Cerebral Palsy: Signs, Early Diagnosis, and Treatment

Cerebral palsy (CP) is the most common motor disability in childhood: a lifelong condition that affects movement, balance and posture because of damage to, or abnormal development of, the developing brain.⁠¹ The main early sign is a delay in rolling over, sitting, standing or walking.⁠¹ A diagnosis is possible before 6 months’ corrected age,⁠² and early intervention can start before a diagnosis is confirmed.⁠^3,5

What is cerebral palsy?

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and to keep their balance and posture.⁠¹ “Cerebral” refers to the brain and “palsy” to weakness or problems using the muscles. CP is caused by abnormal development of, or damage to, the developing brain, and it is the most common motor disability in childhood.⁠¹

Clinicians use an international definition: cerebral palsy is “a group of permanent disorders of the development of movement and posture, causing activity limitation,” caused by non-progressive disturbances in the developing fetal or infant brain.⁠^2,6 Three parts of it matter most to families:

• Permanent, but not progressive. The brain injury does not get worse, though the exact symptoms can change over a lifetime.⁠¹ Muscle and joint problems often progress with age, which is why care continues as a child grows.⁠⁶
• A group of disorders. Symptoms, and how serious they are, vary from person to person.⁠¹⁴
• More than movement. Many children with CP also have an intellectual disability, epilepsy, a behavior disorder, or trouble talking, seeing or hearing (see other health problems).⁠¹⁵

How common is cerebral palsy?

Cerebral palsy affects about 1 in 500 live births, and it is the most common physical disability of childhood.⁠² In the United States, CDC’s monitoring network identified about 1 in 345 8-year-olds with CP, in 2010 data.⁠¹⁶ Studies around the world put it at 1 to nearly 4 per 1,000 live births or children, so the figure depends on where and how it is counted.⁠¹⁶

CDC ran population surveillance from 2002 to 2010 and re-established it with updated methods in 2023, at sites in Georgia, Minnesota, Missouri, Tennessee and Utah.⁠¹⁷

The rate is falling. In some high-income countries it has dropped by 30%, to 1.4 per 1,000, and severity is lessening.⁠⁴ Babies born preterm make up 43% of children with cerebral palsy, so most children with CP were not born early.⁠⁴

What are the types of cerebral palsy?

Cerebral palsy is described by its main movement problem and by the parts of the body it affects.⁠¹ Spastic CP is by far the most common: CDC puts it at about 80% of people with CP, and a 2020 review at 85% of children with CP.⁠^1,4

Ataxic CP is one cause of ataxia in children.

What do spastic diplegia, hemiplegia and quadriplegia mean?

These terms say which parts of the body spastic CP affects.⁠¹

• Spastic diplegia (diparesis): stiffness mainly in the legs, with the arms less affected or not at all. Tight hip and leg muscles can pull the legs together so they cross at the knees (scissoring), which makes walking hard.⁠¹
• Spastic hemiplegia (hemiparesis): one side of the body, usually the arm more than the leg.⁠¹
• Spastic quadriplegia (quadriparesis): the most severe form, affecting both arms and legs, the trunk and the face. People with it usually cannot walk and often have other disabilities, such as intellectual disability, seizures, or problems with vision, hearing or speech.⁠¹
• Monoplegia: one limb only, which is rare.⁠¹⁸

The type does not tell you how much a child can do day to day. The GMFCS level describes that (see GMFCS levels).⁠⁸

What causes cerebral palsy?

Cerebral palsy is caused by damage to, or abnormal development of, the parts of the brain that control movement.⁠¹⁹ In 85% to 90% of children it is congenital, meaning it comes from brain development or damage before or during birth.⁠¹ A small number have acquired CP, which begins more than 28 days after birth.⁠¹⁹

Before birth, infections, fever, trauma or gene changes can cause the brain to develop abnormally. The developing white matter is most sensitive to injury between 26 and 34 weeks of pregnancy, though damage can happen at any time.⁠¹⁹

When children with CP have an MRI, the most common findings are white matter damage (about 45%), damage to the basal ganglia or deep gray matter (13%), a malformation of the brain (10%) and focal infarcts, areas of injury from a blocked blood supply (7%).⁠⁷ After the newborn period, the reported causes of acquired CP are meningitis (about 20%), other infections (30%) and head injury (12%).⁠⁷

Often no single cause is found, and NICE asks doctors to explain to families that it is not always possible to identify one.⁠⁷

Can a lack of oxygen at birth cause cerebral palsy?

