Cerebral Palsy: Risk Factors and Steps That May Lower the Risk

Key points

• Cerebral palsy (CP) is caused by abnormal development of the brain, or damage to the developing brain, that affects a child's ability to control their muscles.
• CP from events before or during birth is congenital CP — the large majority of cases (85%–90%).
• CP can also begin in a child's first years — acquired CP.

Risk factors for congenital CP

A risk factor raises the chance of CP — but having one doesn't mean a child will have CP. Risk factors for congenital CP include:

• Low birthweight: under 5 pounds, 8 ounces (2,500 grams), and especially under 3 pounds, 5 ounces (1,500 grams).
• Premature birth: before the 37th week of pregnancy, and especially before the 32nd. Intensive care for premature babies has improved greatly over recent decades; more very early babies survive, but many have medical problems that put them at risk.
• Multiple births: twins, triplets and more — especially if a twin or triplet dies before or shortly after birth. Part of the added risk comes from these babies more often being early or small.
• Some infertility treatments (assisted reproductive technology, ART): the added risk is mostly explained by preterm and multiple births, both more common with ART.
• Infections during pregnancy: infections can raise proteins called cytokines in the baby's brain and blood. Linked infections include the viruses of chickenpox, rubella (German measles) and cytomegalovirus (CMV), and bacterial infections of the placenta, the fetal membranes or the mother's pelvis.
• Jaundice and kernicterus: jaundice, the yellow skin of many newborns, can, if severe and untreated too long, cause kernicterus, which can cause CP. Kernicterus sometimes comes from an ABO or Rh blood type difference between mother and baby.
• The mother's health: mothers with thyroid problems, intellectual disability or seizures have a slightly higher risk.
• Birth complications: a detached placenta, a ruptured uterus or umbilical cord problems during birth can cut the baby's oxygen and cause CP.

What can be done

The cause of CP often isn't fully known, so little can be done to prevent many cases, and CP due to genetics can't be prevented. But steps before and during pregnancy, and after birth, may lower the risk of developmental problems, including CP. Acquired CP often follows an infection or injury, and some of it can be prevented.

Developmental disabilities are conditions caused by an impairment in physical, learning, language or behavior areas. They begin during childhood development, may affect daily life, and usually last a lifetime.

Before pregnancy

• Treat any infections and bring health conditions under control — ideally before pregnancy.
• Get vaccinated against diseases such as chickenpox and rubella that could harm a developing baby; many of these vaccines should be given before pregnancy.
• If using ART, consider ways to avoid a multiple pregnancy, such as transferring one embryo at a time.

During pregnancy

• Get early and regular prenatal care.
• Call your provider if you get sick, have a fever or other signs of infection.
• Wash your hands often with soap and water.
• Get a flu shot — your best protection against serious flu, for you and your baby, before and after birth.
• Know your blood type. A blood-type or Rh mismatch can cause jaundice and kernicterus; doctors can give the mother Rh immune globulin (RhoGAM) at the 28th week and again soon after birth to prevent it.
• If you're at risk of preterm delivery, ask about prevention: magnesium sulfate given before an expected early preterm birth lowers the risk of CP in babies who survive.

More: during pregnancy.

After birth

• Ask about a bilirubin test for jaundice. Any baby can get it, and severe untreated jaundice can cause kernicterus — a potentially preventable cause of CP. Babies should be checked in the hospital and again within 48 hours of going home.
• Make sure your child is vaccinated against infections that can cause meningitis and encephalitis, including Haemophilus influenzae type b (Hib vaccine) and Streptococcus pneumoniae (pneumococcal vaccine).

More: after the baby arrives.

Resources

• HealthyChildren.org on cerebral palsy, American Academy of Pediatrics.
• Cerebral palsy, National Institute of Neurological Disorders and Stroke.
• Child safety and injury prevention, CDC.

Sources

Based on "Risk Factors for Cerebral Palsy," Centers for Disease Control and Prevention; a work of the United States government in the public domain. The page's four stock photographs are not reproduced.