"Cerebral palsy" is a general term that describes a group of disorders that appear during the first few years of life and affect a child's ability to coordinate body movements. These disorders are caused by damage to a child's brain early in the course of development. The damage can occur during fetal development, during the birth process or during the first few months after birth.

Cerebral palsy ranges from mild to severe. Physical signs of cerebral palsy include weakness and floppiness of muscles or spasticity and rigidity. In some cases, neurological disorders — such as mental retardation or seizures — also occur in children with cerebral palsy.

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There are three major types of cerebral palsy. Some individuals may have symptoms of more than one type.

• Spastic cerebral palsy: About 70 to 80 percent of affected individuals have the spastic type, in which muscles are stiff, making movement difficult (1). Spastic diplegia is a form of spastic cerebral palsy in which both legs are affected. Affected children may have difficulty walking because tight muscles in the hips and legs cause legs to turn inward and cross at the knees (called scissoring). In spastic hemiplegia, only one side of the body is affected, often with the arm more severely affected than the leg. Most severe is spastic quadriplegia, in which all four limbs, the trunk and face are affected. Children with spastic quadriplegia usually cannot walk. They often have mental retardation, difficulty speaking and seizures.
• Athetoid or dyskinetic cerebral palsy: About 10 to 20 percent of affected individuals have the athetoid form, which affects the entire body (1). It is characterized by fluctuations in muscle tone (varying from too tight to too loose) and sometimes is associated with uncontrolled movements (which can be slow and writhing or rapid and jerky). Affected children often have trouble learning to control their bodies well enough to sit and walk. Because muscles of the face and tongue can be affected, there also can be difficulties with sucking, swallowing and speech.
• Ataxic cerebral palsy: About 5 to 10 percent of affected individuals have the ataxic form, which affects balance and coordination (1). They may walk with an unsteady gait with feet far apart. They have difficulty with motions that require precise coordination, such as writing.

Cerebral palsy usually is caused by factors that disrupt normal development of the brain before birth. In some cases, genetic defects may contribute to brain malformations and �miswiring� of nerve cell connections in the brain, resulting in cerebral palsy . Other cases are caused by injuries to the developing brain, such as a fetal stroke. Contrary to common belief, few cases of cerebral palsy are caused by a lack of oxygen reaching the fetus during labor and delivery .

A small number of babies develop brain injuries in the first months or years of life that can result in cerebral palsy. These injuries may be caused by brain infection (such as meningitis) and head injuries. In many cases, the cause of cerebral palsy in a child is not known.

Certain risk factors make it more likely that a baby will develop cerebral palsy. However, most babies with one of these risk factors do not develop cerebral palsy. Risk factors for cerebral palsy include:

• Prematurity: Premature babies (those born before 37 completed weeks of pregnancy) who weigh less than 3 1/3 pounds are between 20 and 80 times more likely to develop cerebral palsy than full-term babies. Many of these tiny babies suffer from bleeding in the brain, which can damage delicate brain tissue, or develop periventricular leukomalacia, destruction of nerves around the fluid-filled cavities (ventricles) in the brain.
• Infections during pregnancy: Certain infections in the mother can cause brain damage and result in cerebral palsy. Examples of these infections include rubella, cytomegalovirus (usually mild viral infection), herpes (viral infections that can cause genital sores), and toxoplasmosis (a usually mild parasitic infection). Maternal infections involving the placental membranes (chorioamnionitis) may contribute to cerebral palsy in full-term as well as premature babies . A 2003 study at the University of California at San Francisco found that full-term babies were 4 times more likely to develop cerebral palsy if they were exposed to chorioamnionitis in the womb .
• Insufficient oxygen reaching the fetus: This may occur when the placenta is not functioning properly or it tears away from the wall of the uterus before delivery.
• Asphyxia during labor and delivery: Until recently, it was widely believed that asphyxia (lack of oxygen) during a difficult delivery was the cause of most cases of cerebral palsy. Studies now show that birth complications, including asphyxia, contribute to only 5 to 10 percent of cases of cerebral palsy.
• Severe jaundice: Jaundice, a yellowing of the skin and whites of the eyes, is caused by the build-up of a pigment called bilirubin in the blood. Mild cases of jaundice usually clear up without treatment and do not harm the baby. However, jaundice can occasionally become severe. Affected babies have high levels of bilirubin in the blood. Without treatment, high bilirubin levels can pose a risk of permanent brain damage, resulting in athetoid cerebral palsy. Certain blood diseases, such as Rh disease, can cause severe jaundice and brain damage, resulting in cerebral palsy. Rh disease is an incompatibility between the blood of the mother and her fetus. It usually can be prevented by giving an Rh-negative woman an injection of a blood product called Rh immune globulin around the 28th week of pregnancy and again after the birth of an Rh-positive baby.
• Blood clotting disorders (thrombophilias): These disorders in either mother or baby may increase the risk of cerebral palsy.

