Cerebral Palsy: What You Need to Know

The term “cerebral palsy” covers a wide range of symptoms and levels of severity, but all types of cerebral palsy stem from damage to the brain or abnormal development of the brain. Cerebral palsy affects the part of the brain that helps coordinate the muscles and maintain balance, so its sufferers often struggle with muscle spasms, limited mobility, and other musculoskeletal symptoms.

So, what causes cerebral palsy?

The answer is complicated. There is no single cause of cerebral palsy. In many cases, cerebral palsy is caused by a number of overlapping factors. First, let’s take a look at the specific types of damage associated with cerebral palsy. Then, we’ll look at factors that cause those types of damage, its symptoms, and how to get treatment and deal with legal issues that arise from cerebral palsy.

What types of brain damage are associated with cerebral palsy?

The brain damage associated with cerebral palsy can occur in four different ways: periventricular leukomalacia, cerebral dysgenesis, intracranial hemorrhage, and asphyxia.

Periventricular Leukomalacia

Periventricular Leukomalacia (PVL) is the predominant form of brain injury and leading known cause of cerebral palsy and cognitive deficits in premature infants. PVL refers to damage to the white matter of the brain and may be caused by lack of oxygen to the brain or serious infections. The brain’s white matter is a communication system; it carries signals between different parts of the brain. When the white matter is damaged, signals can’t travel effectively through the brain. That can lead to a wide range of developmental difficulties, including cerebral palsy. The brain is particularly vulnerable to PVL between 26 and 34 weeks into the pregnancy. (R) (R) (R)

Cerebral Dysgenesis

Cerebral dysgenesis refers to brain malformations. The brain is a delicate organ, and a wide range of genetic mutations and environmental factors may affect its formation. In some cases, genetic mutations are unavoidable. In other cases, they may be caused by exposure to toxins. Serious infections, especially those that cause high fevers, and trauma can also lead to cerebral dysgenesis. (R) (R)

Intracranial Hemorrhage

Intracranial hemorrhage refers to bleeding in the brain, which may occur when a blood vessel is blocked or broken by a fetal stroke. Blood vessels also may break or become blocked if they are malformed due to genetic mutations. Babies with clotting disorders are at higher risk for intracranial hemorrhages, as are babies born to women with high blood pressure and those born more than 10 weeks early. Baby’s blood vessels grow strongest in the final 10 weeks of pregnancy. Serious infections also increase the risk of intracranial hemorrhage. (R) (R)

See also: Vaccinations During Pregnancy: What’s Safe?

Asphyxia

Asphyxia refers to oxygen deprivation. During the course of labor, babies often are deprived of oxygen for a brief period of time while they pass through the birth canal. If oxygen deprivation is prolonged, however, the parts of the brain associated with motor control and balance will start to die off. This is called hypoxic-ischemic encephalopathy; 40-60% of infants die from this serious birth complication before they reach the age of 2, or they have severe disabilities. Asphyxia also may occur when the mother’s blood pressure drops too low, when the placenta detaches from the wall of the uterus, or when the umbilical cord is damaged. (R)

Asphyxia causes two phases of damage. First, cells die off due to lack of oxygen. This occurs within a few minutes. The next phase can happen over several days and weeks. The damaged cells contain dangerous toxins which can be released into the body as blood flow is restored. This is called “reperfusion injury” and can be extremely serious, damaging the brain and other parts of the body. (R)

See also: Baby Development: Types and Signs of Brain Damage

What causes the brain damage associated with cerebral palsy?

The types of damage outlined above don’t just happen on their own. They’re the result of any number of other conditions and issues that may arise during pregnancy, the birth process, or after birth. Remember that in many cases, a number of causes and risk factors may overlap in any given case of cerebral palsy.

For example, children with low birth weights are more likely to suffer from cerebral palsy, along with those born more than a couple of weeks premature. Multiple births increase the risk of cerebral palsy, too — some of that risk is explained by the fact that many twins and triplets have low birth weights and are born early, but not all. Babies conceived with the help of in-vitro fertilization and other fertility technologies also are at higher risk for cerebral palsy. (R)

Cerebral Palsy During Pregnancy

A number of issues can arise during pregnancy that lead to brain damage or abnormal brain development. Experts now believe that almost all cases of cerebral palsy can be attributed to issues arising during pregnancy or birth. Improvements in care during pregnancy and after birth also may be preventing more serious forms of cerebral palsy, as the birth prevalence of children with moderate to severe intellectual disabilities and cerebral palsy has decreased over the past decade. (R)

Genetic Causes

In some cases, a genetic mutation may be at fault. There is no single genetic disorder that causes cerebral palsy, but a number of genetic disorders and mutations can increase the likelihood that your child will develop cerebral palsy. In other words, genetic mutations can interact with each other and with other conditions in the womb to cause cerebral palsy. That’s called “complex inheritance.” Genetic mutations in the child and mother can cause pre-term birth, growth issues in the fetus, preeclampsia, and other conditions that increase the likelihood that the child will develop cerebral palsy.

