The disorder affects a person’s ability to control their motor, or movement, functions. “Cerebral” refers to the brain’s cerebrum, which controls movement. People with cerebral palsy have difficulty controlling certain body movements or cannot control them at all.
Cerebral palsy is a permanent condition, but many therapies and treatments can help people manage their condition and improve their quality of life.
Signs and Symptoms of Cerebral Palsy
The symptoms and early signs of cerebral palsy are a long list, but they nearly all involve some evidence that a person lacks control over their muscle movements. If parents notice their child missing important developmental milestones, they should be sure to let their pediatrician know. The Centers for Disease Control and Prevention (CDC) offers helpful milestone checklists.
Any of a person’s motor skills — skills related to any type of movement — can be affected, including fine motor skills, gross motor skills, and oral motor skills. Oral motor skills are related to anything you do with your mouth, such as eating, drinking, or chewing gum.
Fine motor skills refer to tasks that use small muscles from one area of the body, usually the hands, fingers, or toes. These skills include writing, eating with silverware, curling your toes, turning a doorknob, or buttoning your shirt.
Gross motor skills use many muscles throughout the body for large movements, such as jumping, running, swimming, bending, reaching, and carrying items.
Examples of symptoms include stiff muscles, jerky reflexes, tremors, poor coordination or balance, trouble speaking, seizures, incontinence, stiff or “floppy” muscles, slow movement, problems with sucking or swallowing, or trouble picking things up.
Causes and Risk Factors of Cerebral Palsy
A wide range of exposures or incidents can cause the brain injury that leads to cerebral palsy. Sometimes a physician can be certain about the cause, but other times it may not be possible to know exactly what caused it. The following are some of the possible causes:
- Genetic mutations can cause the brain to develop differently from typical brains and develop a lesion, or injured area.
- Traumatic brain injury due to a fall, car accident, or other serious accident can cause cerebral palsy.
- Infections in infancy, such as viral or bacterial meningitis or another condition with a severe, persistent fever, can cause inflammation in or around the brain and injure it. Severe or untreated jaundice, when the liver does not break down old red blood cells as it should, can also increase the likelihood of cerebral palsy.
- Improper brain development during pregnancy, which can result from multiple possible causes.
- Brain injury or inadequate oxygen during birth can cause cerebral palsy.
- Inadequate blood supply to the fetal or infant brain, called a stroke, can also injure the brain.
- A mother’s infection during pregnancy may cause problems that contribute to developing cerebral palsy in a growing fetus.
Some exposures or circumstances can increase the risk of cerebral palsy but may not necessarily be the sole cause of it. The following can all increase the risk of cerebral palsy:
- Chickenpox (varicella), a viral infection preventable with a vaccine
- Cytomegalovirus, a common viral infection that harms a child only if a mother first has cytomegalovirus during pregnancy
- Herpes, a sexually transmitted virus that can affect the placenta and cause inflammation that can damage the fetus’s nervous system
- Rubella (German measles), a viral infection preventable with a vaccine
- Syphilis, a sexually transmitted bacterial infection
- Toxoplasmosis, caused by a parasite in contaminated food, dirt, and cat feces
- Zika, a virus carried by mosquitos that can also cause microcephaly — an undersized head or brain — in a newborn
Exposure to toxic chemicals during pregnancy or early infancy, such as methylmercury or lead, raises the risk.
Pregnancy and birth complications can increase risk of cerebral palsy:
- Premature birth (before 37 weeks), with risk increasing the earlier the baby is born
- Low birth weight (under 5.5 pounds, or 2.5 kilograms), with risk increasing the lower the weight
- According to the American College of Obstetricians and Gynecologists (ACOG), prolonged labor, typically defined as longer than 20 hours in first-time mothers, more than 14 hours for non-first-time mothers, or more than 16 hours for twins, may affect risk of cerebral palsy, though it’s not yet clear if it does.
- Multiples in pregnancy, such as twins or triplets; risk increases with the number of fetuses a woman is carrying and if any of them die before birth.
- Breech births, where the baby’s feet or buttocks — instead of the head — are closest to the birth canal when labor begins
- Pregnancy complications that involve respiratory or circulatory problems in the baby
- It’s unclear whether injuries from forceps or vacuum extraction are associated with cerebral palsy risk.Study findings are not consistent.
- Difference in blood Rh factors between mother and child. The Rhesus (Rh) factor is a protein on red blood cells that most people have. If a mother does not have Rh but her fetus does, the mother’s immune system may create cells that attack her child’s blood cells, notes ACOG.
How Is Cerebral Palsy Diagnosed?
Most children will undergo several tests:
- Magnetic resonance imaging (MRI) uses radio waves to create an image of the child’s brain. It does not involve radiation.
