Early Signs of Cerebral Palsy In Babies And Treatment

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Cerebral palsy is a term for a group of disorders that affect a person’s ability to move. It may occur due to brain damage that may occur during pregnancy or shortly after birth. The effects of cerebral palsy vary in each baby.

Cerebral palsy is an irreversible condition, but some symptoms may improve or worsen over time. This post tells you about the types, symptoms, causes, risk factors, diagnosis, and treatment of cerebral palsy in babies (1).

Types Of Cerebral Palsy

Cerebral palsy is classified into different types based on brain injury and the body parts involved.

Cerebral palsy by the location of brain injury (2):

1. Spastic cerebral palsy

• Most common form
• Causes stiff and tight muscles
• Happens as a result of damage to the motor cortex in the brain

2. Dyskinetic cerebral palsy

• Also known as athetoid cerebral palsy
• Seen in 6% of cases of cerebral palsy
• Happens due to damage to the basal ganglia

3. Ataxic cerebral palsy

• Seen in 6% of cases of cerebral palsy
• Characterized by shaky movements, issues with body balance, and with the sense of positioning in the space
• Happens due to damage to the cerebellum

4. Mixed cerebral palsy

• A combination of symptoms of more than one of the three types described above
• Happens when the brain injury is in one or more parts of the brain

Cerebral palsy by body part (2):

5. Quadriplegia

• It affects all four limbs
• A person’s torso, facial, and oral muscles may also get affected

6. Triplegia

• It affects three limbs – one arm and both legs
• A person’s torso, facial, and oral muscles may also get affected

7. Diplegia

• It affects both legs
• A person’s arm may also be slightly affected

8. Hemiplegia

• It affects one side of the body
• A hand and leg on the affected side are affected
• About 40% of people with cerebral palsy have hemiplegia

9. Monoplegia

Signs And Symptoms Of Cerebral Palsy

The signs of cerebral palsy appear in the initial months, but many babies are not diagnosed until about two years. The signs of the condition could vary among babies.

The following are the general signs of cerebral palsy (3) (4).

• Developmental delays: A delay may be seen in reaching some milestones, such as rolling over, sitting, crawling, and standing. Developmental delays are usually the initial clues that may point to a probability of cerebral palsy.
• Abnormal muscle tone: Body parts may appear stiff or floppy due to abnormal muscle tone.
• Abnormal posture: The baby may exhibit preference and more usage of one side of the body during movements, such as when reaching out for a toy.
• Retained primitive reflexes: Some infants may retain primitive reflexes that mostly disappear during infancy (5).

The following are the age-specific signs of cerebral palsy (3) (4).

Babies younger than six months:

• Inability to hold head up when picked up from the supine (lying) position
• May feel stiff or floppy
• Legs may seem stiff and may overlap like a scissor
• When held in arms, they may hyperextend their neck and back and seem like they want to push themselves away

Babies older than six months:

• Cannot rollover
• They cannot bring their hands to the mouth
• They cannot bring their hands together
• May use only one arm and hand while keeping the other hand clenched

Babies older than ten months:

• May crawl using only one side of their hands and legs while dragging the limbs on the other side
• May scoot on the buttocks or hop on the knees, but unable to crawl on all fours
• They cannot stand even when held or provided adequate support

Babies and toddlers with cerebral palsy may also display the following additional problems (5).

• Seizures
• Vision, hearing, or speech problems
• Learning disabilities
• Behavioral issues
• Poor cognitive skills
• Developmental regression
• Problems with respiration
• Problems with bladder and bowel function
• Bony deformities such as scoliosis
• Sleep deficiency may be seen due to pain from spastic muscles, mobility impairment, and sensory processing issues (6)

Several of these signs may occur in various diseases, disorders, and conditions that may often cause severe long-term problems. Therefore, consult a doctor promptly if you notice any of these signs in your baby or toddler.

Causes Of Cerebral Palsy

Cerebral palsy is caused due to damage to the developing brain or abnormal development of the brain. Several possible reasons may lead to a damaged or abnormal development of the brain. However, prematurity of birth and stroke are considered to be the main reasons for cerebral palsy in babies (7).

Cerebral palsy that occurs during the fetal stage or during the birth process is known as congenital cerebral palsy. In some babies, cerebral palsy occurs more than 28 days after birth and is called acquired cerebral palsy (4). Some known causes of acquired cerebral palsy are bacterial meningitis, viral encephalitis, circulatory and blood flow problems to the brain, and head injuries (8).

Risk Factors For Cerebral Palsy In Babies

The following conditions and situations are often associated with an increased risk of cerebral palsy in babies (7).

• Premature birth (earlier than 37 weeks)
• Prolonged lack of oxygen during delivery
• Low birth weight
• Multiple births (twins or triplets)
• Males might be at a higher risk
• Severe jaundice immediately after birth
• Problems with blood clotting
• Problems with the placenta
• Maternal blood incompatibility with the fetus
• Maternal infections during pregnancy

It is not fully known how these conditions increase the risk of cerebral palsy. Some babies may develop cerebral palsy without showing any risk factors.

Diagnosis Of Cerebral Palsy In Babies

Cerebral palsy is usually diagnosed with a physical examination and with an analysis of prenatal medical history. A confirmation may be reserved until the baby is about six to 12 months old when a delay in developmental milestones is recognized better.

It is essential to rule out other conditions to get an accurate diagnosis of cerebral palsy. The following diagnostic tests may be conducted to confirm the condition (5).

• Neurological examination: It evaluates the reflexes and motor function.
• X-Rays: It is used to visualize internal tissues, bones, and organs.
• Feeding studies: These are done to check for swallowing and feeding problems in babies.
• APGAR test: It is used to assess the baby’s skin appearance, heart rate, reflexes, muscle tone, and breathing (9). It is performed one, five, and ten minutes after birth. Each category is assigned a score between zero and two, with zero being the least and two the highest. You can read more about the APGAR test here.
• Electroencephalogram (EEG): It helps check the electrical activity in the brain. Electrodes are attached to the baby’s scalp to record the activity.
• Metabolic tests: These tests check if the body lacks any specific enzyme that is necessary to maintain the body’s normal functioning.
• Magnetic resonance imaging (MRI): It is a test done to see the organs and tissues of the body in detail.
• Computed tomography scan (CT Scan): A CT scan uses a combination of X-rays to produce detailed images of all body parts, including bones, muscles, fat, and organs.
• Genetic studies: They are done to look for hereditary conditions.

Treatment For Cerebral Palsy In Babies

There is no cure for cerebral palsy. The treatment focuses on managing existing symptoms, minimizing physical deformities, and improving the quality of life. Most of the treatment procedures may be considered as the baby steps into childhood.

The following procedures could be considered depending on the type of cerebral palsy and the baby’s age (5).

• Positioning aids to enable the baby to sit, lie down, or stand
• Assistive devices such as splints or braces to provide support, protection, and prevent bony deformities
• Oral and injectable medicines to control seizures and to decrease muscle stiffness
• Orthopedic surgeries to correct any concurrent problems, such as scoliosis

Prognosis Of Cerebral Palsy In Babies

Nearly half of the babies diagnosed with cerebral palsy by 12 months outgrow the condition by the age of two years. Several children with cerebral palsy can walk independently with the help of supportive devices (10). Long-term therapy, such as physiotherapy, may reduce the intensity of symptoms and make the child more mobile by adulthood.

Cerebral palsy is an irreversible condition, but the symptoms can be adequate managed with recent medical advancements. Talk to your healthcare provider if you suspect any issues with your baby. Timely initiation of treatment improves the baby’s quality of life for the long term.

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