limbs. It can be further divided into athetoid CP, which involves slow and writhing movements, and dystonic CP, which involves rigid and fixed postures.

Ataxic cerebral palsy

This type of cerebral palsy affects about 5% of children with CP. It is characterized by poor balance and coordination, resulting in unsteady and shaky movements. Ataxic CP can affect the whole body or specific parts, such as the trunk, limbs, or eyes. It can also affect fine motor skills, such as writing, buttoning, or using utensils.

Mixed cerebral palsy

This type of CP affects about 5% of children with cerebral palsy. It is characterized by a combination of two or more types of movement disorders, such as spasticity and dyskinesia. Mixed cerebral palsy can affect different parts of the body in different ways.

Treatment of cerebral palsy in children

The treatment of cerebral palsy in children is aimed at improving function, reducing pain, preventing complications, and enhancing quality of life. The treatment is individualized and multidisciplinary, involving a team of health care professionals, such as pediatricians, neurologists, orthopedists, physical therapists, occupational therapists, speech therapists, psychologists, and educators. The treatment options for CP in children include:

Medications for cerebral palsy

These are medicines that help the body feel better and work more smoothly. They can help with things like tight muscles, jerky movements, shaking, and feeling uncomfortable. Some examples of these medicines are:

  • Botulinum toxin (Botox): This is injected into specific muscles to temporarily reduce spasticity and improve range of motion. It can also help with drooling and bladder control.
  • Baclofen: This is a muscle relaxant that can be taken orally or delivered through a pump implanted near the spinal cord (intrathecal baclofen). It can help reduce spasticity and pain in the limbs and trunk.
  • Diazepam: This is a sedative that can be taken orally or given intravenously. It can help reduce spasticity, anxiety, and seizures.
  • Dantrolene: This is a muscle relaxant that can be taken orally. It can help reduce spasticity and rigidity in the limbs.
  • Antiepileptic drugs: These are used to prevent or control seizures, which can occur in about 30% of children with CP. Some common antiepileptic drugs are phenobarbital, phenytoin, carbamazepine, valproic acid, and levetiracetam.

Other types of therapy for cerebral palsy

  1. Physical therapy is like going to a special exercise class with a teacher called a physical therapist. They help kids with CP do exercises and activities to make their muscles stronger, help them move better, and keep their balance. They can also help kids learn important skills like sitting, standing, walking, or using a wheelchair. Sometimes they might use special devices like braces or splints to help kids’ arms and legs stay in the right position.
  2. Occupational therapy: This involves helping the child learn to perform everyday activities, such as dressing, eating, bathing, or playing. An occupational therapist can teach the child alternative strategies and adaptive equipment, such as walkers, canes, or crutches, to enhance independence and participation. Occupational therapy can also address sensory issues, such as touch, vision, or hearing, that may affect the child’s development and behavior.
  3. Speech and language therapy: This involves helping the child improve communication, using verbal or nonverbal methods, such as sign language or a special device. A speech therapist can also help with swallowing problems, such as drooling or choking, and teach the child exercises to strengthen the muscles of the mouth and throat.
  4. Recreational therapy: This involves engaging the child in art, music, sports, or other activities that can improve motor and cognitive skills, as well as emotional and social well-being. Recreational therapy can also provide opportunities for fun, creativity, and self-expression.

Surgery for cerebral palsy

This may be considered for children with severe or disabling symptoms that do not respond to other treatments. Surgery can help lengthen or release tight muscles and tendons, reposition or stabilize bones and joints, correct spinal deformities, or cut certain nerves to reduce spasticity or abnormal movements.

Some common surgeries for cerebral palsy are:

  • Orthopedic surgery: This is performed to improve the alignment and function of the bones, muscles, and joints. It can involve procedures such as tendon release, tendon transfer, osteotomy, or arthrodesis.
  • Selective dorsal rhizotomy: This is performed to reduce spasticity in the legs. It involves cutting some of the nerve fibers that carry sensory signals from the muscles to the spinal cord.
  • Deep brain stimulation: This is performed to reduce dyskinesia in the limbs or face. It involves implanting electrodes in specific areas of the brain and connecting them to a battery-powered device that delivers electrical impulses.

