Cerebral palsy is the term for a group of brain disorders that affect muscles and body movement. The condition is caused by damage to parts of the brain that control muscle movement, balance, and posture. Signs and symptoms of cerebral palsy usually appear in infancy or early childhood and last throughout a person's life. In most cases, the symptoms do not get worse over time.

Cerebral palsy is the most common movement disorder in children, according to the Centers for Disease Control and Prevention. The level and severity of disability caused by the condition differs from person to person. Some people with cerebral palsy may not be able to walk and need intensive, lifelong care, while others can walk and move with little or no help.

What is cerebral palsy (CP)?

Cerebral palsy (CP) is a group of disorders that cause problems with movement, balance, and posture. CP affects the cerebral motor cortex. This is the part of the brain that directs muscle movement. In fact, the first part of the name, cerebral, means having to do with the brain. The second part, palsy, means weakness or problems with using the muscles.

What are the types of cerebral palsy (CP)?

There are different types of CP:

• Spastic cerebral palsy, which is the most common type. It causes increased muscle tone, stiff muscles, and awkward movements. Sometimes it only affects one part of the body. In other cases, it can affect both arms and legs, the trunk, and the face.
• Dyskinetic cerebral palsy, which causes problems controlling the movement of the hands, arms, feet, and legs. This can make it hard to sit and walk.
• Ataxic cerebral palsy, which causes problems with balance and coordination
• Mixed cerebral palsy, which means that you have symptoms of more than one type

What causes cerebral palsy (CP)?

CP is caused by abnormal development or damage to the developing brain. It could happen when

• The cerebral motor cortex doesn't develop normally during fetal growth
• There is an injury to the brain before, during, or after birth

Both the brain damage and the disabilities it causes are permanent.

Who is at risk for cerebral palsy (CP)?

CP is more common among boys than girls. It affects black children more often than white children.

Certain medical conditions or events that can happen during pregnancy and delivery that may increase a baby's risk of being born with cerebral palsy, including

• Being born too small
• Being born too early
• Being born a twin or other multiple birth
• Being conceived by in vitro fertilization (IVF) or other assisted reproductive technology (ART)
• Having a mother who had an infection during pregnancy
• Having a mother with certain health problems in pregnancy, such as thyroid problems
• Severe jaundice
• Having complications during birth
• Rh incompatibility
• Seizures
• Exposure to toxins

What are the signs of cerebral palsy (CP)?

There are many different types and levels of disability with CP. So the signs can be different in each child.

The signs usually appear in the early months of life. But sometimes there is a delay in getting a diagnosis until after age two. Infants with CP often have developmental delays. They are slow to reach developmental milestones such as learning to roll over, sit, crawl, or walk. They may also have abnormal muscle tone. They may seem floppy, or they may be stiff or rigid.

It's important to know that children without CP can also have these signs. Contact your child's health care provider know if your child has any of these signs, so you can get a correct diagnosis.

How is cerebral palsy (CP) diagnosed?

Diagnosing CP involves several steps:

• Developmental monitoring (or surveillance) means tracking a child's growth and development over time. If there are any concerns about your child's development, then he or she should have a developmental screening test as soon as possible.
• Developmental screening involves a giving your child a short test to check for motor, movement, or other developmental delays. If the screenings are not normal, the provider will recommend some evaluations.
• Developmental and medical evaluations are done to diagnose which disorder your child has. The provider many use many tools to make the diagnosis:
  • A check of your child's motor skills, muscle tone, reflexes, and posture
  • A medical history
  • Lab tests, genetic tests, and/or imaging tests

What are the treatments for cerebral palsy (CP)?

There is no cure for CP, but treatment can improve the lives of those who have it. It is important to begin a treatment program as early as possible.

A team of health professionals will work with you and your child to develop a treatment plan. Common treatments include

• Medicines
• Surgery
• Assistive devices
• Physical, occupational, recreational, and speech therapy

Can cerebral palsy (CP) be prevented?