Because many of the genetic mutations that contribute to the development of cerebral palsy are hereditary, cerebral palsy may run in families — even extending to first cousins. However, genetic influences are only a part of a wide range of causes, and people with cerebral palsy are having fewer babies than those without the disorder. In one study, only 11% of people with cerebral palsy who were age 19 and older had become parents compared to 51% of unaffected people. (R)

Genetic mutations increasing the likelihood of cerebral palsy may also be caused by exposure to environmental toxins such as pesticides, cigarette smoke, certain types of illicit drugs, and more.

Fetal Stroke

Brain damage leading to cerebral palsy also may occur when the fetus has a stroke during the pregnancy, also referred to as “perinatal strokes.” A stroke occurs when a blood clot forms and travels to the brain, blocking blood flow to that part of the brain. Fetal strokes that damage the parts of the brain associated with motor control and balance may cause cerebral palsy.

Fetal stroke occurs between 14 weeks of gestation and the onset of labor. In most cases, it is impossible to identify the cause of a fetal stroke. Genetic heart and clotting disorders increase the risk of fetal strokes, as do serious infections of the mother and fetus, trauma, and alloimmune thrombocytopenia (a platelet disease). Experts also suspect that blood clots may form in the placenta and travel through the umbilical cord to the fetus, causing fetal stroke. (R) (R)

Infections

When you’re pregnant, your blood supply is connected to the baby’s. That’s how they get their nutrition, but it also means they’re at risk if anything dangerous gets into your blood. If you contract a serious infection, your baby can be affected by it as well. An infection can lead to the type of brain damage that causes cerebral palsy. (R)

When a fetus catches the same infection of the mother or the mother develops a fever, that can cause swelling around the baby’s brain. Maternal infection can cause increased levels of cytokines, a type of protein found in the baby’s blood that causes inflammation. Infections linked to cerebral palsy include chicken pox, measles, pelvic infections, toxoplasmosis, cytomegalovirus, many sexually-transmitted infections, and infections of the placenta. (R)

Serious maternal infections also increase the likelihood that the baby will have a low birth weight, which is a risk factor for cerebral palsy.

Maternal Conditions

Some conditions make it more likely that a woman’s baby will develop cerebral palsy. Most notably, women who have thyroid problems or seizure disorders are more likely to have children with cerebral palsy. Women who suffer from diabetes are also more likely to have children with cerebral palsy. (R) (R)

Pregnancy Complications

Complications during pregnancy can cause trauma, inflammation, insufficient blood supply, and other side effects that may lead to brain damage or malformation. For example, some women suffer from “placenta previa,” a condition in which the placenta attaches to the cervix rather than the side of the uterus. That can affect the formation and function of the placenta and can also cause serious bleeding during birth. Some babies twist around in the womb, causing the umbilical cord to wrap around their neck. That can cut off blood flow to the brain and cause permanent damage. (R)

Cerebral Palsy During Birth

In some cases, cerebral palsy may be caused by damage incurred during the birth process. Labor is a difficult and stressful process for both mother and child. A complicated delivery can result in the baby being deprived of oxygen for prolonged periods of time and can also cause trauma to the head, both of which can lead to cerebral palsy.

Maternal Issues

Until you deliver, you share a blood supply with your baby. A normal blood oxygen level is between 80 and 100 millimeters of mercury. If your blood oxygen is low due to an infection or other condition, the baby’s oxygen will also be low. During the stress of labor, that low oxygen level may actually become dangerous and the baby may suffer asphyxia-related brain damage. The same holds true if you have very high or low blood pressure, or if you’re suffering from a serious infection. (R)

Placenta Detachment

The birth process itself can also lead to asphyxia. The placenta is the link between the baby and the mother’s blood supply. It’s supposed to detach during labor, but sometimes detaches too soon. When that happens, the baby doesn’t have access to oxygenated blood and may suffer from asphyxia while the mother can suffer from heavy bleeding. While uncommon, placenta detachment is serious. (R)

Difficult Labor

In some cases, delivery can be especially long and difficult. This is especially true when the baby is in a “breech” position. Ideally, babies are born head-first. A breech birth is when the baby is born feet-first, and it occurs in 3-4% of all deliveries. (R)

A breech birth is more difficult than a normal birth; the baby is prone to get stuck in the birth canal. The birth canal is a tight fit under the best of conditions and a breech birth is particularly tough. The birth canal is tight enough to squeeze all the amniotic fluid out of the baby’s lungs. It’s also tight enough to prevent the baby from drawing in a breath. For the brief time that most babies spend in the birth canal, that’s not a problem. If the baby gets stuck there for an extended period of time, however, it can suffer the damaging effects of asphyxia.

