Cerebral Palsy: Symptoms, Causes, Treatments, and Natural Approaches

In the United States, cerebral palsy affects one in 323 children. Globally, up to four out of every 1,000 babies are born with the condition.

Cerebral palsy is a neurological condition caused by brain damage before, during, or right after a child's birth. Illustration by The Epoch Times, Shutterstock

Cerebral palsy (CP) is the most common cause of physical disability in children.

Cerebral palsy is a neurological condition that affects muscle tone, movement, and posture. It occurs due to damage to the developing brain, which may happen before or after birth. The damage affects parts of the brain responsible for controlling muscle movement, resulting in permanent disabilities that limit activity and function.

Sometimes, other parts of the brain also get damaged, leading to associated conditions like sensory disturbances, hearing and visual difficulties, communication and learning problems, intellectual disability, and epilepsy.

In the United States, cerebral palsy affects one in 323 children. Globally, up to four out of every 1,000 babies are born with the condition.

What Are the Symptoms and Early Signs of Cerebral Palsy?

The symptoms of cerebral palsy vary greatly, depending on which part of the brain is damaged. The core symptoms are motor function problems ranging from mild to severe. Signs and symptoms may even change as the nervous system matures.

Early Signs

Signs may not be noticeable just after birth but usually appear before the child turns 2. Early signs include:

• Delayed development: The child shows delays or cannot reach movement-related milestones like crawling, rolling over, reaching, bringing their hands to their mouths, reaching for objects, sitting, or walking. Meanwhile, achieving them too early, like rolling over, or standing at 2 months, possibly signifying abnormal tone, is also an early feature.
• Abnormal muscle tone: The child may be floppy, with the head falling back when he or she is picked up, or too stiff, with legs crossing over and the neck and back overextending. Some may begin with low tone (hypotonia) in the neck and trunk that gradually changes into increased tone (hypertonia) in the hands and feet during the first year of life.
• Early hand preference: The child shows hand dominance before 12 months.
• Irritability: The child is easily startled, cries excessively, or is jittery or jumpy.
• Reduced level of consciousness: The child appears sleepy, has an irregular sleep pattern, or lacks alertness.
• Oral motor abnormalities: This includes early feeding problems, oral hypersensitivity, excessive drooling, and poor sucking and swallowing.
• Unusual posture: The child moves in a lopsided manner or prefers moving using a particular body part or side of the body.
• Abnormal reflexes: A child with CP has hyperactive deep tendon reflexes on a neurological exam. Meanwhile, reflexes present after birth to help with survival do not disappear by 4 to 6 months of age, while more mature postural reflexes, like protective reflexes, fail to develop.

Common Signs and Symptoms

While some signs and symptoms appear early, others may only become noticeable as the child ages. Symptoms can also continue to develop until the child is 4 to 5 years old. A child with CP may present with the following movement and coordination problems:

• Spasticity, or having tight and stiff muscles, seen in 80 percent of children with cerebral palsy
• Muscle weakness
• Random, jerky, or uncoordinated movements
• Lack of muscle coordination
• Abnormal walking patterns, such as scissoring or crouched gait
• Difficulty using hands for fine, precise movements, like writing or picking up small objects

What Causes Cerebral Palsy?

Cerebral palsy occurs due to damage to the developing brain or abnormal brain development, specifically to the parts of the brain that control movement. The exact cause of the damage is often unknown, but it is likely due to multiple factors.

The injuries or events that cause cerebral palsy can happen before, during, shortly after birth, or in the first years of life while the brain is still developing. Nearly 75 percent of these occur before birth. Meanwhile, 10 percent to 18 percent happen immediately after delivery, and a small number occur beyond the first 28 days of life (neonatal period). Some causes can also be brought on by the mother’s preconception health and living conditions, such as infections, immune system disorders, or drug use.

Before Birth

Problems that occur while the baby is in the womb include:

• Periventricular leukomalacia: Periventricular leukomalacia occurs when the white matter in the brain is damaged or softened, affecting the transmittal of signals from the brain to the body. These structures are more sensitive during 26 to 34 weeks of gestation. One retrospective study found it to be the most common cause of cerebral palsy in premature infants.
• Fetal stroke: The blood supply to the brain can be cut off by a blood vessel blockage (ischemic stroke) or bleed (hemorrhagic stroke). This can be due to blood clots in the placenta, weak blood vessels in the brain, blood clotting problems, maternal high blood pressure, and heart defects.
• Genetic mutations: Mutations in genes that control brain development can cause the brain to develop abnormally. Recent studies also found that up to 10 percent and 30 percent of cerebral palsy cases, particularly in those not exposed to environmental risk factors, occur due to genetic causes.
• Fever and infections: Maternal fevers and infections during pregnancy cause the body to produce cytokines. These cause inflammation in the baby’s brain, which can lead to brain damage. Common infections a mother may acquire that can lead to brain damage in an unborn child include rubella (German measles), varicella (chickenpox), cytomegalovirus, toxoplasmosis, herpes, syphilis, and Zika virus.

