Cerebral palsy is the term used to describe a range of conditions related to developmental and movement issues, which are commonly the result of brain injury at birth, or an adverse event during pregnancy, such as an infection which causes brain injury to the foetus. In rare cases, there may even be a genetic reason for a baby being born with cerebral palsy.
High profile compensation cases involving babies born with cerebral palsy often cite medical negligence at birth as the reason, and usually this involves oxygen deprivation during delivery or while the foetus is in the womb – for example, when a Caesarean section is delayed or a baby has the umbilical cord wrapped round their neck during delivery and is unable to breathe properly.
Sometimes the brain simply does not develop properly during pregnancy – and it can be very difficult for doctors to diagnose this before delivery. There is currently no diagnostic test for cerebral palsy during pregnancy. Babies can also experience brain trauma in the womb, such as a stroke – or may not develop fully for a wide range of reasons.
The first trimester of pregnancy is thought to carry the highest risk for damage to the foetus, which is why mothers-to-be are advised not to smoke, drink alcohol or take part in physically risky activities. Remaining stress free during pregnancy is now also thought to offer the foetus the best chances of normal development.
Premature births may also carry a higher risk for cerebral palsy because the brain has not had the opportunity to develop as much as a full-term foetus.
Researchers writing in the journal Psychology found that, whereas it was once commonly accepted that the brain was fully developed at 37 weeks, in the last few weeks of pregnancy certain areas of the brain’s grey matter – the cells which store information, memories and skills – become denser.
The word cerebral refers to the brain – and palsy describes the type of uncontrolled movements, tremors and stiff muscles of patients with the condition cerebral palsy.
The symptoms a baby with cerebral palsy exhibits will depends on which area of the brain has been injured during gestation or delivery.
The physical symptoms of cerebral palsy – including muscle spasms, contracted and stiff muscles, tremors, trembling and abnormal movements of muscles, including facial muscles – are the result of signals from the brain to the spinal cord not being transmitted properly. This means the patient is unable to control muscle movements – and one or more limbs may be affected, or even one side of the body.
The brain, spinal cord and heart begin to develop in the fifth week of pregnancy in a natural conception.
The brain continues to develop throughout pregnancy, so any infection or adverse event may cause trauma to the foetus from the weeks after conception onwards.
This is not to say that a mother is to blame if her child is born with cerebral palsy, however – even pre-conception factors can in some cases result in cerebral palsy.
According to the charity Scope, there are few high-risk factors which may be relevant, however, although these have not been proven conclusively
- Child born fifth or more in a family
- First born
- Low birth weight or premature baby
- Mothers over 40
- Multiple births (including twins)
- Younger mother or father (under 20 years).
Women are often blamed for birth defects – especially older mothers – but whereas females are born with a set number of eggs and the condition of these deteriorates over a period of time until the menopause, men constantly renew their sperm supplies on a daily basis, which makes the chances of a mutation in sperm’s DNA much higher.
The quality of sperm can be greatly affected by a man’s drinking, smoking and drug-taking habits, which again can contribute to DNA mutations in sperm.
Even sporting activities can affect the quality of sperm – especially when male reproductive organs are encased in sports clothing such as tight-fitting cycle shorts. This may affect fertility rates in men – but the fact that a man’s sperm supply is renewed on a daily basis means that the chance of a mutation in the DNA of sperm is increased.
A female’s eggs may occasionally have a genetic flaw which was present when she was born, or perhaps developed pre-pregnancy or during pregnancy as a result of exposure to chemicals or medications, as in the case of the morning sickness drug Thalidomide – or even the tranquilliser Librium, widely prescribed in the 1960s and 1970s and now known to carry a risk of birth defects in the babies of women who went on to become pregnant after taking it.
In the case of men, healthy eating and healthy lifestyles can help protect against DNA changes in sperm which may lead to birth defects in their children.
But in the case of cerebral palsy, there are so many factors which may contribute that unless there has been a recognised error in the clinical management of a pregnancy or a delivery by medical staff (eg asphyxia at birth), then it can be hard for doctors to pinpoint exactly what caused the condition in a baby.
There have been increased risk factors associated with mothers who are diabetic and may also be obese – being overweight can make delivery more difficult and increase the risk of some sort of intervention being needed, such as forceps delivery in which the baby may sustain a head/brain injury. Babies of diabetic mothers also have a tendency to be larger and have a higher birth weight, which can make delivery more difficult. Diabetes before pregnancy or which sometimes develops during pregnancy is usually well managed by clinicians, however.
In some cases, cerebral palsy may occur after birth as the result of a brain injury – for example if a child undergoes surgery and the brain is starved of oxygen during the procedure, or if the brain is attacked by a viral infection such as meningitis.
The charity Scope has more information about cerebral palsy in babies and how to recognise the signs.