Cerebral palsy is not a single disorder, but a term for any child with development delay, motor delay- delay in sitting, delay in standing, speech delay or intellectual disability. However, the concept is incurrent

In simple terms, cerebral palsy (CP) is a disorder in which there is improper control of muscle movement in different parts of the body.

In a child with cerebral palsy, the brain impulse is distorted leading to poor co-ordination, stiffness, tightness, toe-walking

Cerebral palsy is a disorder in there is poor control physical movements of the body. Cerebral palsy is caused by brain injury during early childhood and infancy. The timing of the brain injury is critical. Brain damage occurs maximally during pregnancy; childbirth, labour, delivery process or immediately after childbirth. After a child is 1 month old, chances of brain injury to cause cerebral palsy is less. The cause of brain injury to new born include

Oxygen Deprivation: A number of complications during pregnancy (e.g., infection of mother, membrane rupture, umbilical cord problems) can reduce the supply of oxygen to the baby. Complications during labour and delivery can also cause oxygen deprivation. Oxygen deprivation leads to death of brain cells

Developmental Abnormalities: cerebral palsy can also result when there is poor development of brain during pregnancy. This can be caused by genetic disorders or infection, fever, or injuries, hypoglycaemia

• Childbirth Trauma: cerebral palsy is commonly caused by injuries during labour and delivery. Obstetrical forceps delivery or vacuum extractors can cause oxygen deprivation and brain injury

HIE – hypoxic ischemic encephalopathy

Perinatal asphyxia or delayed cry after birth

Infection of new born like EONS, LONS, sepsis, meningitis, pneumonia

High jaundice, needing DVET double volume exchange transfusion

Low sugar of new born, neonatal hypoglycaemia

Neonatal seizures, jerks, fits

Prematurity

PVL periventricular leukomalacia

No. Cerebral palsy is a not a genetic disorder. Cerebral palsy is due to injury to the brain during pregnancy or childbirth. It is not triggered by the parent’s DNA. In very rare situation, when there are two or more children with family, unexplained deaths of previous children, marriage between relatives, fluctuating neurological course should prompt evaluation for inherited and metabolic disorders

Cerebral palsy is a disorder with wide variety of symptoms.

The common symptoms of cerebral palsy

Delay in sitting and standing

Delay in head holding

Delay in speech

Vision problems like squint, poor eye contact

Epilepsy, seizures, mirgi

Development delay, intellectual disability and mental retardation

Other associated symptoms include

Poor swallowing, recurrent regurgitation of feed, recurrent vomiting

Recurrent fever, recurrent ear infection and pneumonia

Poor weight gain, poor growth

The severity varies in every child. Some children can have only minor disability in walking with normal intelligence

Some children have only seizures with no other problems

Some children have only small head with no problems

Different permutation of above-mentioned symptoms can be used with different severity

There are several different subtypes of cerebral palsy each of which comes with its own unique set of symptoms and affects different parts of the body. Some degree of physical abnormality will typically be noticeable in a child with cerebral palsy.

No. Cerebral palsy is not considered a progressive disorder, which means that it will not continue to get worse over time. It will improve slowly. The improvement is variable. The speed of improvement is variable. The extent to which child will improve is unpredictable.

Cerebral palsy is due to brain injury during birth. Brain injury is a onetime event with no further damage. The degree of improvement depends on amount of brain not injured. In fact, with effective therapy and treatment, the symptoms of cerebral palsy can improve with time

Cerebral palsy itself is not a potentially life-threatening disorder. Risk of dying is slightly higher for children with cerebral palsy with difficulty chewing and swallowing which predisposes them for choking, aspiration pneumonia. Children with CP are at higher risk for seizures. Though the risk of death from seizures is low, the life time risk of seizure recurrence is high

Currently, there is no role of cure by stem cells

Sadly, there is currently no “cure” to treat children with cerebral palsy. Cerebral palsy is caused by permanent brain damage, so deficits often remain. However, a treatment options are available which will improve quality of life for children with cerebral palsy. Absence of cure doesn’t mean absence of improvement. With good quality physical therapy, physiotherapy, occupation therapy, nutrition therapy, control of seizures

Tests for different function of body need to be done

These include

MRI brain to see for extent of brain damage

EEG test if child has seizures

BERA test for hearing

Test to evaluate general health like haemoglobin, calcium, Vitamin D and vitamin B12

Opthal evaluation for squint

ENT and gastroenterology evaluation for any feeding problems

Physiotherapy evaluation

Paediatric Neurologist- 1-2 monthly

Ophthalmologist- 3-6 monthly

Physiotherapist- 1-4 times a month

Occupation therapist- 1-4 times a month

ENT doctor- once initially

Paediatric Orthopaedic doctor if advised

I am not sure of the role. They are left to the decision of the parents. However, the above-mentioned doctors like paediatric neurologist and physiotherapist need to be shown regularly

Supplements like Iron, multivitamin, calcium is commonly given. Other supplements include piracetam, DHA, omega 6 fatty acid, carnosine, dimethylglycine. However, the role of such supplements is unknown. Fish liver oil is a used by many parents

All vaccines can be given and should be given, Optional vaccines like Hemophilus, pneumococcal and flu vaccine can be considered after discussing with parents

Does a child with cerebral palsy have risk for seizures?

Child with cerebral palsy have higher risk of seizures compared to other children. Even if the EEG is normal and child suffers a seizure, anti-seizure medication should be given. The seizure frequency varies in different children

Certain types of children with cerebral palsy like diplegic cerebral palsy have very minimal impairment with very good intelligent. The only impairment they might have is difficulty in sport requiring quick activities. Because of risk of seizures, children with cerebral palsy should not engage in adventure sports

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