During Birth and Delivery

Brain injury or damage can occur secondary to events during or shortly after birth. These may include:

• Lack of oxygen in the brain (asphyxia) due to problems with the umbilical cord, uterus, or placenta. Prolonged or difficult birth, breech presentation, and the mother having heart and breathing issues can also affect the infant’s oxygen supply.
• Infections during labor, like chorioamnionitis, a bacterial infection caused by bacteria entering the membranes enveloping the fetus.
• Head injuries during delivery.

After Birth

Cerebral palsy can also be acquired (acquired cerebral palsy). While most experts recognize events occurring after the first 28 days of life to cause this type of CP, some include events occurring during the neonatal period and before the child turns 5 (postneonatal cerebral palsy). Examples include:

• Infections like meningitis and viral encephalitis
• Too much bilirubin in the blood, which can cause yellow discoloration of the eyes and skin (jaundice) and can damage the brain’s basal ganglia and cerebellum, leading to dyskinetic cerebral palsy
• Traumatic brain injury, like shaken baby syndrome, resulting from a severe form of child abuse
• Drowning
• Poisoning

What Are the Types of Cerebral Palsy?

Cerebral palsy is grouped into four main types, depending on the tone abnormality and distribution.

Spastic

Spastic cerebral palsy is the most common type, comprising 70 percent to 80 percent of all CP cases. It causes muscle stiffness or rigidity. The spastic type is further broken down into three groups, depending on the parts of the body affected by the motor difficulties:

• Diplegia: This is the most common type of spastic CP, affecting 35 percent of children with CP. It affects either both legs or arms; typically, the legs are more affected than the arms. Most people with it have normal cognitive abilities and have the potential to walk independently.
• Hemiplegia: This type, affecting 25 percent of children with CP, is commonly seen in term infants and occurs due to a stroke in the womb or during delivery. One side of the body is affected, with the arm more affected than the leg. Most people with this type also have normal cognitive abilities and may walk independently.
• Quadriplegia: This is the most severe type of cerebral palsy in terms of motor disability and associated conditions. It affects 20 percent of children with CP and is caused by widespread brain damage or malformations. All four limbs, as well as the trunk and face, are affected. Quadriplegic people are rarely able to walk and have significant functional limitations.

Dyskinetic

Dyskinetic CP, also called athetoid CP, or extrapyramidal CP, is due to damage in brain structures beneath the cerebral cortex, like the basal ganglia. It comprises about 15 percent of CP cases. It is characterized by involuntary, slow, twisting, writhing, and repetitive uncontrolled movements of the arms, legs, feet, and hands, accompanied by fluctuating muscle tone. Dyskinetic CP is sometimes categorized into the following subtypes:

• Choreoathetoid: quick, uncontrolled, twisting movements with low tone affecting the face, trunk, toes, and fingers
• Dystonic: asymmetric posturing coupled with increased tone or spasms

Ataxic

Ataxic CP comprises 5 percent to 10 percent of children with cerebral palsy. This type occurs due to damage or malformation in the cerebellum, a part of the brain responsible for balance and coordination. Children with ataxic cerebral palsy have poor balance, coordination, trunk control, low tone, and tremors. People with ataxic CP walk with a wide support base and have an unsteady gait.

Mixed

Some children may show symptoms from two or more types of cerebral palsy because of damage to different parts of the brain.

There are four types of CP, each caused by damage to a different part or parts of the brain. Illustration by The Epoch Times, Shutterstock

Who Is at Risk of Cerebral Palsy?