Even babies who are not in the breech position may suffer from asphyxia due to a long and difficult labor. In some cases, the birth canal and pelvis simply aren’t wide enough for the baby to pass smoothly through. Mothers must work with their doctors to decide whether to continue with the vaginal birth or to opt for an emergency caesarian section to free the baby.

Breathing Trouble

About 10% of all babies require some help getting them to breathe when they are born. Some babies are born without fully formed airways or lungs, putting them at risk for asphyxia. This is especially common in premature babies. If the baby’s airways are not fully formed, it may be unable to get enough oxygen. Babies who cannot breathe on their own will be placed on a ventilator until their airways and lungs develop enough to function on their own. (R)

Mucus or other debris from the birth process may also obstruct babies’ airways. Doctors typically suction out the baby’s mouth immediately after birth to avoid this issue, but sometimes the obstruction is difficult to dislodge. The longer it takes to clear the airways, the higher the risk of damage from asphyxia.

Anemia

Some babies are born with a condition called “anemia,” in which the blood cannot carry enough oxygen. Anemic babies are at risk for asphyxia. Babies may be anemic because of genetic abnormalities affecting the formation of red blood cells. (R)

Anemia may also occur due to blood loss caused by trauma during the birth process. For example, the umbilical cord or placenta may be damaged during birth, causing serious blood loss in the baby. Blood loss may also occur if the baby suffers an internal hemorrhage during the birth process.

If the anemia is severe, the baby may require a blood transfusion in order to survive. Severe anemia can cause asphyxiation as the blood can’t carry enough oxygen to the brain and other organs, so it must be diagnosed and treated quickly.

Cerebral Palsy After Birth

Cerebral palsy that develops more than 28 days after birth is called “acquired cerebral palsy.” Children who suffer from acquired cerebral palsy were not born with the condition, but developed it due to damage sustained after birth. This represents just a small percentage of cerebral palsy cases. (R)

Acquired cerebral palsy may be caused by head trauma or by serious infections such as meningitis or encephalitis, which create high fevers and swelling around the brain. Risk factors also include preterm or low birthweight, not getting certain vaccinations, and injury.

See also: Millions of Women Don’t Know They Have Birth Injuries — And They’re Suffering

What are the signs of cerebral palsy in infants?

Cerebral palsy affects 2-3 children for every 1,000 born. Its symptoms can begin to show within the first few months of baby’s life, but may not be officially diagnosed as cerebral palsy until they’re about 2 years old. (R)

In addition to trouble with movement and coordination, cerebral palsy can cause a wide variety of other mental and physical symptoms. Approximately 30-50% of children with cerebral palsy will also have intellectual or developmental disabilities. Some children with cerebral palsy may have learning difficulties, especially in areas involving spatial reasoning. Some children may have sensory disorders, causing extreme sensitivity or insensitivity to stimuli. (R)

Physical side effects of cerebral palsy include:

• Delayed physical growth
• Difficulty gaining weight
• Delayed sexual development
• Deformities of the spine, leading to twisted or curved posture
• Osteoarthritis
• Visual impairment, especially crossed eyes
• Hearing impairment
• Difficulty controlling muscles used in speech, causing slurred speech and drooling
• Incontinence due to lack of control of bladder muscles
• Contractures, a painful condition in which muscles lock into abnormal positions
• Inability to participate in physical activity, limiting development of strength and fitness
• Seizure disorders

These symptoms may not be present in every case of cerebral palsy; severe cases may have several or all of them.

Children with cerebral palsy may also have chronic pain due to the constant muscle spasms and the associated damage to the joints. As they get older, cerebral palsy can lead to degenerative arthritis and bone loss as the joints are stressed and weight-bearing exercise, the best defense against osteoporosis, is difficult. Cerebral palsy is hard on the body and the mind and many cerebral palsy sufferers age prematurely under the strain. However, nearly all children with cerebral palsy survive to adulthood. (R)

Types of Cerebral Palsy

Cerebral palsy is divided into several subtypes based on specific movement- and coordination-related symptoms. These subtypes are further divided by the parts of the body affected and the severity of the symptoms. For example, the prefixes hemi-, di-, and quad- mean half, two, and four, respectively. They indicate the parts of the body most affected by cerebral palsy. The suffixes –paresis and –plegia mean weakness and paralysis, respectively. So, quadriplegia means paralysis of all four limbs. Diparesis means weakness of the legs. Hemiparesis means weakness of either the left or right side of the body. These terms are used in conjunction with the subtypes described below, so a child might have spastic quadriparesis, or spastic cerebral palsy that causes weakness in all four limbs.

Let’s take a look at the major subtypes of cerebral palsy.