- A cranial ultrasound — an ultrasound of the head — can only be done in babies. Ultrasounds create images by sending sound waves into the body that bounce back.
- A computerized tomography (CT) scan is a type of X-ray that creates a 3D image of the brain or other parts of the body.
- A test called an electroencephalogram (EEG) records electrical activity in the brain to see if the person has seizures. It involves attaching electrodes to a person’s scalp.
- Electromyography (EMG) and nerve conduction tests look for problems in the nerves or muscles.
- Blood, urine, and skin tests are not always necessary. However, sometimes doctors order these tests to look for other possible conditions, such as genetic or metabolism problems.
If someone receives a diagnosis of cerebral palsy, additional tests will look for sensory or developmental problems caused by the condition:
- Mental ability
- Other development
People with dyskinetic, or athetoid, cerebral palsy (about 10 percent of cases) experience changes in muscle tone, causing rapid, jerky movements or slow, uncontrolled movements.
The last type, ataxic cerebral palsy (about 10 percent of cases), causes difficulty primarily with balance and muscle coordination.
People can also have a mixture of these three types.
Even within these categories, no two cases of cerebral palsy are alike. It may affect only one arm in one person and both arms and legs in another. It may affect the face, only the feet, or the entire body.
Functioning as a Family When a Child Has Cerebral Palsy
The whole family is affected when a child has cerebral palsy. Parents may go through a period of grief when a child is first diagnosed, and many experience a high stress level over time due to the pressures of caregiving. Siblings must navigate what it means to have a brother or sister with needs and abilities that differ from their own.
In spite of the challenges that come with having a family member with CP, couples and families who take the time to communicate with one another — and to care for themselves, as well as for the child with CP — are often able to thrive as a family.
Reaching out to extended family members for support, as well as to local groups and organizations, can help a family get the emotional and practical help they need.
School and Cerebral Palsy
Parents of children with cerebral palsy need to start educating themselves early about issues related to school. Many children with cerebral palsy qualify for an individualized education program (IEP), which spells out the instruction and services a student will receive in their public school.
Many students with cerebral palsy will also need assistive technologies to help with schoolwork and the support of specialists, such as occupational and speech therapists.
A child’s social life is important, too.
It’s important to begin conversations on these topics with the local school district before your child starts school, so that teachers and other staff are prepared to best serve the needs of your child.
Prognosis of Cerebral Palsy
Other factors, such as early aging, a weakened immune system, overall disabilities, and musculoskeletal disorders can affect how long a person with cerebral palsy lives as well. The major factors affecting life expectancy are:
- Severity of the condition
- Number and severity of disabilities
- Feeding difficulties
- Intellectual or cognitive functioning
- Respiratory functioning
- Mobility difficulties
- Vision and hearing impairment
- Quality of medical care and treatments
Duration of Cerebral Palsy
Cerebral palsy is a lifelong condition that has no cure. However, with appropriate treatment and the necessary support, people with cerebral palsy can life fulfilling lives.
Cerebral palsy will never get worse, but it will never go away either. The brain injury is permanent and cannot be healed or cured. Conditions related to cerebral palsy, however, may improve or worsen over a person’s lifetime.
Physical therapy, movement aids, surgery, medication, and other treatments can all help a person manage cerebral palsy. These treatments can increase their ability to do certain tasks and live independently.
Cerebral palsy does not cause death except in very rare severe cases in infants or very young children.
Treatment and Medication Options for Cerebral Palsy
Treatment for cerebral palsy will depend on a person’s symptoms, disabilities, complications, and other medical conditions.
Most people with cerebral palsy will need an interdisciplinary team of healthcare providers, including a pediatrician, neurologist, mental health practitioner, orthopedic surgeon, physical therapist, speech therapist, occupational therapist, and others.
Speech therapy, physical therapy, and occupational therapy can help develop life and communication skills. And special education professionals and assistive technology experts can help people with cerebral palsy reach their educational and vocational goals.
A person with cerebral palsy may take medication to treat seizures or muscle problems, and they may also undergo surgery on their muscles, spine, brain, eyes, or abdomen.
A wide range of medications are used to treat different symptoms or complications of cerebral palsy:
- Drugs called anticholinergics are used to help with uncontrolled movements. They work by blocking the chemicals in the brain that cause the movements.
- Botulinum toxins are neuromuscular blocker medications made from bacteria. They can reduce uncontrolled movements in muscles for three to six months.
- Medications used to stop or reduce seizures are called anticonvulsants. Sometimes people may need to change their anticonvulsant medications if the one they are taking stops working.
