Cerebral palsy in children: early signs, therapies and long-term outlook

Cerebral palsy happens when the brain does not develop normally during pregnancy or is damaged during or soon after birth. NHS inform says it usually causes abnormal muscle tone and movement and is not normally progressive. The NHS describes it as a group of lifelong conditions, and says the severity varies widely: some people have only minor problems while others are severely disabled.

NHS inform describes four main patterns of muscle tone. Spastic is the most common and involves tightening of the muscles. Dyskinetic involves muscles that shift from tight to floppy, with involuntary movements. Ataxic is the least common and shows as shaky movement and poor balance. Mixed describes signs of more than one type.

The NHS says symptoms are not usually obvious just after birth and normally become noticeable from an early age. Possible signs include:

• delays in development milestones, for example not sitting by 8 months or not walking by 18 months

• seeming too stiff or too floppy

• weak arms or legs

• fidgety, jerky or clumsy movements, or random uncontrolled movements

• walking on tiptoes

• swallowing, speech or vision problems, or learning disabilities

The NHS lists bleeding in the baby's brain or reduced blood and oxygen supply to the brain, an infection caught during pregnancy, temporary lack of oxygen during a difficult birth, meningitis and a serious head injury, while noting that in many cases the exact cause is not clear. NHS inform adds premature birth, neonatal encephalopathy and stroke in the baby's brain to its list of risk factors.

NHS inform makes a point that matters to many families: it is not always possible to tell why a child has developed cerebral palsy, and parents are not to blame.

The NHS says to speak to your health visitor or GP with any concerns about a child's health or development, because the same symptoms can have a number of causes and are not necessarily a sign of anything serious, and a child may be referred to specialists in child development for checks and tests. NHS inform says there is no one test for cerebral palsy: the clinician looks at medical history and how well the child moves, balances and reacts, watches development over time, and may use brain scans such as an MRI to confirm.

NHS inform recognises that waiting for a diagnosis can be very stressful for parents and signposts its mental wellbeing advice for parents who feel anxious or isolated.

There is no cure, but the NHS says treatments help people be as active and independent as possible, delivered by a team working to an individual plan. NHS inform describes what each therapist does.

NHS inform lists struggles with eating, drinking and swallowing, vision, pain, fatigue, sleep, epilepsy, learning disability, behavioural problems, bladder control, constipation, saliva control and sensory processing as possible features. It also notes secondary symptoms caused by the effect on the body, such as tight joints and muscles, dislocations and changes in pain and fatigue. Not every child has all of these, and a team approach can address them individually.

The NHS says it can be difficult to predict the outlook, but that most children live into adult life and some for many decades, that many go to mainstream school while some have special educational needs, and that the condition can limit activity and independence although many people lead full, independent lives. NHS inform says cerebral palsy does not normally shorten life expectancy, but symptoms can change with age even in adulthood, and to contact the GP practice if there is a change in condition or symptoms are getting worse.

The NHS names Scope as the main UK charity for people with cerebral palsy and their families, offering an online community and helpline. The NHS also says daily challenges can lead to problems such as depression in some people, and suggests speaking to the care team about likely effects.