Spastic Cerebral Palsy

Spastic cerebral palsy is the most common subtype (affecting 77% of cases) and is associated with stiff muscles and awkward movements. It often affects just one side of the body or just the legs. In those cases, the child usually normal intelligence but may have difficulty forming clear speech. Sometimes, spastic cerebral palsy affects the entire body. This more severe form is usually accompanied by some level of intellectual disability. Children with severe spastic cerebral palsy often cannot walk and may suffer frequent seizures. (R)

Dyskinetic Cerebral Palsy

Dyskinetic cerebral palsy is an umbrella term encompassing several different subtypes. Dyskinetic types of cerebral palsy are characterized by involuntary muscle writhing and spasms. Dyskinetic forms of cerebral palsy are identified by the type of muscle movement the disorder causes: chorea, dystonia, and athetosis.

“Chorea” comes from the Greek word meaning “to dance.” People with choreiform cerebral palsy experience involuntary fidgeting and twitching. Some forms of choreoathetoid cerebral palsy are mild, with small twitches and manageable spasms, while more severe forms involve wild and dramatic movements. The twitches and spasms associated with chorea may also occur in conjunction with other types of cerebral palsy.

Dystonic cerebral palsy is characterized by involuntary, slow, twisting or repetitive muscle movements. It can also cause children to adopt unusual postures. These movements and postures may be repetitive or sustained for long periods of time. Unfortunately, the movements may also be painful. Dystonic movements may be triggered by an attempt to control muscle movement or by fear, stress, pain, or anxiety.

Athetoid cerebral palsy is characterized by slow, involuntary writhing. The writhing is often worse when the child attempts to move, but is usually present even when the child is at rest. Athetoid cerebral palsy makes it difficult for sufferers to maintain muscle tone; their muscles relax and tense or spasm involuntarily. That can make it difficult to stand or sit, let alone perform more precise movements. Athetoid cerebral palsy often affects the entire body. Its effect on the lips and tongue typically cause some level of speech impediment.

Ataxic Cerebral Palsy

Ataxic cerebral palsy is the least common form, accounting for just 5-10% of cerebral palsy sufferers. “Ataxia” refers to a lack of coordination or control, which is the main characteristic of ataxic cerebral palsy. Specifically, it affects voluntary muscle movements. Children with this type of cerebral palsy often have difficulty executing smooth and precise movements. Movements may be jerky and poorly controlled. That can make all sorts of daily tasks very difficult — from buttoning a shirt to using a fork to walking. Ataxia also affects depth perception and balance, so those with ataxic cerebral palsy may be shaky or unsteady on their feet. Ataxic cerebral palsy is often linked to damage to the cerebellum, which controls voluntary muscle movements.

Mixed Cerebral Palsy

Not every instance of cerebral palsy fits into one of the three subtypes described above. Some children display a mix of symptoms that can’t be neatly categorized. These cases fall under the label of mixed cerebral palsy.

Classifications of Cerebral Palsy

The severity of your child’s cerebral palsy is classified according to the Gross Motor Function Classification System. This deals with five different levels of motor function, including how independent your child is with sitting, walking, or standing. (R)

The levels are as follows:

• Level 1: Walks without limitations.
• Level 2: Can walk long distances without limitations but can’t run or jump. They might need assistive devices when first learning how to walk, along with a wheelchair when outside the home.
• Level 3: Can sit and stand with little support but need a cane or walker indoors and a wheelchair outdoors.
• Level 4: Can walk with assistive devices and move independently in a wheelchair, but need some support while sitting.
• Level 5: May be able to control a wheelchair, but need help maintaining their head and neck position and may need support sitting or standing.

How do you treat cerebral palsy?

Unfortunately, cerebral palsy is incurable. However, there are many treatments available to improve your child’s quality of life and ability to live independently. Treatment for cerebral palsy may include surgery, assistive devices, various types of therapy, medications, and treatments for other conditions associated with cerebral palsy, including epilepsy, incontinence, osteoarthritis, bone loss, and chronic pain.

You’ll need to work with your child’s doctor to determine what course of treatment will be best for your child’s unique needs, but let’s take a look at the basics of treatment.

Surgery Options

Some children with cerebral palsy may require surgery in order to walk or stand normally. Cerebral palsy can cause the muscles and tendons in the legs to be unusually short or tight, which may be painful and may cause the child to walk on his/her toes. Orthopedic surgery can lengthen and loosen those tendons and muscles, allowing the child to have a more comfortable and functional gait. (R)

Cerebral palsy can also cause deformities of the spine. In some cases, orthopedic surgery is a good option for straightening and correcting the spine. Straightening the spine can relieve abnormal joint pressure and make walking easier.

In some very severe cases where other treatment methods have been ineffective, children may benefit from a procedure called “selective dorsal rhizotomy.” In this procedure, the surgeon severs certain overactive nerves at the base of the spinal column. This stops the muscles from spasming uncontrollably and can significantly decrease the child’s pain and discomfort. However, the surgery is risky and can cause side effects including numbness and loss of sensation in the limb to which the severed nerves were connected. (R)

Finally, some children may need surgery to correct the vision problems associated with cerebral palsy, especially strabismus (cross eyes).