- Benzodiazepines are another group of drugs that are sometimes used short-term to treat a treat a seizure. They are not usually taken long-term.
- Muscle relaxers, called antispastics, can be prescribed to loosen stiff muscles, tremors, and similar symptoms. They can also increase range of motion in someone with cerebral palsy.
- Anti-inflammatories can treat different types of pain that people with cerebral palsy may experience. This includes abdominal pain, muscle or joint pain, pain after a surgery, and pain caused by other treatments, such as an injection or feeding tube placement.
- Antidepressants are drugs used to treat depression or anxiety in people with cerebral palsy.
- Constipation is common in children with cerebral palsy, so laxatives and stool softeners may be prescribed to help with bowel movements.
Alternative and Complementary Therapies
Assistive Technologies for Cerebral Palsy
Assistive technologies are any item or system used to maintain or improve the functioning of an individual with a disability.
People with cerebral palsy can benefit from a range of technologies, from high-tech, computerized devices that help with mobility or communication to low-tech equipment that helps with tasks of daily living.
Some people can also benefit from technology that improves hearing or vision.
Prevention of Cerebral Palsy
It’s not possible to prevent all, or even most, cases of cerebral palsy. But it is possible to reduce risks for cerebral palsy, particularly during pregnancy.
The following are activities pregnant women can do to reduce risk:
- Get appropriate prenatal care and attend all appointments, so your doctor is alerted early to problems such as preterm labor, placenta problems, and other risk factors.
- Receive treatment for pregnancy complications, such as preeclampsia, gestational diabetes, anemia, and placenta problems, notes MyChildWithoutLimits.org.
- Get all vaccines recommended before or during pregnancy to prevent infections that may increase risk of cerebral palsy.
- Avoid activities that increase risk of toxoplasmosis, per the CDC.
- Use mosquito repellent and other protections (such as air-conditioning and long sleeves and pants) in areas affected by Zika, notes the CDC.
- Get Rh factor testing. If negative, get the recommended treatment.
- Avoid smoking, drinking, illicit drugs, and unnecessary medication.
- Avoid exposure to X-rays unless absolutely necessary.
- Eat a healthy diet that includes all necessary vitamins and minerals.
After birth, parents and caregivers can reduce risk with the following behaviors:
- Be sure your child receives all recommended vaccines, which prevent infections that could cause cerebral palsy.
- Educate yourself about shaken baby syndrome, also called abusive head trauma, notes the National Center on Shaken Baby Syndrome, and have a support network in place to help you adjust to parenthood and understand your baby’s behavior, notes the CDC.
- Follow child safety guidelines, such as using a car seat, a safe crib without recalls, a bicycle helmet while riding, and similar safeguards.
Complications of Cerebral Palsy
Cerebral palsy can lead to several complications resulting from the muscle and coordination difficulties it causes, including the following:
- Severe muscle tightening and shortening, which can slow, interrupt, or deform the growth of bone
- Malnutrition due to feeding difficulties, sometimes leading to growth and bone problems
- Depression or other mental health problems related to coping with the effects of cerebral palsy
- Lung disease from breathing problems
- Additional movement or neurological disorders
- Osteoarthritis, where cartilage and then bones break down over time
- Low bone density, called osteopenia, which can increase risk of fractures
- Imbalance of eye muscles
Research and Statistics: How Many People Have Cerebral Palsy?
Cerebral palsy is the most common cause of physical disability occurring in childhood. An estimated 764,000 people live with cerebral palsy in the United States, including about 1 in 323 children.
Cerebral palsy is typically thought of as a childhood disorder. But most children with cerebral palsy live into adulthood, and many of those adults work, have families, and are active in their communities.
Still, adults with cerebral palsy do not grow out of the neurological problems they had as children, and many contend with additional health problems, as well. Common health issues among adults with CP include weakness, chronic pain, and repetitive strain injuries. Depression is also common among adults with cerebral palsy.
Engaging with peer support groups and connecting with national patient organizations can help adults with cerebral palsy find the care they need and stay socially active with what can be an isolating condition.
Black Americans and Cerebral Palsy
In addition, Black children with cerebral palsy were 1.7 times more likely than white children with cerebral palsy to have difficulty walking or to not be able to walk.
Other common co-occurring conditions include learning disabilities, chronic pain, attention deficit hyperactivity disorder (ADHD), mental health conditions, and vision, hearing, or speech problems.
Resources We Love
Families in which a child has cerebral palsy, as well as adults living with cerebral palsy, can benefit by connecting to programs and services designed to meet their needs. But finding these programs and services can be a challenge. These national nonprofit organizations can help.