It can, but less often than many people think. Scientists once thought CP was mainly caused by lack of oxygen during birth; they now think it causes only a small number of cases.⁠¹ A 2021 study in JAMA notes that asphyxia accounts for less than 10% of cases.⁠²⁰

When it does happen, a detached placenta, a torn uterus or a problem with the umbilical cord during birth can cut off the baby’s oxygen and result in CP.⁠²¹ An MRI cannot accurately show when such an injury happened.⁠⁷

Is cerebral palsy genetic?

Cerebral palsy is not considered a genetic disorder, but genetic factors can raise the risk.⁠¹⁴ A 2020 review estimates that genes likely contribute in about one-third of children with CP, especially those without risk factors such as prematurity or lack of oxygen.⁠⁴

In a 2021 study of exome sequencing, a genetic diagnosis was found in 32.7% of patients referred to a clinical laboratory and 10.5% of a health-system group, and more often in people who also had intellectual disability, epilepsy or autism.⁠²⁰ Specialists may suggest genetic or metabolic testing,⁠¹³ and a child with no known risk factors, or with a family history of a progressive neurological disorder, should see a pediatric neurologist.⁠⁷

What are the risk factors for cerebral palsy?

A risk factor makes CP more likely, but having one does not mean a child will have CP.⁠²¹ The main ones are:

• Premature birth, before 37 weeks and especially before 32 weeks of pregnancy.⁠²¹
• Low birthweight, under 5 pounds 8 ounces (2,500 grams), and especially under 3 pounds 5 ounces (1,500 grams).⁠²¹
• Twins, triplets and other multiple births, especially if one of the babies dies before or shortly after birth.⁠²¹
• Infections during pregnancy, such as chickenpox, rubella and cytomegalovirus (CMV), or infection of the placenta or the membranes around the baby (chorioamnionitis).⁠^7,21
• Some infertility treatments, mostly because they make preterm and multiple births more common.⁠²¹
• Severe jaundice left untreated too long, which can cause kernicterus.⁠²¹
• A mother’s thyroid problems, intellectual disability or seizures, which slightly raise the risk.⁠²¹
• Problems around birth, such as a lack of oxygen or neonatal encephalopathy, and newborn infection (sepsis), particularly in babies born weighing under 1.5 kg (about 3.3 pounds).⁠^7,21
• Meningitis after birth.⁠⁷

Risk factors can add up, and a child with any of them should have closer developmental follow-up through the first 2 years.⁠⁷

Can cerebral palsy be prevented?

Some cases can. CP linked to genetics cannot be prevented, but steps before, during and after pregnancy can lower the risk.⁠²¹

• Magnesium sulfate before a very early birth. Given to mothers expected to deliver early, it reduces CP by about 30% in children up to 2 years’ corrected age; about 60 mothers need treatment to prevent one case.⁠^4,22 By school age, the 2026 Cochrane review found it may make little to no difference in outcomes.⁠²²
• Steroids before a preterm birth, and caffeine for preterm babies coming off a ventilator, are also rated effective for preventing CP.⁠⁴
• Cooling after a difficult birth. Started within 6 hours of birth in term and late preterm babies with moderate to severe brain injury from lack of oxygen (hypoxic-ischemic encephalopathy), cooling reduces death or major disability.⁠²³ It prevents about 15% of the CP linked to lack of oxygen during labor.⁠⁴
• Treating newborn jaundice, since kernicterus is a cause of CP that can potentially be prevented.⁠²¹
• Vaccines against infections that cause meningitis and encephalitis, including the Hib and pneumococcal vaccines.⁠²¹
• Prenatal care. Because CP is linked to preterm birth and low birthweight, good prenatal and perinatal care may reduce the risk.⁠²⁴

What are the early signs of cerebral palsy?