Assistive Devices

Orthotic devices may help children with cerebral palsy increase their mobility and compensate for balance and coordination problems. These devices may include braces or splints for the limbs to straighten them and properly align the muscles. Other types of braces may be used to help stretch and loosen tight muscles, easing pain and making movement easier. If your child is not mobile, he/she may use a walker, scooter, or wheelchair to get around.

Therapy

Children with cerebral palsy may benefit from several different types of therapy. Physical therapy is one of the most powerful tools used to treat cerebral palsy and often begins when the child is still very young. Physical therapy will focus on strength training, coordination, and balance. It may also include more passive types of therapy, such as application of heat or cold to the muscles. Your physical therapist may make use of various orthotic devices to help stretch or align your child’s muscles. The specific course and content of physical therapy will depend on your child’s unique needs but is generally designed to increase coordination and mobility, strengthen and align the muscles to reduce pain and increase coordination, increase fitness, improve posture, and psychologically encourage the child. More research needs to be done on the full scope of benefits for physical therapy, though it remains a popular therapy option. (R)

Cerebral palsy sufferers may also benefit from occupational therapy. Occupational therapy typically focuses on making everyday tasks manageable. It may include learning how to dress, finding ways to get in and out of cars comfortably, and working out strategies for other tasks that are difficult for those with impaired mobility and muscle control. It may also involve learning how to set up a living space that meets the needs of your child, making the space safe and ensuring important items are within easy reach.

Many children with cerebral palsy suffer from some form of speech impediment. This is caused by difficulty controlling the muscles used in speech and, in some cases, may be exacerbated by intellectual disabilities. Children with a speech impediment may benefit from speech therapy. Speech therapy focuses on increasing and improving control of those muscles to make speech easier. It may also include strategies for communicating more clearly, using gestures, or sign language. In some cases, children may learn to use a set of pictures of common objects or a computer with a voice synthesizer to ease communication. (R)

Some speech therapy programs can also help children increase control over the muscles controlling swallowing, drooling, and eating. Children with poor control over those muscles are at risk for aspirating food or liquid into their lungs, causing serious infections and breathing problems. Therapy can help children strengthen those muscles and swallow properly.

Finally, children with cerebral palsy may benefit from recreational therapy. This type of therapy is focused on the wellbeing and happiness of the child and often involves art, sports, cultural activities, and other exercises to broaden the child’s physical and emotional horizons. Recreational therapy can also benefit children in other aspects of their treatment, improving speech, mobility, and self-esteem.

Medication

A number of medications can help soothe and relax your child’s stiff, sore, contracted muscles. These include baclofen, dantrolene sodium, tizanidine, diazepam, and others. In some severe cases, children may benefit from an implanted baclofen pump that delivers the drug straight to the spinal cord. Most of the drugs have mild side effects, but some may cause drowsiness. More serious side effects include liver damage and changes in blood pressure. Discuss the options and risks with your child’s doctors when considering oral medications to treat cerebral palsy. (R)

More recently, some doctors have been treating cerebral palsy patients with botulinum toxin — the same type used in Botox cosmetic treatments. Botulinum toxin (BT-A) impairs the function of the nerves that cause muscle spasms and can offer relief for several months at a time. It’s not permanent and must be administered several times a year. This treatment is typically most effective where only a few muscles are affected by relatively mild cerebral palsy, and recommended at ages 2-6, when gait patterns and motor functions are still flexible. (R)

What are the legal issues surrounding cerebral palsy?

Sometimes, cerebral palsy just happens. It may be the result of an unavoidable infection or genetic mutation. It may be the result of a fetal stroke. Sometimes, there’s nothing you can do to prevent it. Most cases of cerebral palsy aren’t preventable, but the result of complicated and unavoidable health issues.

Sometimes, however, the brain damage that causes cerebral palsy could have been prevented. Sometimes it’s the result of negligence or error on the part of the doctor or medical team supervising your pregnancy or delivery. In the case of acquired cerebral palsy, it may be the result of negligence or error of the doctor treating your child’s illness or the negligence of a third party that injured your child.

It may heartbreaking to think that your child could have been protected from cerebral palsy. There’s no way to undo that damage. However, you may be legally entitled to compensation for the medical expenses, pain and suffering, and other costs associated with your child’s injuries.

