Cerebral palsy

What cerebral palsy is

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and to maintain balance and posture. It is caused by damage to, or abnormal development of, the parts of the brain that control movement, and that damage happens before, during or shortly after birth or in early childhood. “Cerebral” refers to the brain and “palsy” to weakness or problems with using the muscles. CP is a description of a movement disorder; it is not a disease with a single cause.

CP ranges from mild, affecting one limb or one side, to severe, affecting the whole body and accompanied by other conditions such as seizures, vision or hearing problems, or learning difficulties. It does not get worse over time, although symptoms can change as a child grows.

What is known about causes

The National Institute of Child Health and Human Development (NICHD) describes several possible causes and risk factors, including abnormal brain development during pregnancy, infections during pregnancy, problems with blood flow to the baby’s brain, premature birth and low birth weight, severe jaundice, and events at or after birth that reduce oxygen or cause bleeding in the brain. In many children, no specific cause is identified. NICHD and the National Institute of Neurological Disorders and Stroke (NINDS) are both clear that a lack of oxygen during labor is one possible cause among several, not the usual one.

How cerebral palsy is diagnosed

There is no single test. Clinicians watch a child’s development over time, looking at muscle tone, reflexes, posture and the age at which milestones such as rolling, sitting and walking are reached. Brain imaging and other tests may be used to look for an explanation or to rule out other conditions. Because development varies, a diagnosis is often made in the first two years but can take longer, particularly for milder forms.

Treatment and support

There is no cure, but treatment helps children do as much as they can. NICHD lists physical, occupational and speech therapy, medications to help with muscle tone and seizures, braces and other assistive devices, and in some cases surgery. Early, coordinated care can help a child do more; how much it changes for an individual child varies.

Cerebral palsy and HIE

Families whose child had hypoxic-ischemic encephalopathy as a newborn sometimes later receive a diagnosis of cerebral palsy, and the two can be related: a brain injury from reduced oxygen or blood flow is one of the recognised causes of CP. They are not the same thing, and a diagnosis of one does not imply the other. Our HIE guide explains the first condition and why clinical bodies call for a broad evaluation of its cause.

What is uncertain

• For many children, the cause.
• How a particular child will develop; early assessments do not determine the long-term outcome.
• Whether, in any individual case, something could have been done differently, which is a question for expert review of the record and not something that can be inferred from the diagnosis.

What a legal review would look at

If a family asks an attorney to review the birth, the review looks at the pregnancy and labor records, the monitoring, the timing of decisions and the newborn course, and engages physician experts to ask whether care fell below the standard and whether any shortfall caused the injury. Because CP has many possible causes, the causation question is examined with particular care, and a careful attorney will tell a family honestly when the record does not support a claim. Time limits differ by state and can be affected by the child’s age at the time of injury; we do not state deadlines until a state’s rules have been reviewed by an attorney licensed there.

Questions worth asking your child’s care team