Certain factors can increase a pregnant woman’s risk of having a child with cerebral palsy. These include:

• Exposure to toxins: Pregnant women consuming even low levels of methylmercury, a type of mercury, can give birth to infants with cerebral palsy and severe developmental delays. Besides heavy metals, tobacco use, excessive alcohol consumption, substance use, and certain medications can also increase the risk of having a child with cerebral palsy.
• Breech delivery: Breech vaginal delivery is now avoided due to the risk of asphyxia. However, studies show that breech position, regardless of delivery type, increases a child’s risk of cerebral palsy, suggesting that the position reflects abnormalities before the onset of labor.
• Multiple births: Carrying twins or multiples has a fourfold higher risk due to a higher risk of preterm birth.
• Blood incompatibility: If a woman’s Rh blood type is incompatible with her baby’s, it increases the infant’s risk of dyskinetic cerebral palsy. The Rh factor is a type of protein on the exterior of red blood cells.
• Health conditions: A woman’s preexisting health conditions, like heart disease, diabetes, obesity, thyroid disorders, and epilepsy, can increase an unborn child’s risk of CP.
• Assisted reproductive technologies (ARTs): Infants conceived via assisted reproductive technologies such as in vitro fertilization (IVF) are at a higher risk of developing CP, with each IVF twin having over a fourfold greater risk of cerebral palsy.

Pregnancy and birth factors can also increase a child’s risk of developing cerebral palsy. These include:

• Prematurity: About half of babies born with cerebral palsy were premature.
• Birth defects: Neurological birth defects like hydrocephalus (cerebrospinal fluid buildup in the brain) and non-brain-related abnormalities are strongly associated with cerebral palsy both in preterm and full-term babies.
• Low birth weight: Babies who weigh less than 5 pounds, 8 ounces (2,500 grams) have a high risk of developing cerebral palsy. According to one review article, babies with a birth weight of 2 pounds, 4 ounces (1,000 grams) to 3 pounds, 5 ounces (1,500 grams) had a 4.2 percent greater risk, and those with an extremely low birth weight (under 2 pounds, 3 ounces) had an 8.4 percent greater risk.
• Low Apgar score: An Apgar score provides a quick measure of a newborn’s condition after birth. An assessment of zero to 10 is given based on an examination of pulse, skin coloration, respiration, muscle tone, and reflexes. A score of less than 3 after both a five- and 10-minute assessment is associated with a higher risk of cerebral palsy or death.
• Sex: Boys are slightly more likely to have CP than girls, with a ratio of 1.3:1.

How Is Cerebral Palsy Diagnosed?

Doctors diagnose cerebral palsy based on the presence of defining features. Generally, children receive a diagnosis by age 2 as clinical features become more evident. However, a definitive diagnosis may be delayed if the child’s symptoms are mild.

Health care providers may notice signs of cerebral palsy during well-child visits and refer to specialists like neurologists and developmental pediatricians for further assessment.

These specialists typically diagnose cerebral palsy through medical history, physical and neurological examination, and standardized assessments. They may also use tests to confirm the diagnosis, identify the cause of CP, and rule out other conditions. These include the following:

• Cranial ultrasound uses high-frequency sound waves to produce images of the brain and the cerebrospinal fluid surrounding it. Because this is the least invasive imaging test, it is typically used during the first year of life, especially in high-risk premature infants.
• Magnetic resonance imaging (MRI) creates detailed three-dimensional or cross-sectional images of tissues and organs using a strong magnetic field and radio waves.
• Electroencephalogram (EEG) involves attaching sensors to the scalp to measure and record the brain waves, or electrical signals produced by the brain.
• Computed tomography (CT) scanning provides pictures of organs, bones, and other tissues inside the body by combining data from a series of X-rays.
• Blood tests involve taking a blood sample to rule out other possible conditions, like genetic disorders.
• Electromyograms (EMG) use mild electrical stimulation to check the function of skeletal muscles and the nerves that control them. The test involves inserting one or more thin, sterile needles into the muscle being tested.

Early diagnosis is crucial so the child can receive early intervention, maximizing the impact on the developing brain’s neuroplasticity. Fortunately, imaging tests can identify brain injury, allowing diagnosis as early as 6 months of age.

Specialists may give an interim diagnosis of “high risk of CP” when they cannot definitively diagnose cerebral palsy. Children with motor problems and either an abnormal MRI scan or a clinical history indicating a risk for CP typically receive this type of diagnosis. These children are tracked and monitored and may receive early intervention.

What Are Possible Complications of Cerebral Palsy?