Cerebral Palsy Birth Injury Lawsuits

Generally, claims for compensation turn on the negligence of a doctor, hospital, or other care provider. Depending on the nature of your claim, you may sue the doctor, the hospital, or both. In order to win compensation in court, you’ll need to prove three facts:

• First, you’ll need to prove that you and your doctor had a doctor/patient relationship. That usually comes in the form of an agreement that your doctor will provide care during your pregnancy and/or delivery. Generally, a doctor/patient relationship is formed when the doctor treats you, which may involve administering regular checkups during pregnancy, treating any issues that arise during pregnancy, or delivering your baby. A doctor/patient relationship is not formed when you simply ask a doctor for advice and the doctor doesn’t treat you or take responsibility for your care in any way.
• Second, you’ll need to show that your doctor was negligent in caring for you. Perhaps he/she didn’t perform a standard diagnostic test. Perhaps he/she missed obvious signs of problems. Perhaps he/she gave you the wrong drug or performed a c-section too late to prevent brain damage to the baby. Negligence is usually proven by testimony from expert witnesses who can attest to the industry’s standard of care and that your doctor failed to act in accordance with that standard.
• Third, you’ll need to show that the doctor’s negligence caused your baby’s injuries. If your child’s cerebral palsy was caused by asphyxia and your doctor failed to perform a c-section when it was called for, that’s fairly strong evidence that the doctor’s actions caused your child’s injuries. If, on the other hand, the doctor was negligent in a way that didn’t hurt you or the baby, you do not have a claim for compensation. For example, if the doctor failed to check your blood pressure according to standard procedure but your child’s cerebral palsy is attributable to a genetic mutation, then you don’t have a claim.

The steps described above apply to claims against doctors specifically. The process for making a claim against a hospital is similar, but significantly more complicated. Hospitals are responsible for the actions of their employees, but doctors are often not employees of the hospital. So, you could sue a hospital if a nurse negligently caused your baby’s injuries but not necessarily if the fault lies with the doctor.

The legal process for claiming compensation for negligence leading to cerebral palsy is extremely complicated and best handled by an experienced local attorney. Every case is different and will need to be handled differently.

See also: How Common are Birth Injuries and Birth Defects?

Who can bring a claim?

In general, only the person actually injured by the negligence of another can bring a suit. Obviously, that rule doesn’t work when the injured party is a baby. The parents or legal guardian of a child with cerebral palsy can bring a claim on the child’s behalf.

If you have cerebral palsy, you may be able to file suit yourself. Some states allow people injured as minors to bring a lawsuit within 2 years of their 18th birthday. A local attorney can determine if you’re eligible to file a claim.

What compensation can you win?

The compensation you win in a lawsuit is called “damages.” A cerebral palsy lawsuit may involve two types of damages: compensatory and punitive.

Compensatory damages are meant to compensate the victim for losses suffered due to the injury. These may be economic losses, such as medical expenses or the lost wages of a parent who must stay home to care for the child. They may also be non-economic losses, such as compensation for pain and suffering. Most lawsuits are limited to compensatory damages.

Punitive damages are imposed as a punishment to the party at fault. Punitive damages are available where the injury was caused by purposeful or reckless behavior. There must be something worse than ordinary negligence involved. For example, a doctor who failed to perform a c-section because he/she was under the influence of alcohol and couldn’t perform her job may be required to pay punitive damages.

See also: Safe Delivery: How Doctors Can Avoid Birth Injuries

Cerebral Palsy Legal Help: How can I tell if my doctor was negligent?

Let’s take a look at some of the actions that can give rise to a claim for compensation.

Negligence During Pregnancy

There are a number of issues and complications that can arise during pregnancy and cause cerebral palsy. Serious infections and pregnancy-related complications can cause fetal stroke or swelling or hemorrhage in the baby’s brain. They can cause your body or the baby’s body to release or produce toxins that damage the baby’s brain. If your blood pressure drops, it can deprive the baby’s brain of oxygen.

Your doctor should be monitoring your health and watching for signs and symptoms of complications that can affect the baby. Sometimes, the doctor fails to diagnose a condition that puts the baby at risk. Your doctor may miss the signs of a serious infection or fail to notice changes in the mother’s or baby’s health. In some cases, a doctor may fail to perform standard tests used to monitor the baby’s wellbeing.

If your doctor fails to diagnose a problem in time, you may be entitled to compensation for the harm caused.

Negligence During Delivery

Most cerebral palsy-related claims against doctors stem from the doctor’s actions or inactions during delivery. A slow or complicated delivery can put the baby at risk for cerebral palsy and doctors are responsible for avoiding those risks as much as possible. For example, doctors should order c-sections when necessary to protect the baby from asphyxia. Failure to order a c-section or unnecessary delay in ordering a c-section means the baby may be deprived of oxygen for longer than necessary, which can cause brain damage. Doctors must also carefully monitor the mother’s blood pressure and take quick action to protect the baby if it gets too high or too low. In some cases, doctors will induce labor using a drug called “Pitocin.” Giving the wrong dose of Pitocin to the mother can damage the baby’s brain.

See also: Vacuum Extraction, Forceps Delivery, and Birth Trauma Risks

Injuries After Birth

In about 10% of cases, cerebral palsy is acquired due to an injury or illness after birth. These issues may also be attributable to negligence and may also entitle you to compensation. In cases where an illness caused cerebral palsy, you may have a negligence claim against the doctor that treated your child. In cases of cerebral palsy caused by injury, you would bring a claim against the person responsible for the injury rather than the doctor or hospital.

