Cerebral palsy

Symptoms

The symptoms of cerebral palsy are not usually obvious just after a baby is born. They normally become noticeable from an early age.

Speak to your health visitor or a GP if you have any concerns about your child's health or development.

Movement and development problems

The main symptoms of cerebral palsy are problems with movement, co-ordination and development.

Possible signs in a child include:

• delays in reaching development milestones – for example, not sitting by 8 months or not walking by 18 months
• seeming too stiff or too floppy (hypotonia)
• weak arms or legs
• fidgety, jerky or clumsy movements
• random, uncontrolled movements
• muscle spasms
• shaking hands (tremors)
• walking on tiptoes

The severity of symptoms varies significantly from child to child.

The parts of the body affected can also vary. Sometimes only 1 side of the body is affected, sometimes the whole body is affected, and sometimes mainly the legs are affected.

Other symptoms

People with cerebral palsy can also have a range of other problems, including:

• feeding, drooling and swallowing problems
• constipation
• problems with speaking and communication
• seizures or fits (epilepsy)
• difficulty falling asleep and/or staying asleep
• gastro-oesophageal reflux disease (GORD) – where acid from the stomach leaks up into the oesophagus (gullet)
• an abnormally curved spine (scoliosis)
• hips that pop out (dislocate) easily
• difficulty controlling the bladder (urinary incontinence)
• a learning disability – about half of children with cerebral palsy have a learning disability
• eye problems – including reduced vision, a squint or uncontrollable eye movements
• hearing loss

Causes

Cerebral palsy is caused by a problem with the brain that happens before, during or soon after birth.

The brain can either be damaged or not develop normally, although the exact cause is not always clear.

Problems before birth

Cerebral palsy is usually caused by a problem that affects the development of a baby's brain while it's growing in the womb.

These include:

• damage to part of the brain called white matter, possibly as a result of a reduced blood or oxygen supply – this is known as periventricular leukomalacia (PVL). 
• an infection caught during pregnancy – such as cytomegalovirus, rubella (german measles), chickenpox or toxoplasmosis
• a stroke – where there's bleeding in the baby's brain or the blood supply to their brain is cut off
• an injury to the unborn baby's head

Problems during or after birth

Cerebral palsy can also sometimes be caused by damage to a baby's brain during or shortly after birth.

For example, it can be due to:

• the brain temporarily not getting enough oxygen (asphyxiation) during a difficult birth
• an infection of the brain, such as meningitis
• a serious head injury
• choking or nearly drowning, resulting in the brain not getting enough oxygen
• a very low blood sugar level (hypoglycaemia)
• a stroke

Risk Factors

Some things can increase a baby's risk of being born with cerebral palsy including:

• being born prematurely (before the 37th week of pregnancy) – babies born at 32 weeks or earlier are at a particularly high risk
• having a low birthweight
• being part of a multiple birth, such as a twin or triplet
• the mother smoking, drinking a lot of alcohol, or taking drugs such as cocaine, during pregnancy

Diagnosis

Examination and checks

First a specialist may:

• ask about your child's medical history and development
• check for any symptoms of cerebral palsy
• ask about any problems during your pregnancy, during the birth or soon afterwards

An assessment of your child's movements and learning abilities may also be carried out.

Brain scans

A brain scan may be used to look for signs of cerebral palsy.

One or more of the following scans may be recommended:

• a cranial ultrasound scan – a small handheld device that sends out sound waves is moved over the top of your child's head to create an image of their brain
• an MRI scan – a scanner that uses magnetic fields and radio waves to produce a more detailed image of the brain
• a CT scan – a scanner that takes several X-ray pictures to create a detailed image of the brain

Other tests

Other tests that may be used to help confirm cerebral palsy and rule out other conditions include:

• an electroencephalogram (EEG) – where small pads are placed on the scalp to monitor brain activity and check for signs of epilepsy
• an electromyogram (EMG) – where tiny needles are gently inserted into the muscles and nerves to check how well they're working
• blood tests – to check for problems that can cause similar symptoms to cerebral palsy

Treatment Options

There's currently no cure for cerebral palsy, but treatments are available to help people with the condition be as active and independent as possible.

Treatments include:

• physiotherapy – techniques such as exercise and stretching to help maintain physical ability and hopefully improve movement problems
• speech therapy to help with speech and communication, and swallowing difficulties
• occupational therapy – where a therapist identifies problems that you or your child have carrying out everyday tasks, and suggests ways to make these easier
• medicine for muscle stiffness and other difficulties
• in some cases, surgery to treat movement or growth problems

A team of healthcare professionals will work with you to come up with a treatment plan that meets your or your child's needs.

When To See A Doctor

Speak to your health visitor or a GP if you have any concerns about your child's health or development.

Symptoms like those of cerebral palsy can have a number of different causes and are not necessarily a sign of anything serious.

Your child may be referred to specialists in child development who can do some checks and tests.