The Cerebral Palsy Foundation works to connect medical institutions, industry partners, researchers, practitioners, and administrators with individuals with cerebral palsy and their families to bring about changes that will improve the lives of people with cerebral palsy today and eventually prevent the condition from occurring.
The mission of United Cerebral Palsy is to be a resource for individuals with cerebral palsy and other disabilities, and to promote inclusion, independence, and the ability to be productive for this population.
The March of Dimes website contains helpful information about cerebral palsy, and the organization runs several programs that try to reduce cerebral palsy and other conditions caused at birth.
The Child Neurology Foundation brings together healthcare providers, researchers, patients, families, caregivers, volunteers, and advocates to improve the lives of children with neurological problems.
Easterseals is a large nonprofit organization that provides services to people with disabilities, including early intervention, childcare for children of all abilities and conditions, rehabilitation services, and training, education, and job placement services.
Resources for People Affected by Cerebral Palsy
Families in which a child has cerebral palsy, as well as adults living with cerebral palsy, can benefit by connecting to programs and services designed to meet their needs. But finding these programs and services can be a challenge.
National nonprofits such as the Cerebral Palsy Foundation and United Cerebral Palsy can help. So can medical professionals who treat cerebral palsy, clinics that specialize in cerebral palsy, special education professionals, and assistive technology experts.
Editorial Sources and Fact-Checking
- Cerebral Palsy: Hope Through Research. National Institute of Neurological Disorders and Stroke. March 20, 2020.
- Data & Statistics for Cerebral Palsy. Centers for Disease Control and Prevention.
- Placental Insufficiency. MedlinePlus.
- Cerebral Palsy: Symptoms and Causes. Mayo Clinic. August 17, 2019.
- Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery. The American College of Obstetricians and Gynecologists. March 2014.
- Oztürk A, Demirci F, Yavuz T, et al. Antenatal and Delivery Risk Factors and Prevalence of Cerebral Palsy in Duzce (Turkey). Brain & Development. January 2007.
- Thorngren-Jerneck K, Herbst A. Perinatal Factors Associated With Cerebral Palsy in Children Born in Sweden. Obstetrics and Gynecology. December 2006.
- O’Callaghan ME, MacLennan AH, Gibson CS, et al. Epidemiologic Associations With Cerebral Palsy. Obstetrics and Gynecology. September 2011.
- The Rh Factor: How It Can Affect Your Pregnancy. The American College of Obstetricians and Gynecologists. February 2018.
- Fertility Drugs Contribute Heavily to Multiple Births. March of Dimes. January 15, 2010.
- Zhu JL, Hvidtjørn D, Basso O, et al. Parental Infertility and Cerebral Palsy in Children. Human Reproduction. December 2010.
- Kulkarni AD, Jamieson DJ, Jones HW, et al. Fertility Treatments and Multiple Births in the United States. The New England Journal of Medicine. December 5, 2013.
- Cerebral Palsy: Diagnosis and Treatment. Mayo Clinic. August 17, 2019.
- Abdel-Hamid HZ. Cerebral Palsy Workup. Medscape. August 22, 2018.
- What Is Cerebral Palsy? Centers for Disease Control and Prevention. September 11, 2020.
- Strauss D, Brook J, Rosenbloom L, et al. Life Expectancy in Cerebral Palsy: An Update. Developmental Medicine & Child Neurology. July 11, 2008.
- Hutton JL, Pharoah POD. Life Expectancy in Severe Cerebral Palsy. Archives of Disease in Childhood. March 2006.
- Li L, Zhang M, Zhang Y, et al. Acupuncture for Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials. Neural Regeneration Research. June 2018.
- Elmacı DT, Cevizci S. Dog-Assisted Therapies and Activities in Rehabilitation of Children With Cerebral Palsy and Physical and Mental Disabilities. International Journal of Environmental Research and Public Health. May 12, 2015.
- Whalen CN, Case-Smith J. Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children With Cerebral Palsy: A Systematic Review. Physical and Occupational Therapy in Pediatrics. August 2012.
- Weisleder P. Unethical Prescriptions: Alternative Therapies for Children With Cerebral Palsy. Clinical Pediatrics. January 2010.
- Can Cerebral Palsy Be Prevented? MyChildWithoutLimits.org.
- Parasites — Toxoplasmosis (Toxoplasma Infection): Pregnant Women. Centers for Disease Control and Prevention. August 25, 2017.
- Zika Virus: Prevent Mosquito Bites. Centers for Disease Control and Prevention. February 5, 2018.
- Learn More. National Center on Shaken Baby Syndrome.
- Preventing Shaken Baby Syndrome. Centers for Disease Control and Prevention.
- Wu YW, Xing G, Fuentes-Afflick E, et al. Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy. Pediatrics. March 2011.