You cannot prevent the genetic problems that can cause CP. But it may be possible to manage or avoid some of the risk factors for CP. For example, making sure that pregnant women have been vaccinated could prevent certain infections that can cause CP in unborn babies. Using cars seats for infants and toddlers could prevent head injuries, which can be a cause of CP.

Cerebral palsy (CP) is the most common motor disability in childhood, and children with CP and their families need support. Learn more about CP and what signs to look for in young children.

1. Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture.
2. CP is the most common motor disability of childhood. About 1 in 323 children has been identified with CP according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network.
3. CP is more common among boys than girls, and more common among black children than among white children.
4. Most (about 75%-85%) children with CP have spastic CP. This means that their muscles are stiff, and as a result, their movements can be awkward.
5. Over half (about 50%-60%) of children with CP can walk independently.

6. Many children with CP have one or more additional conditions or diseases along with their CP, known as co-occurring conditions. For example, about 4 in 10 children with CP also have epilepsy and about 1 in 10 have autism spectrum disorder.

7. Most CP is related to brain damage that happened before or during birth and it is called congenital CP. The following factors can increase the risk for congenital CP:
   • Being born too small
   • Being born too early
   • Being born a twin or other multiple birth
   • Being conceived by in vitro fertilization or other assisted reproductive technology
   • Having a mother who had an infection during pregnancy
   • Having kernicterus (a type of brain damage that can happen when severe newborn jaundice goes untreated)
   • Having complications during birth
8. A small percentage of CP is caused by brain damage that happens more than 28 days after birth. This is called acquired CP. The following factors can increase the risk for acquired CP:
   • Having a brain infection, such as meningitis
   • Suffering a serious head injury
9. The specific cause of CP in most children is unknown.
10. CP is typically diagnosed during the first or second year after birth. If a child’s symptoms are mild, it is sometimes difficult to make a diagnosis until the child is a few years older.
11. With the appropriate services and support, children and adults with CP can stay well, active, and a part of the community.

Early Signs of CP

From birth to 5 years of age, a child should reach movement goals―also known as milestones―such as rolling over, sitting up, standing, and walking. A delay in reaching these movement milestones could be a sign of CP. It is important to note that some children without CP also might have some of these signs. The following are some other signs of possible CP.

In a baby 3 to 6 months of age:

• Head falls back when picked up while lying on back
• Feels stiff
• Feels floppy
• Seems to overextend back and neck when cradled in someone’s arms
• Legs get stiff and cross or scissor when picked up

In a baby older than 6 months of age:

• Doesn’t roll over in either direction
• Cannot bring hands together
• Has difficulty bringing hands to mouth
• Reaches out with only one hand while keeping the other fisted

In a baby older than 10 months of age:

• Crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
• Scoots around on buttocks or hops on knees, but does not crawl on all fours

There are several types of cerebral palsy, classified by the kind of movement affected, the body parts affected, and how severe the symptoms are. Some types involve intellectual and developmental disabilities (IDDs) as well as movement problems.

