At birth a baby with cerebral palsy is often limp and floppy, or may even seem typical.
TYPICAL
FLOPPY
Child hangs in upside down ‘U’ with little or no movement.
Baby may or may not breathe right away at birth, and may turn blue and floppy. Delayed breathing is a common cause of brain injury.
Delayed development. Compared to other children in the village, the child takes longer 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 difficulty. 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 challenges 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.
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 take longer than others to begin speaking. 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.
Luis! Do you want to play with Oscar? Luis!
Intelligence Some children may be assumed to have cognitive delay because they move slowly or awkwardly, have less control of the muscles in their face, appear to need more time to understand what others are saying, or have difficulty showing what they know.
About half of the children with cerebral palsy have cognitive delay, but this should not be decided too soon. The child needs to be given help and training to show what she is really like. Parents can often tell that she understands more than she can show.
How many is 7 minus 4?
That's right! 3!
Hearing and sight are sometimes affected. If this 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.
Even if a child can hear loud banging, he may not hear well enough to understand words.
Seizures (epilepsy, fits, convulsions) occur in some children with cerebral palsy.
Restless behavior. Sudden changes of mood from laughing to crying, fears, fits of anger, and other difficult behavior 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 injury may also affect behavior. These children need a lot of help and patience to overcome their fears and other unusual behavior.
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. They may also 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 injury, 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 typical). If you are not sure, testing for abnormal reflexes may help you tell cerebral palsy from polio.