Children with cerebral palsy often have many associated conditions that may be due to brain damage or the abnormal brain development that caused the condition. These include:

• Seizures
• Eye problems, including crossed eyes, reduced vision, and abnormal eye movements
• Hearing problems
• Problems with sensation and perception
• Learning disorders
• Intellectual and developmental disabilities
• Bowel and bladder issues, like incontinence and constipation
• Speech and language problems
• Nutrition issues
• Mental health issues, like behavioral problems and depression
• Sleeping problems

At the same time, motor problems like spasticity and muscle weakness can contribute to other complications, including:

• Bone problems: Joint misalignment and pressure on joints can lead to osteoarthritis. Lack of movement, certain medications, and poor nutrition can cause osteopenia and osteoporosis.
• Malnutrition: Sucking, chewing, and swallowing problems can prevent a child from getting adequate nutrition.
• Dental issues: Medications, limited oral care and hygiene, poor nutrition, and excessive drooling can increase the risk of dental problems.
• Breathing problems: Swallowing problems can cause food and drink to go to the lungs, leading to aspiration pneumonia.
• Secondary musculoskeletal conditions: Abnormal tone can lead to muscle imbalances, resulting in various conditions, including spinal deformities like scoliosis, muscle contractures, and foot abnormalities like club foot and tiptoe walking.

What Are the Treatments for Cerebral Palsy?

There is no cure for cerebral palsy. Treatment aims to improve a person’s functional abilities, help them stay as independent as possible, and prevent complications. Treatment varies from person to person, depending on their needs and associated problems.

1. Medications

Medications can address symptoms and complications associated with cerebral palsy. Some that are often prescribed include:

• Baclofen, dantrolene, and benzodiazepines like diazepam for spasticity
• Botox injections to relax stiff muscles or muscle groups for months
• Gabapentin, carbidopa-levodopa, and benztropine for dystonia (muscle contractions)
• Stool softeners and laxatives for constipation
• Painkillers for spasms and pain
• Anti-seizure medications for epilepsy
• Medications to reduce excessive drooling
• Antidepressants for anxiety and depression

2. Orthotic, Assistive, and Mobility Devices

Orthoses are wearable medical devices that stabilize, support, or correct body parts to improve function and movement. Examples include ankle foot orthosis (AFO), spinal braces, and arm and hand splints. These are typically used with walkers, crutches, or wheelchairs to help a person with CP move indoors and outdoors.

Children with cerebral palsy can also use various assistive devices to make daily life easier and promote independence. Examples include reachers, hearing aids, eyeglasses, and communication devices.

3. Therapy

A variety of therapies can help treat cerebral palsy, including:

• Physical therapy: Physical therapists aim to improve a child’s tone, strength, flexibility, balance, movement patterns, and mobility through muscle training and exercises
• Occupational therapy: Occupational therapists help physical therapists, especially during the first few years of life, to address issues like head and trunk control, posture, movement patterns, and hand use. They also help children with CP gain independence in everyday activities and routines through exercises, activities, and adaptive equipment.
• Speech therapy: Speech therapists help improve the child’s ability to speak or teach them new communication methods, such as sign language or communication devices. They can also address eating and swallowing issues.
• Recreational therapy: Recreational therapy improves a child’s participation in sports, leisure, art, and cultural activities to promote physical and emotional well-being, self-esteem, and other skills.
• Social services
• Counseling
• Psychotherapy
• Educational support

4. Surgery

A range of surgical procedures can help address movement difficulties, such as:

• Intrathecal pump: Doctors may recommend baclofen to be given through a surgically implanted pump for severe spasticity.
• Orthopedic surgery: This type of surgery can help lengthen muscles and tendons, correct joint and spine position, address misalignment, and increase joint motion.
• Selective dorsal rhizotomy: This procedure involves cutting nerves serving spastic muscles to relax them or reduce abnormal movements.

How Does Mindset Affect Cerebral Palsy?

While a positive mindset may not directly improve cerebral palsy, it may influence one’s coping and experience of the condition. An older study found that a positive attitude toward one’s condition is correlated with school adjustment and good school achievement.

Mental, social, behavioral, and emotional problems are common in children and adults with cerebral palsy. These people also have a higher risk of developing anxiety and depression. Mindfulness can help address these issues.

A 2023 randomized controlled trial found that mindfulness-based stress reduction improved emotional regulation, depression, and stress in adults with CP. Similarly, a 2024 study showed that individuals with physical disabilities, including CP, who underwent mindfulness interventions had fewer symptoms of anxiety and depression, higher levels of self-compassion and mindfulness, and better health-related quality of life compared to those who did not. A scoping review also suggests that mindfulness interventions may benefit motor function and communication in individuals with cerebral palsy.

Mindfulness and positive thinking may also benefit caregivers. Parents of children with CP often experience significant stress, depression, and anxiety. One case of three mothers of children with CP showed that mindfulness-based cognitive therapy improved their quality of life.

What Are the Natural Approaches to Cerebral Palsy?

Natural remedies are available for treating CP. However, few studies support their effectiveness. Because of this, please consult your child’s doctor before considering them.