• Spastic cerebral palsy.This type is the most common form of the disorder. People with spastic cerebral palsy have stiff muscles which cause jerky or repeated movements. There are different forms of spastic cerebral palsy, depending on the body parts affected. These forms are:
  • Spastic hemiplegia (pronounced hem-i-PLEE-jee-uh) or hemiparesis (pronounced hem-ee-puh-REE-sis). This type affects the arm, the hand, and sometimes the leg on only one side of the body. Children with this form may have delays in learning to talk, but intelligence is usually normal.
  • Spastic diplegia (pronounced dahy-PLEE-jee-uh) or diparesis (pronounced dahy-puh-REE-sis). People with this form mostly have muscle stiffness in the legs, while the arms and face are less severely affected. Intelligence and language skills are usually normal.
  • Spastic quadriplegia (pronounced kwod-ruh-PLEE-jee-uh)or quadriparesis (pronounced kwod-ruh-puh-REE-sis). This is the most severe form of cerebral palsy, involving severe stiffness of the arms and legs and a floppy, or weak, neck. People with spastic quadriplegia are usually unable to walk and often have trouble speaking. This form may involve moderate to severe IDD as well.
• Dyskinetic (pronounced dis-ki-NET-ik) cerebral palsy. This type involves slow and uncontrollable jerky movements of the hands, feet, arms, or legs. The face muscles and tongue may be overactive and cause some children to drool or make faces. People with this type often have trouble sitting straight or walking. People with dyskinetic cerebral palsy do not usually have intellectual problems.
• Ataxic (pronounced uh-TAK-sik) cerebral palsy. This form of the disorder affects balance and depth perception. People with ataxic cerebral palsy walk in an unsteady manner and have a hard time with quick or precise movements such as writing, buttoning a shirt, or reaching for a book.
• Mixed types.This kind of cerebral palsy includes symptoms that are a mix of the other types.

Some events or medical problems during pregnancy can increase the risk of congenital cerebral palsy. These risk factors include:

• Low birth weight or preterm birth. Infants born preterm (defined as before 37 weeks of pregnancy) and infants who weigh less than 5.5 pounds at birth are at greater risk of cerebral palsy than are early term (defined as 37 weeks to 38 weeks of pregnancy) and full-term (defined as 39 weeks to 40 weeks of pregnancy) infants and those who are heavier at birth. The earlier the birth and the lower the infant’s birthweight, the greater the risk.
• Multiple gestations. Twins, triplets, and other multiple births are at higher risk of cerebral palsy. The risk is also greater for an infant whose twin or triplet dies before or shortly after birth.
• Infertility treatments. Infants born from pregnancies resulting from the use of certain infertility treatments are at higher risk for cerebral palsy than are infants born from pregnancies not related to infertility treatments. Much of this increased risk may be due to the fact that infertility treatments are more likely to result in preterm delivery and multiple gestations.
• Infections during pregnancy. Toxoplasmosis, rubella (German measles), cytomegalovirus, and herpes can infect the womb and placenta, leading to brain damage in the fetus.
• Fever during pregnancy. Sometimes fever in the mother during pregnancy or delivery can lead to brain damage in the fetus, resulting in cerebral palsy.
• Blood factor between mother and fetus does not match. Those who have a certain protein found on red blood cells—abbreviated Rh—are Rh positive; those who do not have the protein are Rh negative. If a mother’s Rh factor is different from that of the fetus, her immune system may attack the blood cells of the fetus, including blood cells in the brain, which can lead to brain damage.
• Exposure to toxic chemicals. If a mother is exposed to a toxic substance, such as high levels of methyl mercury (found in some thermometers and in some seafood), during pregnancy the fetus is at higher risk of cerebral palsy.
• Maternal medical conditions:
  • Abnormal thyroid function
  • Intellectual and developmental disability
  • Too much protein in the urine
  • Seizures
• Complicated labor and delivery. Infant heart or breathing problems during labor and delivery and immediately after birth increase the risk of cerebral palsy.
• Jaundice (pronounced JAWN-dis).Jaundice, which causes an infant’s skin, eyes, and mouth to turn a yellowish color, can be a sign that the liver is not working normally. Jaundice occurs when a substance called bilirubin (pronounced BIL-uh-roo-bin) builds up faster than the liver can clear it from the body. This condition is common and is usually not serious. However, in cases of severe, untreated jaundice, the excess bilirubin can damage the brain and cause cerebral palsy.
• Seizures. Infants who have seizures are more likely to be diagnosed with cerebral palsy later in childhood.

