Cerebral Palsy (CP) Symptoms & Causes

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Cerebral palsy (CP) is a broad term that describes a group of neurologic (brain) disorders. In all of its forms, CP:

•   is a lifelong condition
•   affects the communication between the brain and the muscles
•   causes a permanent state of uncoordinated movement and posturing
•   is believed to result from an episode or injury that causes a lack of oxygen
    to the brain (but in many cases, no exact cause can be found)

Children with CP often have one or more associated medical conditions, such as:

•   learning disabilities and developmental delays
•   bone problems, including scoliosis
•   asthma and other respiratory problems
•   speech and communication impairment

While the specific brain injury or issue responsible for CP doesn't progress or worsen over time, your child’s symptoms may change as he ages. Monitoring and managing these symptoms requires multidisciplinary collaboration by experts in several specialties.

When your child is treated in Boston Children's Hospital’s Cerebral Palsy Program, he has access to all of Boston Children’s subspecialists. Depending on your child’s circumstances, he may be seen by experts in our Orthopedic Center, Neurosurgery Department and Physical Therapy and Occupational Therapy Services, among others. You and your family also have full access to our extensive support services, including counseling, educational materials and community resources.

What causes cerebral palsy?

Cerebral palsy is believed to occur when there is either abnormal development or damage—for example, trauma or another episode that cuts off the supply of oxygen—to the areas in the brain that control motor function. In many children with CP, the exact cause of their disorder cannot be identified.

Although CP often emerges without a specific cause, certain risk factors have been linked to the disorder. They include:   

•   premature birth
•   very low birth weight (especially in babies weighing less than 1,000 grams, or 2.2 lbs.)
•   brain hemorrhages (bleeding within the brain)
•   brain trauma
•   complications of labor and delivery
•   some viruses affecting the mother during pregnancy, including cytomegalovirus (CMV)
•   chemical/substance abuse by the mother during pregnancy
•   some infections affecting the mother during pregnancy, including rubella (German measles), toxoplasmosis and
    urinary tract infections or kidney infections 

How common is cerebral palsy in children?

Cerebral palsy affects about 2 to 3 out of every 1,000 babies. It is somewhat more common in:

•   boys than girls
•   multiple births than single births
•   African-Americans than other ethnicities

What are the symptoms of cerebral palsy?

It’s important to note that each child with CP may have different symptoms, ranging from muscle weakness and poor motor control to muscle tightness (called spasticity) in the arms or legs and muscle stiffness (including clenched fists). Children with CP may also have additional problems, including:

•   seizures
•   vision loss or impairment
•   hearing loss or impairment
•   speech impairment
•   learning disabilities
•   behavioral problems
•   developmental delays
•   respiratory problems, such as asthma and aspiration
•   bowel control problems
•   bladder control problems
•   bone abnormalities, including scoliosis
•   gastroesophageal reflux (GERD)
•   constipation

Babies with CP are often slow to reach developmental milestones, such as learning to roll over, sit, crawl or walk. They may also have certain reflexes present—for example, the Moro reflex, automatically extending the arms when placed on the back with legs tilted—past the time these reflexes normally disappear.

Since the symptoms of CP may resemble other conditions, it is a must to talk to a qualified physician to make an exact diagnosis and recommend the right treatment plan for your child. 

What are the different types of cerebral palsy?

Cerebral palsy is classified according to the kind of motor function the child experiences, as follows:  

spastic diplegia ("di" means two)

spastic movements of the arms or legs. (this is also sometimes called paraplegia)

spastic quadriplegia ("quad" means four)

spastic movements in all four limbs (both arms and legs)

spastic hemiplegia ("hemi" means half)

spasticity affecting one half, or one side, of the body (for example, the right arm and right leg)

spastic double hemiplegia

spasticity in both sides of the body, although the extent of shaking is different on one side compared to the other

athetoid

involuntary, uncontrolled and purposeless movements dystonia: rigidity and poor tone throughout the muscles 

Questions to ask your doctor

You and your family play an essential role in your child’s treatment for cerebral palsy. It’s important that you share your observations and ideas with your child’s treating clinician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations. 

You’ve probably thought of many questions to ask about your child’s condition and prognosis. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you. (If your child is old enough, you can encourage him or her to write down questions, too.)

Initial questions to ask your doctor might include: 

•   How did you arrive at this diagnosis?
•   Are there any other conditions my child might have instead?
•   Does my child require further testing at this time?
•   What is my child’s prognosis?
•   What medications will you prescribe and what are the possible side effects?
•   Does my child need a brace, walker or other equipment at this time?
•   Does my child need surgery, and if so, what procedure do you recommend and why?
•   What role should I play in my child’s treatment?
•   How should I talk to my child about this condition and the long-term outlook?
•   How should I explain my child’s condition to family members and teachers?
•   How can I talk about my child’s condition to his classmates and other kids?
•   How can I make sure my child is receiving the emotional support he needs?
•   What changes do I need to make to my child’s home and school routines?
•   What other resources can you point me to for more information?

Frequently Asked Questions (FAQ) about Cerebral Palsy

Q: Can changes to my child’s diet help manage his cerebral palsy?
A: Although dietary modifications can’t cure CP or eliminate its symptoms, a proper diet is hugely important for kids with cerebral palsy. Since many children with CP have difficulty chewing and swallowing, parents need to take extra care to ensure they’re consuming enough nutrients and calories. Your treating clinician can give you more specific recommendations for your child’s situation.

Q: Is my child at risk for other health complications as he ages?
A:
While every child’s cerebral palsy is different, having CP does place a child at risk of developing other health problems later in life. These can include:

•   increased spasticity
•   joint pain and discomfort or arthritis
•   dental problems (since it can be very difficult for a person with cerebral palsy to remain still during a dental exam
    or treatment, there is a higher risk of undetected dental disease)

Talk to your treating clinician about your child’s specific symptoms and prognosis. Good medical management is key in helping your child enjoy an optimal quality of life.

Q: Can Children’s diagnose and treat cerebral palsy in newborns?
A:
Our Fetal-Neonatal Neurology Program evaluates, diagnoses and formulates treatment plans for newborns and babies whose neurological problems are present at birth or emerge in early infancy.

Q: Will my child definitely need supportive equipment, such as a walker or brace?
A:
Not every child with cerebral palsy will require a wheelchair, walker or brace. These devices, like any other medical treatment, are prescribed to address the symptoms and circumstances of a specific patient. 

Q: Will my child definitely need surgery?
A:
Surgery can be very helpful for children with serious difficulties with spasticity, muscle contracture, deformities and other symptoms of CP. However, as with any other treatment option, your treating clinician is the best source of information and recommendations for managing your child’s particular symptoms. 

Q: Is there a cure for cerebral palsy?
A: Unfortunately, cerebral palsy is a lifelong condition for which there presently is no cure. Boston Children’s clinicians are engaged in ongoing research in hopes of one day curing—and possibly preventing—this disorder.

Children's journal project lets kids, families talk about their experiences with CP

Children diagnosed with cerebral palsy—as well as their parents, siblings and caregivers—can share their thoughts, feelings, concerns and hopes. The Cerebral Palsy Experience Journal gives patients, loved ones and health professionals a new way of making their voices heard while helping others facing similar situations.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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