Just as there are particular types of brain damage that cause cerebral palsy, there are also certain medical conditions or events that can happen during pregnancy and delivery that will increase a baby’s risk of being born with cerebral palsy. Research scientists have examined thousands of expectant mothers, followed them through childbirth, and monitored their children’s early neurological development to establish these risk factors. If a mother or her baby has any of these risk factors, it doesn’t mean that cerebral palsy is inevitable, but it does increase the chance for the kinds of brain damage that cause it.

Low birthweight and premature birth. The risk of cerebral palsy is higher among babies who weigh less than 5 ½ pounds at birth or are born less than 37 weeks into pregnancy. The risk increases as birthweight falls or weeks of gestation shorten. Intensive care for premature infants has improved dramatically over the course of the past 30 years. Babies born extremely early are surviving, but with medical problems that can put them at risk for cerebral palsy. Although normal- or heavier-weight babies are at relatively low individual risk for cerebral palsy, term or near-term babies still make up half of the infants born with the condition.

Multiple births. Twins, triplets, and other multiple births -- even those born at term -- are linked to an increased risk of cerebral palsy. The death of a baby’s twin or triplet further increases the risk.

Infections during pregnancy. Infectious diseases caused by viruses, such as toxoplasmosis, rubella (German measles), cytomegalovirus, and herpes, can infect the womb and placenta. Researchers currently think that maternal infection leads to elevated levels of immune system cells called cytokines that circulate in the brain and blood of the fetus. Cytokines respond to infection by triggering inflammation. Inflammation may then go on to cause central nervous system damage in an unborn baby. Maternal fever during pregnancy or delivery can also set off this kind of inflammatory response.

Blood type incompatibility. Rh incompatibility is a condition that develops when a mother’s Rh blood type (either positive or negative) is different from the blood type of her baby. Because blood cells from the baby and mother mix during pregnancy, if a mother is negative and her baby positive, for example, the mother’s system won’t tolerate the presence of Rh-positive red blood cells. Her body will begin to make antibodies that will attack and kill her baby’s blood cells. Rh incompatibility is routinely tested for and treated in the United States , but conditions in other countries continue to keep blood type incompatibility a risk factor for cerebral palsy.

Exposure to toxic substances. Mothers who have been exposed to toxic substances during pregnancy, such as methyl mercury, are at a heightened risk of having a baby with cerebral palsy.

Mothers with thyroid abnormalities, mental retardation, or seizures. Mothers with any of these conditions are slightly more likely to have a child with cerebral palsy.

There are also medical conditions during labor and delivery, and immediately after delivery, that act as warning signs for an increased risk of cerebral palsy. Knowing these warning signs helps doctors keep a close eye on children who face a higher risk. However, parents shouldn’t become too alarmed if their baby has one or more of these conditions at birth. Most of these children will not develop cerebral palsy. Warning signs include:

Breech presentation. Babies with cerebral palsy are more likely to be in a breech position (feet first) instead of head first at the beginning of labor.

Complicated labor and delivery. A baby who has vascular or respiratory problems during labor and delivery may already have suffered brain damage or abnormalities.

Small for gestational age. Babies born smaller than normal for their gestational age are at risk for cerebral palsy because of factors that kept them from growing naturally in the womb.

Low Apgar score. The Apgar score is a numbered rating that reflects a newborn's condition. To determine an Apgar score, doctors periodically check a baby's heart rate, breathing, muscle tone, reflexes, and skin color during the first minutes after birth. They then assign points; the higher the score, the more normal a baby's condition. A low score at 10-20 minutes after delivery is often considered an important sign of potential problems such as cerebral palsy.

Jaundice. More than 50 percent of newborns develop jaundice after birth when bilirubin, a substance normally found in bile, builds up faster than their livers can break it down and pass it from the body. Severe, untreated jaundice can cause a neurological condition known as kernicterus, which kills brain cells and can cause deafness and cerebral palsy.

Seizures. An infant who has seizures faces a higher risk of being diagnosed later in childhood with cerebral palsy.

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