Some risk factors for acquired cerebral palsy are:

• Infancy.Infants are at greater risk than older children for an event that causes brain damage.
• Preterm or low birthweight. Children born preterm or at a low birthweight have a higher risk for acquired cerebral palsy.
• Not getting certain vaccinations. Childhood vaccinations can prevent brain infections that can cause cerebral palsy.
• Injury. Not taking certain safety precautions for infants or lack of adult supervision can lead to injury that can cause cerebral palsy.

Cerebral palsy is caused by damage or abnormal development in the parts of the brain that control movement. These events can happen before, during, or shortly after birth or in the first few years of life, when the brain is still developing. In many cases the exact cause of cerebral palsy is not known.

The majority of children with cerebral palsy were born with the condition, a situation called congenital cerebral palsy.

Causes of cerebral palsy that occur before birth include:

• Damage to the white matter of the brain. The brain’s white matter sends signals throughout the brain and the rest of the body. Damage to white matter can disrupt the signals between the brain and the body that control movement. The white matter in the fetus’s brain is more sensitive to injury between 26 weeks and 34 weeks of pregnancy, but damage can happen at any time during pregnancy.
• Abnormal brain development. Disruptions in the normal growth process of the brain can cause abnormalities. These abnormalities affect the transmission of brain signals. Infections, fever, trauma, or gene changes (mutations) can cause the brain to develop abnormally.
• Bleeding in the brain. A fetus can have a stroke, which is a common cause of brain bleeding. Strokes occur when blood vessels in the brain become blocked or broken, leading to brain damage. Conditions including blood clotting problems, abnormally formed blood vessels, heart defects, and sickle cell disease can also cause bleeding in the brain.
• Lack of oxygen in the brain. The brain can become damaged if it does not get enough oxygen for a long time. Very low blood pressure in the mother, a torn uterus, detachment of the placenta, problems with the umbilical cord, or severe trauma to the infant’s head during labor and delivery can prevent oxygen from getting to the brain.

A small number of children have what is called acquired cerebral palsy, which means the disorder begins more than 28 days after birth. Causes of acquired cerebral palsy may include:

• Brain damage in the first few months or years of life
• Infections, such as meningitis or encephalitis
• Problems with blood flow to the brain due to stroke, blood clotting problems, abnormal blood vessels, a heart defect that was present at birth, or sickle cell disease
• Head injury from a car accident, a fall, or child abuse

Even though the symptoms of cerebral palsy often differ from person to person, they can include:

• Ataxia (pronounced uh-TAK-see-uh), the loss of muscle coordination when making movements
• Spasticity (pronounced spa-STIS-i-tee), stiff or tight muscles; jerky, repeated movements; and stronger-than-normal reflexes (for example, the knee-jerk reflex)
• Weakness in arms or legs
• Walking on the toes
• Walking in a crouched position
• Muscle tone that is either too stiff or too floppy
• Drooling
• Trouble with swallowing or speaking
• Shaking (tremor) of arms, legs, hands, or feet
• Sudden, uncontrolled movements
• In infants and toddlers, delays in motor skills (such as sitting, crawling, walking)
• Trouble with precise movements such as writing or buttoning a shirt

It’s important to note that many of these symptoms result from problems with muscles and not from problems with cognition or thinking. For example, a person with cerebral palsy may have trouble speaking because he or she cannot control or move the muscles involved with speaking, not because of brain problems with language.

The symptoms of cerebral palsy vary in type, can range from mild to severe, and can change over time. Symptoms are different for each person, depending on the areas of the brain that have been affected. All people with cerebral palsy have movement and posture problems.

In addition to problems with muscle movement, symptoms occasionally include:

• Intellectual and developmental disabilities
• Seizures
• Feeling unusual physical sensations
• Vision problems
• Hearing problems

The signs of cerebral palsy usually appear in the first few months of life, but many children are not diagnosed until age 2 or later. In general, early signs of cerebral palsy include:

• Developmental delays. The child is slow to reach milestones such as rolling over, sitting, crawling, and walking. Developmental delays are the main clues that a child might have cerebral palsy.
• Abnormal muscle tone. Body parts are floppy or too stiff.
• Abnormal posture. The child might also use one side of the body more than the other when reaching, crawling, or moving.