The main sign is a delay in reaching movement milestones, such as rolling over, sitting, standing or walking.⁠¹ Signs vary widely, and some babies without CP show some of them too, so one sign on its own is not a diagnosis.⁠¹

Signs of cerebral palsy in babies under 6 months

• The head lags when you pick your baby up from lying on their back.⁠¹
• Your baby feels stiff, or feels floppy.⁠¹
• When cradled in your arms, your baby seems to overextend the back and neck, as if pushing away from you.⁠¹
• When you pick your baby up, the legs get stiff and cross or scissor.⁠¹
• Unusual or few movements, movements that differ from one side to the other, or feeding difficulties.⁠⁷

Signs of cerebral palsy after 6 months

• Not rolling over in either direction.⁠¹
• Not bringing the hands together, or having trouble bringing them to the mouth.⁠¹
• Reaching with only one hand while keeping the other in a fist.⁠¹
• Using one hand much more than the other before age 1: an early hand preference is one of the most common delayed-milestone signs in CP.⁠⁷
• Not sitting by 8 months, or not walking by 18 months, corrected for prematurity.⁠⁷
• After 10 months, crawling lopsided, pushing off with one hand and leg while dragging the other side, or scooting on the bottom or hopping on the knees instead of crawling on all fours.⁠¹
• Toe walking that persists, which NICE says should be referred for assessment (see toe walking).⁠⁷

See also our guides to delayed motor milestones and hypotonia (low muscle tone).

Is the Moro reflex a sign of cerebral palsy?

A Moro reflex that lasts longer than expected can be one clue, but it is not a diagnosis. Babies who develop CP are known to keep primitive reflexes, the Moro among them, longer than other babies, or to lose them late.⁠²⁵ A full neurological exam within a structured motor assessment is better than checking reflexes one by one,⁠²⁵ and the most accurate early tools are the General Movements Assessment, the HINE and MRI (see below).⁠² Our Moro reflex guide explains the reflex itself.

How is cerebral palsy diagnosed?

There is no single test. The doctor looks closely at the child’s motor skills, muscle tone, reflexes and posture, and takes a careful medical history from the parents.⁠¹³ The American Academy of Pediatrics recommends developmental screening at well-child visits at 9, 18, and 24 or 30 months, and many movement problems are easy to see by 9 months.⁠¹³ A concern on screening leads to referral to a specialist.⁠¹³

Specialists may order brain imaging (MRI, CT, or ultrasound in premature babies), an EEG, and genetic or metabolic tests.⁠^13,14 MRI can show where the damage is and what type it is, and can reveal metabolic disorders that look like CP.⁠¹⁴ NICE advises MRI when the cause is not clear from the history, development and examination.⁠⁷

At what age is cerebral palsy diagnosed?

Most children are diagnosed in their first or second year; when symptoms are mild, a diagnosis may not be confirmed until a child is a few years older.⁠¹³ The diagnosis used to be made between 12 and 24 months, but it can now be made before 6 months’ corrected age, and experts consider the old silent period of waiting outdated.⁠²

Can cerebral palsy be diagnosed before 6 months?

Yes, in babies at risk, using a combination of tools with the clinical history. Before 5 months’ corrected age, these are the most accurate:⁠²

NICE suggests the GMA during routine follow-up between birth and 3 months for babies at increased risk.⁠⁷ If your baby has any of the risk factors above, ask whether these assessments are planned.

What does high risk of cerebral palsy mean?

It is a temporary diagnosis, used when CP is suspected but cannot yet be confirmed.⁠² A baby must have abnormal movement (motor dysfunction) plus an abnormal brain scan, a history that indicates risk, or both.⁠² Its purpose is to start CP-specific therapy right away: the international early intervention guideline says intervention should start as soon as possible, and recommends against waiting and seeing.⁠⁵

Who diagnoses cerebral palsy?

A developmental pediatrician, a child neurologist or a pediatric physiatrist (a rehabilitation doctor), usually after a referral from your child’s doctor.⁠¹³ A physical therapist who suspects CP may refer you back to the pediatrician for the diagnosis.⁠¹⁸

What do the GMFCS levels mean?

