Peace! Love! Hope! Cure! Cerebral Palsy (Part One)

In many countries the figure now stands at one in 300 children are born or will develop cerebral palsy. Cerebral palsy means brain paralysis. It is a special condition that affects movement and body position. It comes from brain damage that happened before the baby was born, at birth, or as a baby. The whole brain is not damaged, only parts of it, mainly parts that control movements. Once damaged, the parts of the brain do not recover, nor do they get worse. However, the movements, body positions, and related problems can be improved or made worse depending on how we treat the child and how damaged his or her brain happens to be. The earlier we start with the treatment the better for our baby.

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Parent A: How can I recognize if my baby cerebral palsy?

A.A: At birth, a baby with cerebral palsy is often limp and floppy, or may even seem normal. Baby may or may not breathe right away at birth, and may turn blue and floppy. Delayed breathing is a common cause of brain damage.

Compared to other children, the child is slow to hold up his head, to sit, or to move around. He may not use his hands. Or he only uses one hand and does not begin to use both.

Feeding problems, the baby may have difficulties with sucking, swallowing and chewing. She may choke or gag often. Even as the child gets bigger, these and other feeding problems may continue.

Difficulties in taking care of the baby or young child. Her body may stiffen when she is carried, dressed, or washed, or during play. Later she may not learn to feed or dress herself, to wash, use the toilet, or to play with others. This may be due to sudden stiffening of the body, or to being so floppy she ‘falls all over the place’.

The baby may be so limp that her head seems as if it will fall off. Or she may suddenly stiffen like a board, so that no one feels able to carry or hug her.

The baby may cry a lot and seem very fussy or ‘irritable’. Or she may be very quiet (passive) and almost never cry or smile.

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Communication difficulties, the baby may not respond or react as other babies do. This may partly be due to floppiness. Stiffness or lack of arm gestures, or control of face muscles. Also, the child may be slow in beginning to speak. Later some children develop unclear speech or other speaking difficulties. Although parents find it hard to know exactly what the child wants, they gradually find ways of understanding many of his needs. At first the child cries a lot to show what he wants. Later he may point with his arm, foot or eyes.

Intelligence, some children may seem dull because they are so limp and slow moving. Others move so much and awkwardly they may appear stupid. Their faces twist, or they may drool because of weak face muscles or difficulty swallowing. This can make an intelligent child appear mentally slow. About half of the children with cerebral palsy are mentally slow, but this should not be decided too soon. The child needs to be given help and training to show what she is really is like. Parents can often tell that she understands more than she can show.

Hearing and sight are sometimes affected. If this problem is not recognized, the family may think that the child lacks intelligence. Observe the child carefully and test him to find out how well he can hear and see.

Seizures, (epilepsy, fits, convulsions) occur in some children with cerebral palsy.

Restless behaviour Sudden changes of mood from laughing to crying, fears, fits of anger, and other difficult behaviour may be present. This may partly be due to the child’s frustration of not being able to do what he wants with his body. If there is too much noise and activity the child can become frightened or upset. The brain damage may also affect behaviour. These children need a lot of help and patience to overcome their fears and other unusual behaviour.

Sense of touch, pain, heat, cold, and body position are not lost. However, the children may have trouble controlling movements of their bodies and trouble with balance.
Because of their damaged brains they may have difficulty learning these things. Patient teaching with lots of repetition can help.

Abnormal reflexes, Babies have certain ‘early reflexes’ or automatic body movements that normally go away in the first weeks or months of life. In children with brain damage, they may last much longer. However, these are only important if they affect how the child moves. ‘Knee jerk’ and other tendon-jump reflexes are usually over-active (jump higher than normal). If you are not sure, testing for abnormal reflexes may help you tell cerebral palsy from polio.

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Parent C.P: What then causes cerebral palsy?

A.A: The causes are often difficult to find but here is some of the common ones.

Causes before birth:

Infections of the mother while she is pregnant. These include German measles and shingles (herpes zoster).

Differences between the blood of mother and child (rh incompatibility).

Problems of the mother, such as diabetes or toxemia of pregnancy.

Inherited. This is rare.

No cause can be found in about 30% of the children though.

Causes around the time of birth:
Lack of oxygen (air) at birth. The baby does not breathe soon enough and becomes blue and limp. In some areas, misuse of hormones (oxytocics) to speed up birth narrows the blood vessels in the womb so much that the baby does not get enough oxygen. In other cases, the baby may have the cord wrapped around her neck. The baby is born blue and limp—with brain damage.

Birth injuries from difficult births. These are mostly large babies of mothers who are small or very young. The baby’s head may be pushed out of shape, blood vessels torn, and the brain damaged.

Prematurely. Babies born before 9 months and who weigh less than 2 kilos (5 pounds) are much more likely to have cerebral palsy. In rich countries, over half the cases of cerebral palsy happen in babies that are born early.

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Causes after birth:
Very high fever due to infection or dehydration (water loss from diarrhoea). It is more common in bottle-fed babies.

Brain infections (meningitis, encephalitis). There are many causes, including malaria and tuberculosis.

Head injuries.

Lack of oxygen from drowning, gas poisoning or other causes.

Poisoning from lead glazes on pottery, pesticides sprayed on crops, and other poisons.

Bleeding or blood clots in the brain, often from unknown cause.

Brain tumours. These cause progressive brain damage in which the signs are similar to cerebral palsy but steadily get worse.

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Parent C.P: Is cerebral palsy contagious?
A.A: No! No! It cannot be passed from one child to another.

Parent C.P: Can persons with cerebral palsy marry and have children?
A.A: Yes!! And the children will not have the condition (except maybe in a very rare type of cerebral palsy).

Parent C.P: What medical or surgical treatment is there?
A.A: Uhhmmm.. Except for drugs to control seizures, medicines usually do not help. (Although medicines to reduce spasticity are often prescribed, they usually do no good, and may cause problems.) Surgery is sometimes useful for correcting severe, stubborn contractures. However, surgery to weaken or release spastic muscles is less often effective and sometimes makes things worse. Careful evaluation is needed. Surgery usually should be considered only if the child is already walking and has increasing difficulty because of contractures. In a child who cannot balance well enough to stand, surgery usually will not help. Sometimes surgery to separate the legs can help make cleaning and bathing easier.

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Parent C.P: What can be done?
A.A: The damaged parts of the brain cannot be repaired, but often the child can learn to use the undamaged parts to do what she wants to do. It is important for parents to know more or less what to expect: Families can do a lot to help these children learn to function better. Generally, the child who is more intelligent will learn to adapt successfully to her condition. However, intelligence is not always necessary. In fact, some intelligent children become more easily frustrated and discouraged, so they stop trying. Extra effort is needed to find new and interesting ways to keep them progressing. Even children with severe mental slowness can often learn important basic skills. Only when mental damage is so great that the child does not respond at all to people and things is there little hope for much progress. However, before judging the child, who does not respond, be sure to check for deafness or loss of eyesight. Family members can learn to play and do daily activities with the child in ways that help her both to function better and to prevent secondary problems such as contractures. Most important is that the parents (and grandparents!) learn not to do everything for the child. Help her just enough that she can learn to do more for herself. For example, if your child is beginning to hold up her head, and to take things to her mouth, by standing on her knees as she paints a sign, this girl is improving her balance.

Most of the information I was able to attain from helping children with cerebral palsy from Hesperian health guides and Early support for children, young people and families.

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