1. Acupuncture

A meta-analysis of randomized controlled trials found that adding acupuncture to rehabilitation training improved gross motor function, enhanced daily life activities, and reduced spasms in children with cerebral palsy. A similar study found that combining traditional Chinese medicine (TCM)—mainly acupuncture and scalp acupuncture—with modern rehabilitation therapies improved motor development, increased functional independence, and reduced muscle tone in children with cerebral palsy. However, researchers said their results should be interpreted cautiously due to how varied the included studies were.

One small study involving 36 children with cerebral palsy found that scalp acupuncture led to symptom relief, improved quality of life, and even complete resolution of symptoms in some of the children. Similarly, a 2019 study involving 52 Chinese children found that combining scalp acupuncture with exercise therapy and conventional rehabilitation significantly improved gross motor function and the ability to perform activities of daily living (ADL) compared to traditional rehabilitation alone.

2. Herbal Medicine

A 2018 study that reviewed systematic reviews assessing the use of oriental herbal medicine (OHM) found that the ADL scale scores of children with cerebral palsy were significantly higher in those who received OHM in addition to traditional rehabilitation. However, the authors stressed that more high-quality studies are needed before OHM can be recommended as an adjunct therapy.

3. Supplements

The following dietary supplements have some scientific support backing them:

• Nutrition shake: A 2020 study on 30 children examined the effects of a shake-based nutritional support supplement that included fruits, vegetables, cereals, and fish, as well as vitamins, minerals, and additions like spirulina. Researchers found that children who received the supplement and deworming showed significant standing and walking improvements, attributed to reduced spasticity. The subjects were dewormed to ensure they had no parasites competing for nutrients. These improvements were more significant than those in groups that were not dewormed and those who were dewormed and received World Health Organization-recommended nutritional therapy.
• L-tryptophan: A 2019 animal study found that cerebral palsy impairs chewing, and supplementation with the essential amino acid l-tryptophan reduced the chewing deficits of rats with cerebral palsy.
• L-arginine: In another study examining the data of 96 Chinese children, supplementing with l-arginine, an amino acid involved in nitric oxide production, protein building, and blood flow, significantly improved the nutritional status and immune and motor function of children with hypotonic cerebral palsy.

How Can I Prevent Cerebral Palsy?

Most of the events that cause cerebral palsy are not fully understood or preventable. However, you can take specific measures before and during pregnancy to reduce your risk of complications, and there are steps you can take after your child is born to reduce the risk of acquired cerebral palsy.

Before Pregnancy

• Manage underlying health conditions.
• Consider getting vaccinated: A 2020 Bangladesh study found that mothers of children with CP had lower immunization rates than the national average. Additionally, one 2022 review found that mothers vaccinated against cytomegalovirus and Zika virus can prevent the vertical transmission of infections that can cause developmental defects and lifelong disabilities in their children.
• Transfer one embryo at a time when using infertility treatments.
• Stick to whole foods, avoid processed food whenever possible, and address any nutritional deficiencies.

During Pregnancy

• Attend routine prenatal appointments.
• Ensure proper nutrition and avoid foods high in heavy metal contamination, such as fish high in mercury (e.g., tilefish, swordfish, king mackerel, tuna). Large, deep-sea fish that eat other fish typically have higher mercury content.
• Manage conditions like preeclampsia.
• Avoid smoking, alcohol, and illegal drugs.
• Reduce the risk of infections with good personal hygiene.
• Find out your blood type to minimize the risk of blood type and Rh incompatibility. Doctors can treat the mother to prevent kernicterus, a kind of brain damage, in the baby.

After Pregnancy

• Baby-proof your home to avoid head trauma that could result in CP.
• Consider vaccinations for your child. Meningitis and encephalitis can lead to CP in babies; vaccines to prevent these infections include the Haemophilus influenzae type B (HiB) vaccine and the Streptococcus pneumoniae (pneumococcal) vaccine.
• Use age- and size-appropriate car sets.
• Never leave your child unattended.

Reduce Specific Risks

• Preterm birth: Medication can reduce complications if you are at risk of preterm delivery. Studies show that taking magnesium sulfate can reduce the risk of your child developing cerebral palsy if you’re at risk of delivering preterm. Additionally, a 2023 review of randomized controlled trials revealed one trial’s finding that giving 20 milligrams per kilogram of caffeine citrate to preterm or low-birth-weight infants decreased their risk of developing cerebral palsy.
• Asphyxia: Therapeutic hypothermia aims to lower the body or head temperature of infants by about 3.6 degrees Fahrenheit (2 degrees Celsius) for 48 hours to reduce the risk of cerebral palsy in those who experienced oxygen deprivation during labor and delivery.