The Gross Motor Function Classification System (GMFCS) sorts children with cerebral palsy into five levels by how they move on their own: sitting, moving between positions and getting around.⁠²⁶ Level I is the most mobile and level V the least.⁠⁸ It was developed in 1997 by consensus of 48 physical therapists, occupational therapists and developmental pediatricians.⁠²⁷ In broad terms, this is how the levels look between ages 6 and 12:⁠²⁶

Levels are quite stable after age 2, and children are unlikely to change level even with therapy.⁠⁸ Before age 2, a baby born early is classified at corrected age.⁠²⁶ The level describes gross motor function only, and parents of children aged 6 to 12 can classify their own child accurately with a parent version.⁠⁸

The level shapes the outlook for walking (see will a child with cerebral palsy walk) and the risk to the hips,⁠^9,11 and it guides therapy: for levels IV and V the focus may be health, preventing secondary problems, and technology and adapted equipment; for levels I to III, gross motor skills.⁠⁸

W-sitting, sitting on the floor with the knees bent and the feet out to the sides, is described in the GMFCS as a common way for children at level III to sit between their second and fourth birthdays.⁠²⁶ Read more in our W-sitting guide.

What other health problems come with cerebral palsy?

Many children with CP have other conditions as well, and these can affect daily life more than the movement problem itself.⁠⁵ A systematic review found that among children with CP:⁠¹⁵

• 3 in 4 were in pain;⁠¹⁵
• 1 in 2 had an intellectual disability;⁠¹⁵
• 1 in 3 had hip displacement;⁠¹⁵
• 1 in 4 had epilepsy (see seizure disorders);⁠¹⁵
• 1 in 4 had a behavior disorder, and 1 in 4 had problems with bladder control;⁠¹⁵
• 1 in 5 had a sleep disorder, and 1 in 5 drooled;⁠¹⁵
• 1 in 10 were blind, 1 in 15 were tube-fed, and 1 in 25 were deaf.⁠¹⁵

Vision problems short of blindness are more common: NICE says around 1 in 2 children and young people with CP have some form of visual impairment, and recommends an eye assessment at diagnosis.⁠⁷ Children with CP are also 5 times more likely than other children to have a sleep disorder.⁠⁵

Does cerebral palsy affect intelligence?

Not always. About half of children with CP have an intellectual disability and about half have normal intelligence, and the share with intellectual disability is falling.⁠^2,4,15 Communication difficulties do not necessarily go with intellectual disability,⁠⁷ and learning disorders can occur even when intelligence is normal.⁠¹⁸

Is pain common in cerebral palsy?

Yes. In the systematic review, 3 in 4 children with CP were in pain.⁠¹⁵ Common causes include hip and spine problems, high muscle tone, muscle fatigue, constipation, vomiting and reflux, and trouble communicating can make the cause harder to find.⁠⁷ Ask your child’s team to check for pain at every visit.

What is the best treatment for cerebral palsy?

There is no cure, but early identification and treatment can improve the lives of people with CP.⁠³ Common treatments include medicines, surgery, braces, and physical, occupational and speech therapy, and no single treatment is the best one for every child.⁠¹ The evidence now shows clearly what works and what does not.⁠⁴

A systematic review of CP treatments grades each one with traffic lights: green for “do it”, yellow for “probably do it” or “probably do not do it”, and red for “do not do it”.⁠²⁸ Yellow-light treatments should be tracked with a sensitive outcome measure, and red-light ones stopped, since alternatives exist.⁠²⁸ In the 2020 update, 3% of the 398 outcomes graded were red.⁠⁴

Which cerebral palsy treatments work?

The 2020 review rated these effective (green):⁠⁴

• Therapy: acceptance and commitment therapy, action observation, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor therapy, pressure care, Stepping Stones Triple P (a parenting program), strength training, task-specific training, treadmill training (including partial body-weight support) and weight-bearing.⁠⁴
• Medical and surgical care: anticonvulsants, bisphosphonates, botulinum toxin (alone, or with occupational therapy or casting), diazepam, dental care, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy and umbilical cord blood cell therapy.⁠⁴

Which treatments do not work for cerebral palsy?

The same review rated these red (do not do it): craniosacral therapy, hyperbaric oxygen, neurodevelopmental therapy in its original passive form, and sensory integration therapy.⁠⁴ In moderate-quality trials, cranial sacral osteopathy and hyperbaric oxygen made no difference to motor skills, and serious side effects occurred.⁠⁴

Many families try complementary or alternative treatments, such as supplements or oxygen treatment. None is approved by the FDA for CP, so discuss any therapy or supplement with your child’s doctor first.⁠¹⁴

What should you ask your child’s cerebral palsy team?