Prevention of cerebral palsy in children

CP cannot be completely prevented, but some measures can be taken to reduce the risk of brain injury or abnormal development that can lead to CP. These include:

  • Getting regular prenatal care, including screening and treatment for infections, diabetes, high blood pressure, or other maternal health problems
  • Getting vaccinated for rubella, chickenpox, and other infectious diseases before or during pregnancy
  • Avoiding alcohol, tobacco, drugs, or environmental toxins during pregnancy
  • Monitoring fetal growth and well-being, and seeking prompt medical attention for any signs of distress or complications
  • Choosing a safe and appropriate mode and place of delivery, and ensuring adequate fetal monitoring and emergency care
  • Providing prompt and adequate resuscitation and stabilization for newborns who have breathing difficulties, low blood sugar, or other problems
  • Preventing head trauma or infection in infants and young children, by using car seats, helmets, and other safety devices, and following immunization and hygiene guidelines

Risks and Complications of cerebral palsy in children

CP can affect various aspects of a child’s health and development, and may lead to various complications, such as:

  • Contractures: These are permanent shortening or tightening of the muscles and tendons, leading to reduced range of motion and deformity of the limbs and joints.
  • Hip dislocation: This is a condition where the head of the thigh bone slips out of the socket of the pelvis, causing pain, stiffness, and difficulty walking.
  • Scoliosis: This is a condition where the spine curves sideways, causing back pain, breathing problems, and reduced height
  • Osteoporosis: This is a condition where the bones become weak and brittle, increasing the risk of fractures and deformities. Osteoporosis can be caused by reduced physical activity, poor nutrition, hormonal changes, or medication side effects.
  • Malnutrition: This is a condition where the body does not get enough nutrients, such as calories, protein, vitamins, or minerals, to function properly. Malnutrition can be caused by feeding difficulties, swallowing problems, gastrointestinal disorders, or dietary restrictions.
  • Growth failure: This is a condition where the child does not grow or develop as expected, resulting in low height, weight, or head circumference. Growth failure can be caused by genetic factors, hormonal disorders, or environmental factors, such as malnutrition, infection, or stress.
  • Dental problems: These include tooth decay, gum disease, or tooth loss, which can affect the appearance, function, and health of the mouth. Dental problems can be caused by poor oral hygiene, dry mouth, acid reflux, or medication side effects.
  • Respiratory problems: These include pneumonia, bronchitis, asthma, or sleep apnea, which can affect the breathing, oxygenation, and quality of sleep. Respiratory problems can be caused by aspiration, infection, allergy, or muscle weakness.
  • Urinary problems: These include urinary tract infection, urinary incontinence, or urinary retention, which can affect the bladder, kidney, and urethra. Urinary problems can be caused by neurogenic bladder, spastic bladder, or medication side effects.
  • Bowel problems: These include constipation, diarrhea, or fecal incontinence, which can affect the colon, rectum, and anus. Bowel problems can be caused by neurogenic bowel, spastic bowel, or medication side effects.
  • Skin problems: These include pressure ulcers, eczema, or dermatitis, which can affect the integrity, appearance, and comfort of the skin. Skin problems can be caused by immobility, friction, moisture, infection, or allergy.
  • Pain: This is a subjective sensation of discomfort, distress, or suffering, which can affect the physical, emotional, and social well-being. Pain can be caused by muscle spasm, contracture, fracture, infection, inflammation, or nerve damage.
  • Mental health problems: These include depression, anxiety, or behavioral disorders, which can affect the mood, cognition, and personality. Mental health problems can be caused by biological factors, psychological factors, or social factors, such as stress, trauma, isolation, or stigma.

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