Even when the condition is present at birth, the signs of cerebral palsy (CP) may not be noticed until a child is between 1 and 3 years of age. This is due to the way children develop and mature. Health professionals and parents may not recognize that a baby's movements are irregular until they become more pronounced as a child grows. These babies and young children may retain newborn reflexes and fail to reach age-appropriate developmental milestones. Parents and caregivers usually are the first to notice that a baby has developmental delays that may be early signs of CP.

When CP is severe, signs are often noticed at birth or shortly thereafter. However, some early signs of severe CP vary according to the specific type present.

Common signs of severe CP that may be noticed shortly after birth include:

* Problems sucking and swallowing.

* A weak or shrill cry.

* Unusual positions. Often the body is either very relaxed and floppy or very stiff. When held, babies may arch their backs and extend their arms and legs. These postures are different from and more extreme than those that sometimes occur in babies with colic.

Some problems related to CP become more evident over time or develop as a child grows. These may include:

* Smaller muscles in affected arms or legs. Nervous system problems prevent movement in affected arms and legs. Inactivity affects muscle growth.

* Abnormal sensations and perceptions. Some people with CP feel pain when touched lightly. Even everyday activities, such as brushing teeth, may hurt. Abnormal sensations can also make it difficult to identify common objects by touch, such as feeling the difference between a soft foam ball and a hard baseball.

* Skin irritation. Drooling is common when facial and throat muscles are affected. Drooling irritates the skin, particularly around the mouth, chin, and chest.

* Dental problems. Children who have difficulty brushing their teeth have increased risk of developing cavities and gum disease (gingivitis). Seizure medications may also contribute toward developing gum disease.

* Accidents. Falls and other accidents are a risk, depending on muscle control, joint stiffness, and general physical strength. In addition, CP-related seizures can cause accidental injuries.

* Infections and long-term illnesses. Severe CP causes problems with eating. If food is inhaled into the lungs, a child's risk of developing pneumonia increases. Adults are at increased risk for heart and lung disease.

Some children with CP often also display a group of behavioral symptoms, such as excessive sleepiness, irritability, and little interest in their environment.

Expectations

All people with cerebral palsy (CP) have some problems with body movement and posture. However, many babies do not show signs of CP at birth. Parents and caregivers may notice the first signs of CP, such as the baby not rolling over, sitting, crawling, or walking at the expected ages.

Signs of CP may become more obvious as the child grows. Some developmental problems may not appear until after a baby's first year. The brain injury that causes CP does not get worse over time; however, its effects can appear, change, or become more severe as the child gets older.

The specific effects of CP depend on its type and severity, the level of mental impairment, and whether other complications develop or other medical conditions are present.

* The type of CP present and how much of the body that is affected will determine a child's mobility.

o Most people with CP have forms of spastic cerebral palsy, which affects only part of the body. For example, a child with spastic cerebral palsy may develop symptoms mostly in one leg or one side of the body. Most children usually learn ways to accommodate for their handicaps. Some people can live on their own; others live and work in situations that provide some level of assistance. When both legs are affected, children can move around with the help of a scooter board (a device used to self-propel while lying down), modified stroller, wheelchair, or other special equipment.

o Total body cerebral palsy causes the most severe problems. Severe spastic CP and athetoid (dyskinetic) CP are types of total body CP. Many of those affected are not able to take care of themselves, either because of severe physical disabilities or mental retardation. However, some people can live on their own with the help of family members and/or health care aides.

* Complications, such as seizures, and other long-term physical effects of CP can be difficult to predict until a child is between 1 and 3 years of age. Sometimes, however, such predictions are not possible until a child reaches school age when learning, communication skills, and other abilities can be measured. The amount of help and supervision needed depends on the number and severity of problems.

* The severity of mental impairment, if any, is a strong predictor of daily functioning. Approximately 75% of people with CP have some degree of cognitive impairment . 2 About 60% of these people are mentally retarded (ranging from mildly to severely); the remainder often function normally but have some type of learning disability. 2

* Other medical conditions, such as vision or hearing problems, are often associated with CP. Sometimes these conditions are known right away; in others they are not detected until a child gets older.

Also, just like people with normal physical development, people with CP have social and emotional concerns throughout their lives. Because their physical limitations may add to these concerns, people with CP need the awareness and consideration of others.

Of all children diagnosed with cerebral palsy, 90% live to adulthood (beyond 20 years old). 3 A more precise life expectancy can be estimated by evaluating the type of CP present, its severity, and the impact of any conditions that are often related to CP. Most adults with the mild or moderate form—and some with the severe form—live independently and have jobs. Opportunities for independent living and employment for adults with CP have improved. These opportunities are a result of better home support services and advances in technology, such as computers to assist with speech, powered wheelchairs, and other devices.