Cerebral Palsy

What’s the Problem?

Cerebral palsy (CP) is a disorder of movement or coordination caused by an abnormality of the brain. Children with CP may have difficulty walking, talking, eating, and keeping their balance. About half of the people with cerebral palsy need to use aids such as braces, walkers, or wheelchairs to help them get around. People with CP are likely to have other disabilities as well; mental retardation is the most common. Depending on the seriousness of their disability, people with cerebral palsy may need special medical care, educational and social services, and other help throughout their lives from both their families and communities.

A study of costs associated with living with cerebral palsy found that over a lifetime, each person with CP needs $800,000 (in year 2000 dollars) more than the average healthy person. Many of these costs are borne by families, who often find it difficult to obtain all the services they need to help their children.

Who’s at Risk?

Each year about 10,000 babies in the United States develop CP. Babies born weighing less than about 3 pounds and babies born early (after only about 7 months of pregnancy) are especially at risk of developing cerebral palsy. Infertility treatments (e.g., in vitro fertilization treatments) may also increase a woman’s risk of having a baby with CP. This is partly because women who receive such treatments are more likely to have twins, babies who are small, or babies who are born early.

Can It Be Prevented?

The causes of CP are mostly unknown. However, we do know that CP usually occurs before birth or during early childhood. About 80% of CP occurs before birth or 1 month of age, but less than 10% of CP develops as a result of complications during labor and delivery. Kernicterus – a condition associated with untreated and severe jaundice in newborns – is a rare but preventable cause of cerebral palsy. The major features of kernicterus are cerebral palsy, sensorineural hearing loss, vision problems, and dental problems. Mental retardation is also associated with some cases of kernicterus. However, phototherapy and exchange transfusions effectively prevent kernicterus if treatment is timely.

The Bottom Line

• Cerebral palsy usually is not caused by problems during labor and delivery.
• In-vitro fertilization increases the risk of having a child born with cerebral palsy.
• Since CP has been associated with premature, low-birth weight babies, women should consult their doctors for ways to prevent these conditions. Several factors that have been shown to be associated with prematurity and low birth weight include smoking, alcohol abuse and poor medical management of maternal conditions such as diabetes and hypertension.
• Children born prematurely are at increased risk for CP, so it is important that their development be closely monitored for any signs of delay.
• Severe jaundice needs to be treated early. Kernicterus, a condition associated with severe jaundice in the newborn, is a preventable condition that can result in CP.

Case Example

A healthy full-term baby boy was born weighing 7 pounds and 14 ounces. The pregnancy was medically uneventful. During pregnancy the woman tried to do “all the right things;” she received prenatal care, took prenatal vitamins, did not smoke or drink, and even attended birthing classes.

At birth, the baby’s vital signs and tests all indicated that he was healthy. He started breast-feeding immediately. However, the following morning the baby looked a little jaundiced, but the mother was reassured that this was normal and that many babies have jaundice.

At 26 hours the baby was discharged, and the parents were given instructions for routine follow-up. When the baby was 7 days old, he became fussy. He cried a lot more, was no longer feeding well, and had a strange arch in his back. The next morning the mother called the pediatrician and was asked to immediately bring the baby in for an exam. Blood was drawn to measure the amount of bilirubin (the factor that causes jaundice) in the baby’s blood. The physician ordered the mom to take her baby to the hospital. At the hospital, the baby was given an exchange transfusion. The baby then spent the next few weeks in the hospital’s neonatal intensive care unit. When the baby was 7 months old, he was referred to a children’s diagnostic center, where the physician suspected cerebral palsy and recommended physical therapy.