Paediatrics

Cerebral Palsy

Cerebral palsy is a permanent disorder of movement and posture attributed to a non-progressive disturbance in the developing brain; the neurological lesion is static, but tone-related musculoskeletal problems and associated impairments require proactive, lifelong multidisciplinary care.

In a nutshell

Cerebral palsy is a permanent movement and posture disorder caused by a non-progressive disturbance in the developing brain. Recognise abnormal movement or tone, delayed milestones and early hand preference; regression or an atypical course suggests another neurological disorder. Refer for urgent multidisciplinary assessment, offer MRI when the cause is unclear, and actively manage dysphagia, communication, epilepsy, pain, sleep, hip displacement, bone health, participation and transition. Use goal-focused rehabilitation and specialist tone-management pathways rather than memorised drug doses.

Classic presentation

A child has delayed sitting or walking, early hand preference and asymmetric or stiff movement. The diagnosis is clinical and developmental; check for associated feeding, communication, vision, hearing and seizure problems, and reconsider the diagnosis if skills are lost.

Key points

The brain disturbance is non-progressive; contractures, hip displacement, scoliosis and pain can still progress.
NICE warning points include not sitting by 8 months corrected, not walking by 18 months corrected, and hand preference before 1 year corrected.
Loss of acquired skills, unexpected focal signs, progressive family history or discordant MRI are red flags for another disorder.
Offer MRI when the aetiology is unclear; MRI cannot establish the timing of hypoxic-ischaemic injury or predict prognosis alone.
Clinical dysphagia assessment is first line; specialist videofluoroscopy is selective, not routine initial testing.
Hip surveillance is essential: radiograph at 24 months for bilateral cerebral palsy and repeated surveillance according to GMFCS and migration percentage.
Treat tone with goal-focused rehabilitation and specialist escalation; adults may use their tone for standing or transfers, so reducing it is not automatically beneficial.

First-line investigation

Urgent child-development multidisciplinary assessment with developmental history, neurological examination, functional classification and assessment of feeding, communication, vision, hearing, cognition and seizures.

Management

Recognise and refer

Refer suspected cerebral palsy or delayed motor milestones to an urgent child-development multidisciplinary service; use enhanced follow-up for infants at increased risk.¹

Define the whole-person problem

Assess movement, tone, function, feeding, communication, cognition, vision, hearing, seizures, pain, sleep, growth and family goals; offer MRI when the cause is unclear.¹

Rehabilitate and prevent complications

Use goal-focused physiotherapy, occupational therapy, orthoses, equipment and postural management; follow hip, bone-health, nutrition and respiratory surveillance pathways.^1,2

Use specialist tone pathways

Consider focal botulinum toxin or specialist oral, intrathecal, orthopaedic or neurosurgical options only for agreed goals and with rehabilitation, risk discussion and current prescribing guidance.^2,4

Review function across life

Ask about pain, sleep, dysphagia, seizures, communication, mental health and care needs at review; plan transition and adult neurodisability review, including annual review for adults with complex needs.^1,3

Exam traps

Cerebral palsy is not synonymous with birth asphyxia; use the full antenatal, perinatal and postnatal history.
A static lesion does not mean static disability: growth and abnormal tone can produce progressive musculoskeletal complications.
Early hand preference before 1 year corrected is a warning sign, not normal handedness.
Regression is not typical cerebral palsy and requires specialist investigation.
Do not use videofluoroscopy as the routine initial dysphagia assessment.
Do not reduce spasticity without defining the goal; some adults rely on tone for posture, standing, walking or transfers.

Illustrations

Periventricular leukomalacia on MRICoronal and axial brain MRI panels demonstrating periventricular white-matter injury; retain the source attribution and licence while image-quality remediation remains in the separate image campaign.Shields LB et al., Cureus 2025, CC-BY-4.0 · CC-BY-4.0

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.