How to Get Help with a Birth Injury Claim

If your child has cerebral palsy and you believe it may have been caused by the negligence of a medical care provider or other party, you should speak to an experienced local attorney immediately. Even if you’re not sure of the cause, it’s a good idea to reach out to an attorney. Your attorney will help you evaluate your case, help you decide if a lawsuit is the right choice for you, and can tell you more about what to expect from the legal process. It’s important to act quickly because the law limits the amount of time you have to file a claim. That limit is called a “statute of limitations.” It varies by state, but you typically need to file a claim within 2-4 years of the injury in question.

Doctors work hard to protect you and your child but sometimes they make mistakes. Unfortunately, those mistakes can mean a lifetime of difficulty for your child. It’s not easy to decide to pursue a claim. No lawsuit can repair the damage or heal your child’s cerebral palsy. However, if a medical care provider injured your child, the compensation from a lawsuit can help you provide your child with the medical care he/she needs. If a doctor is a fault, you and your child should not have to bear the cost.

What questions should I ask my doctor?

If your child has been diagnosed with cerebral palsy, you probably have a lot of questions. What information do you need from your child’s doctors? See below for some sample questions.

1. What types of damage are associated with cerebral palsy?

While most cases of cerebral palsy do not require immediate treatment, some children may need to start treatment right away to avoid muscle and joint damage.

2. How will my child develop?

It may be difficult to determine exactly how serious a case of cerebral palsy is until your child is older, but your doctor can give you an idea of what to expect. Some children with cerebral palsy will have delayed physical and mental development. Children with severe cases may never learn to walk or talk. Ask about what to expect so you can prepare and so you can keep an eye out for unusual developments.

3. What care will be necessary going forward?

Will your child need physical therapy? What about medications? You’ll need a complete list of recommended treatments and a list of therapists or other specialists that can provide the care your child needs.

Some children with cerebral palsy need surgery to loosen and lengthen muscles and tendons, repair spinal deformities, or correct vision problems. Ask your doctor if your child is likely to need surgery. You may also ask for a list of qualified surgeons so you can choose the one that’s best for your child.

Children with cerebral palsy may need orthotic devices such as splints or braces to improve mobility. Some children may need wheelchairs, walkers, or scooters. Talk to your doctor about what devices your child may need and where you can get them.

You may need special equipment in your home to care for your child. Ask your doctor if you’ll need special beds, toilets, ramps, or other items to accommodate your child.

4. What is my child’s long-term outlook?

Will your child be able to live independently? Will physical therapy or other treatment be necessary on an ongoing basis? The sooner you get a sense of your child’s long-term health, the sooner you can start to plan for the future.

5. What caused my child’s cerebral palsy?

It is not always possible to identify the cause of cerebral palsy. Finding a cause where possible can be useful for a number of reasons. The cause may be a genetic mutation or environmental toxin and you may want to know whether any other children you have would be at risk. The cause may be medical malpractice, in which case you may want to sue your medical care providers for compensation to help cover the medical expenses and other costs associated with the injury.

6. What support resources are available?

Raising a child is hard under any circumstances. Raising a child with health problems is even harder. Your doctor can put you in touch with local communities of parents of children with cerebral palsy or local support organizations that can help you manage the costs and difficulties of raising a child with cerebral palsy.

Remember, there are no stupid questions. When the health of your child is at stake, you can’t ask too many. Don’t be embarrassed or nervous to ask for clarification of anything you don’t understand.

What should I expect if I have a child with cerebral palsy?

You want the best for your child, so it can be devastating to learn that your new little one may have serious health problems.

Most cases of cerebral palsy are diagnosed early, within a year or two of birth. Very mild cases may not become apparent until the child is 5 or 6 years old. Every baby is regularly tested to ensure proper growth, nutrition, and development. If your child is not growing appropriately or is lagging behind developmental milestones (at ages 9 months, 18 months, and 24 or 30 months), your doctor may want to monitor your child more closely and have checkups at more frequent intervals. A number of conditions can affect your child’s growth and development, so your doctor will perform tests and continue monitoring your child’s development to rule out other potential diagnoses. (R)

If your doctor believes that your child may have cerebral palsy, he/she will refer you to a specialist (usually a pediatric neurologist or developmental pediatrician) who can perform more rigorous testing of your child’s development, muscle tone, and other factors to determine if your child has cerebral palsy. There is no specific test that can confirm or rule out cerebral palsy, so your child’s doctors will rely on your medical history, your child’s medical history, and testing of your child’s developmental progress. In some cases, your doctor may perform a CAT scan, an MRI, or a cranial ultrasound to look for lesions (damaged areas) or malformations of the brain.

Because there is no specific test for cerebral palsy, diagnosis can take time. While many children are diagnosed before the age of 2, other diagnoses can take much longer. Doctors don’t want to give you the wrong diagnosis and they don’t want to miss any of the other conditions that can cause symptoms similar to cerebral palsy, so they will take their time and try to be as thorough as possible.