Children without cerebral palsy may show some of these signs. If you notice any of these signs, you should talk to your child’s health care provider.

Some age-specific signs may include:

• Infants younger than 6 months of age:
  • Cannot hold up their head when picked up from lying on their back
  • May feel stiff or floppy
  • When picked up, their legs get stiff or cross
  • When held, they may overextend their back and neck, constantly acting as though they are pushing away from you
• Infants older than 6 months of age:
• Cannot roll over
  • Cannot bring their hands to their mouth
  • Have a hard time bringing their hands together
  • Reach out with only one hand while holding the other in a fist
• Infants older than 10 months of age:
  • Crawl in a lopsided way, pushing with one hand and leg while dragging the opposite hand and leg
  • Scoot around on their buttocks or hop on their knees but do not crawl on all fours
  • Cannot stand even when holding onto support

Children without cerebral palsy may show some of these signs. If you notice any of these signs, you should talk to your child’s health care provider.

Most children with cerebral palsy are diagnosed during their first 2 years of life. But if symptoms are mild, a health care provider may not be able to make a diagnosis before the age of 4 or 5.

During regular well-baby and well-child visits, a child’s health care provider will examine:

• Growth and development
• Muscle tone
• Control of movement
• Hearing and vision
• Posture
• Coordination and balance

If a health care provider finds signs of cerebral palsy during an examination, he or she may then use one or more brain scanning methods to look for damage in the brain. These methods may include:

• Ultrasound. This method is used most commonly in high-risk preterm infants to take pictures of the brain. Ultrasound is not as good as other methods at taking images of the brain, but it is the safest way to look at the brains of preterm infants.
• Computed tomography (CT). CT uses X-rays to take pictures of the brain and can show areas that are damaged.
• Magnetic resonance imaging (MRI). MRI uses a computer, a magnetic field, and radio waves to create an image of the brain. It can show the location and type of damage in better detail than CT.
• Electroencephalogram (EEG). If a child has had seizures, a health care provider may order this test to rule out another disorder such as epilepsy. Small disks called electrodes are placed on the scalp to measure the brain’s activity.

If a health care provider thinks that your child has cerebral palsy, he or she may then refer the child to specialists such as a pediatric neurologist (doctor who specializes in the brain and nervous system), a developmental pediatrician (doctor who specializes in child development), an ophthalmologist (eye doctor), or an otologist (hearing doctor), depending on the specific symptoms. These health care providers can help give a more accurate diagnosis and create a treatment plan.

A child may need one or several different types of treatment depending on how severe the symptoms are and what parts of the body are affected. The treatment differs from person to person, depending on each one’s specific needs. Although the initial damage of cerebral palsy in the brain cannot be reversed, earlier and aggressive treatments may help to improve function and adjustments for the young nervous system and musculoskeletal system.

Families may also work with their health care providers and, during the school years, school staff to develop individual care and treatment programs.

Common types of treatment for cerebral palsy include:

• Physical therapy and rehabilitation. A child with cerebral palsy usually starts these therapies in the first few years of life or soon after being diagnosed. Physical therapy is one of the most important parts of treatment. It involves exercises and activities that can maintain or improve muscle strength, balance, and movement. A physical therapist helps the child learn skills such as sitting, walking, or using a wheelchair. Other types of therapy include:
  • Occupational therapy. This type of therapy helps a child learn to do everyday activities such as dressing and going to school.
  • Recreational therapy. Participating in art programs, cultural activities, and sports can help improve a child’s physical and intellectual skills.
  • Speech and language therapy. A speech therapist can help a child learn to speak more clearly, help with swallowing problems, and teach new ways to communicate, such as by using sign language or a special communication device.
• Orthotic devices. Braces, splints, and casts can be placed on the affected limbs and can improve movement and balance. Other devices that can help with movement and posture include wheelchairs, rolling walkers, and powered scooters.
• Assistive devices and technologies. These include special computer-based communication machines, Velcro-fastened shoes, or crutches, which can help make daily life easier.
• Medication. Certain medications can relax stiff or overactive muscles and reduce abnormal movement. They may be taken by mouth, injected into affected muscles, or infused into the fluid surrounding the spinal cord through a pump implanted near the spinal cord. For children who have cerebral palsy and epilepsy (seizures), standard epileptic medications should be considered, but these medications may also have negative effects on the developing brain.
• Surgery. A child may need surgery if symptoms are severe. For instance, surgery can lengthen stiff, tightly contracted muscles. A surgeon can also place arms or legs in better positions or correct or improve an abnormally curved spine. Sometimes, if other treatments have not worked, a surgeon can cut certain nerves to treat abnormal, spastic movements. Before conducting surgery, it is important for a health care provider to assess the procedure’s benefits by carefully analyzing biomechanics of the joints and muscles.

Not all therapies are appropriate for everyone with cerebral palsy. It is important for parents, patients, and health care providers to work together to come up with the best treatment plan for the patient.

Can cerebral palsy be prevented?

Because cerebral palsy is associated with preterm and low birth weight infants, good prenatal care and perinatal support may reduce risks. This includes careful management of vaccines; for example, women can get a vaccine to prevent rubella (German measles) before getting pregnant to reduce their risk for this infection that could cause cerebral palsy. Acquired cerebral palsy can sometimes be prevented by using common safety practices, such as correctly installed car seats for infants and toddlers and having children wear helmets during certain activities to prevent head injuries.

What other conditions are associated with cerebral palsy?

In addition to the main symptoms, people with cerebral palsy sometimes have related conditions, which can include:

• Intellectual and developmental disability (IDD). Up to one-half of people with cerebal palsy have IDD.
• Seizures. About half of all children with cerebral palsy have one or more seizures during their lifetime.
• Delayed growth. Children with moderate to severe cerebral palsy are often very small for their age.
• Abnormally shaped spine. The spine may curve in a way that makes sitting, standing, or walking more difficult.
• Vision problems.
• Hearing loss.
• Infections and long-term illnesses. Many people with cerebral palsy have a higher risk of heart and lung disease and pneumonia (infection of the lungs).
• Malnutrition. Because people with cerebral palsy can have trouble swallowing, sucking, or feeding, it can be hard to get the proper nutrition or eat enough to gain or maintain weight.
• Dental problems. Some people with cerebral palsy may have movement problems that prevent them from being able to take care of their teeth.

Do adults with cerebral palsy face special health challenges?

Adults with cerebral palsy can experience:

• Contractures. Abnormal muscle and joint function in more severe cerebral palsy can lead to degeneration and tightening of muscle tissue.
• Musculoskeletal deformities. Abnormal coordination and muscle function can lead to scoliosis or hip problems.
• Early aging. Because cerebral palsy places extra stress and strain on the body, many adults begin to have age-related problems when they reach their 40s. In people with cerebral palsy, the heart, veins, arteries, and lungs must work harder throughout life and may wear out sooner.
• Arthritis. Over a person’s life, constant pressure from limbs and joints that are not properly aligned may cause painful swelling in the joints.
• Depression. People with disabilities such as cerebral palsy are three to four times as likely to have depression as people in the general population.
• Post-impairment syndrome. This syndrome can result from the muscle and bone abnormalities and arthritis related to cerebral palsy. It can cause pain, extreme tiredness, and weakness.
• Pain. Adults with cerebral palsy often have pain in their hips, knees, ankles, and back. The pain is caused by the constant stress and strain from muscle problems over a lifetime.
• Other medical conditions. Adults with cerebral palsy are more likely to have high blood pressure, bladder problems, problems swallowing, and broken bones.