Cerebral Palsy (CP)
Cerebral Palsy (CP)
General and supportive measures
ICD 10 G80.9
DESCRIPTION
Cerebral palsy (CP) describes a group of disorders of movement and posture. It is the commonest cause of developmental disturbances in children. CP results from an insult to the developing foetal or infant brain, which is nonprogressive. There may be associated abnormalities of sensation, perception, cognition, communication and behaviour.
DIAGNOSTIC CRITERIA
- Motor deficit with delay in motor milestones.
- Not sitting by 8 months (corrected for gestational age).
- Not walking by 18 months (corrected for gestational age).
- Hand preference before 12 months (corrected for gestational age).
- No loss of function (i.e. milestone regression).
- Serial examinations may be needed to establish the diagnosis.
Clinical picture may be described by:
- The predominant abnormality of tone and the distribution of areas involved.
| Regional involvement | Spastic | Hemiplegia |
| Spastic | Diplegia | |
| Global involvement | Spastic | Quadriplegia |
| Dyskinetic | Athetoid | |
| Dyskinetic | Dystonic | |
| Ataxic | Ataxic |
Risk factors:
- Preterm labour and birth.
- Small for gestational age.
- Multiple pregnancy.
- Neonatal encephalopathy.
- Neonatal sepsis.
- Meningitis or septicaemia.
Developmental follow up from birth to 2 years is essential in high risk patients.
GENERAL AND SUPPORTIVE MEASURES
- Multidisciplinary team approach.
- Screen for ophthalmologic and hearing impairments.
- Screen for speech and language disorders.
- Monitor growth, nutrition and swallowing function.
- Physiotherapy.
- Occupational therapy.
- Psychology.
- Assess level of functioning according to the Gross Motor Function Classification System (GMFCS).
MEDICINE TREATMENT
Medication for relief of spasticity, dystonia and dyskinesia may be used in some patients for improvement in function, range of motion at various joints, disturbances from uncontrolled movements.
Co-morbidities and complications:
| Neurological | Epilepsy, hydrocephalus, visual and hearing impairment. | See: Epilepsy. |
| Behavioural and learning | Sleep disturbance, depression, autistic features, learning difficulties, vulnerability. | See: Child and Adolescent Psychiatry, Depression, Autism spectrum disorders. |
| Gastro-intestinal | Difficulty swallowing, gastro-oesophageal reflux, constipation. | See: Alimentary Tract, Constipation and Gastro-oesophageal reflux disease (GORD). |
| Bone | Osteoporosis, scoliosis, hip dislocation, pathological fractures. | |
| Respiratory | Susceptibility to chest infections and aspiration. | See: Respiratory System. |
| Skin | Drooling, pressure sores. | |
| Dental | Poor oral hygiene, susceptibility to dental caries. | See: Primary Health Care STGs and EML, Dental and oral conditions, Dental abscess and Dental caries. |
|
Genito-urinary |
Neurogenic bladder | See: Nephrological/Urological disorders, Dysfunctional bladder. |
Table adapted from: Smith, M and Kurian, M. Medical management of cerebral palsy. Paediatrics and Child Health, 2016-09-01, Volume 26, Issue 9, Pages 378–382.
Note:
These patients frequently experience pain as a result of these complications.
Remember to suspect and manage pain in children with CP.
REFERRAL
For consideration of medical treatment of spasticity, dystonia or dyskinesia in consultation with the multidisciplinary team.
Click here to access NEMLC Report.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Paediatric Hospital Level_Updated May 2025
Chapter 13: The Nervous System_13.12 Cerebral Palsy (CP)