Cerebral Palsy as an Infant

Children with cerebral palsy typically have delayed growth and development. Your little one will likely be smaller than her peers and lag behind on developmental milestones like sitting up, walking, and speaking. She may have unequal leg lengths. By the time your child is a toddler, you’ll have a fairly good of idea of what he/she can do. Some children have mild symptoms and are relatively unimpaired. Others have much more severe symptoms and may not ever be able to walk or talk. Pay attention to your child and learn what he/she can do. (R)

It’s not always going to be easy. It’s frustrating when your child is behind other children of the same age. It’s also frustrating when your child has trouble with potty training or with learning to speak. Remember that it’s frustrating for your child, too. Many children with cerebral palsy do not have intellectual disabilities, but some do — or they may have other impairments that are limiting. The best thing you can do is be loving and patient and work on ways to communicate with each other.

While many children with cerebral palsy won’t have any trouble keeping up with their peers, those with severe symptoms can benefit from modern technology. Programs specifically designed for children with cerebral palsy can allow them to draw, play, practice life skills, and communicate just like other toddlers. These programs can also help children and parents stick to a therapy regimen and practice the exercises and activities prescribed in therapy.

Going to School with Cerebral Palsy

Children with cerebral palsy may need special accommodations in school due to mobility limitations, such as special physical education classes that take into account their abilities. Some children with cerebral palsy also may require other special education classes. For example, cerebral palsy can cause spatial reasoning glitches that make math more difficult. You’ll need to work with your child’s teachers to make your child’s needs clear. (R)

You should always inform your child’s school that your child has cerebral palsy. You’ll need to notify them of any mobility limitations and medical needs. Your child may need to take certain medication multiple times a day and the school nurse’s office will handle that. You should also warn the school if your child suffers from epilepsy or other condition associated with cerebral palsy and create a detailed plan for how the school should handle any medical concerns.

Children with severe cerebral palsy may need more intensive special education care. States are required by law to provide educational services to all students, regardless of disability, and they have resources and staff in place to handle children with intensive needs. Some areas may also have private school options.

Therapy and Other Treatment

Each child is different and each will have different treatment needs. You’ll work with your child’s doctor to create a treatment plan, which may include surgery, therapy, or medication.

The treatment plan will change with your child as your she develops. You’ll need to stay in touch with her doctors and therapists to make sure the treatment plan is meeting your child’s needs and growing with your child. That may mean considering surgery to loosen muscles or tendons as your child learns to walk. It may mean starting speech therapy or occupational therapy. It may mean adjusting medications as your child grows and develops.

If your child’s symptoms are mild, you won’t have to spend much time on treatment. For those with severe symptoms, it may feel like you’re always in and out of a doctor’s office. If you’re struggling to manage your child’s treatment, there are resources available to help you manage the time and financial costs of treatment.

Adult Life

It’s not easy for any parent when their child goes out into the world. It can be especially difficult if your child has health problems. Most children with cerebral palsy will go on to lead independent lives — in one study, those with cerebral palsy who were age 8 to 12 reported the same quality of life as other children the same age without cerebral palsy. They’ll finish school, find jobs, settle down, and start families. They will always have cerebral palsy, but it can be managed and it doesn’t have to hold them back. (R)

Unfortunately, some children will have a harder time. Children with very severe cerebral palsy may not be able to lead independent lives. You may need help caring for your child, such as a health aide. You may find that your child is better cared for in a group home or care facility with extensive medical resources. Decisions about your adult child’s care may be difficult, but you’ll have to face them with your child’s best interests at heart.

Cerebral Palsy Resources for Parents

Raising any child is physically, emotionally, and financially demanding. Raising a child with cerebral palsy can be even more difficult. Remember that you don’t have to go it alone. There are extensive local and online support groups where you can connect with other parents and people with cerebral palsy to learn what works for them, to share resources, to swap stories, or to give or receive emotional support.

The following are just a few:

• United Cerebral Palsy: United Cerebral Palsy is an organization dedicated to supporting children with cerebral palsy and their families. Local UCP affiliates can provide help with housing, medical care, therapy, and more. UCP also provides educational materials about cerebral palsy and associated conditions.
• Medicare and Medicaid: Medicare and Medicaid can cover your child’s health care costs, including hospital visits and home care.
• State resources for assistive devices: Each state has a program designed to help children with disabilities get access to the assistive devices they need.
• Variety: The Children’s Charity: Variety provides assistance with mobility devices for disabled children. In some areas, it also provides specialized transport to school, medical appointments, and more.
• United Healthcare Children’s Foundation: United Healthcare Children’s Foundation provides financial assistance to cover the costs of children’s healthcare needs beyond what is covered by insurance. Families are eligible to receive up to $5,000 per year in aid.
• Partnership for Prescription Assistance: The Partnership for Prescription Assistance provides access to low-cost medications and medical care for qualifying patients and also offers local clinics for basic health care services.