• What GMFCS level would you give my child, and why?
• Has my baby had a General Movements Assessment or the HINE?
• Is my child in a hip surveillance program, and when is the next X-ray?
• Which of these treatments are green-light, and which are we monitoring?
• What outcome measure are we using, and when will we review it?
• Are these goals ours, or the service’s?
• Is my child in pain, and how would we know?
• When do we start planning the move to adult care?

Physical therapy for cerebral palsy

Physical therapists help people with CP gain strength and movement so they can function at their best through all stages of life.⁠¹⁸ The physical therapy treatments rated effective are active: goal-directed and task-specific training, strength and fitness training, treadmill and mobility training, weight-bearing, casting, home programs, and hippotherapy (therapy on horseback, rated effective for improving symmetry).⁠⁴ Stretching, resistance and strength training can maintain or improve strength, balance and movement skills, and help prevent contractures.⁠¹⁴

For babies, the international guideline recommends task-specific motor training in which the infant discovers solutions to movement challenges, and recommends against passive, therapist-controlled handling.⁠⁵

What happens at a physical therapy evaluation for cerebral palsy?

The physical therapist asks about the pregnancy, the birth, your child’s health and your concerns. They watch your child in different positions, assess muscle tone, strength, flexibility and reflexes by hand, and check how well your child sits, stands and grasps.⁠¹⁸ They work with your child’s doctor, who may order tests such as an MRI.⁠¹⁸ You can contact a physical therapist directly for an evaluation.⁠¹⁸

What happens in a physical therapy session for cerebral palsy?

Sessions are built around goals your family chooses: setting those goals at the start is one of the guideline’s three best-practice principles.⁠⁵ The practice is the task itself. If the goal is climbing the stairs at home, the session works on stairs, because task-specific training is what the evidence supports.⁠⁴ Between sessions, a home program does real work, and home programs are rated effective.⁠⁴ For any treatment with weaker evidence, the therapist should track progress with an outcome measure, so you can see whether it is working.⁠²⁸

How does physical therapy change as a child with cerebral palsy grows?

• Birth to 4: the physical therapist coaches you in positioning, movement, feeding, play and self-calming, sets goals with you, and builds a program of play. Therapy usually happens at home, in day care, at a clinic or a mix (see in-home therapy).⁠¹⁸
• Ages 5 to 18: goals shift to getting around school and the community; growth spurts mean the program and equipment need adjusting, and therapy may happen at school, in the community or both.⁠¹⁸
• Teens: a personal fitness program, and sports such as swimming, cycling or bowling, to build lifelong habits and prevent problems with posture and joint mobility.⁠¹⁸
• Adults: managing pain, conserving energy, adaptive equipment, and changes at home and work that support independence.⁠¹⁸

Read more: Physical therapy for cerebral palsy in children. Find a pediatric physical therapist.

How does occupational therapy help cerebral palsy?

Occupational therapy helps a child take part in everyday life. Occupational therapists focus on improving function and making the most of a child’s mobility, and help people find new ways to do activities and manage routines at home, at school and in the community.⁠¹⁴

For children with one-sided (unilateral) CP, two hand therapies are rated effective.⁠⁴ Constraint-induced movement therapy (CIMT) briefly restrains the stronger arm so the other arm gets used, and bimanual therapy then practices using both arms together.⁠²⁹ The early intervention guideline recommends CIMT or bimanual training as soon as unilateral CP is suspected, starting with short CIMT sessions of 30 to 60 minutes in a therapist-supervised home program for 6 weeks in early infancy, increasing in intensity with age.⁠⁵

Goal-directed training, environmental enrichment, home programs and occupational therapy after botulinum toxin injections are also rated effective.⁠⁴

Read more: Occupational therapy for cerebral palsy in children. Find a pediatric occupational therapist.

Does cerebral palsy affect speech?

Often, though most children with CP talk. In high-income countries, 3 in 4 children with CP will talk.⁠² Around 1 in 2 have some difficulty with communication, around 1 in 3 have specific difficulties with speech and language, and at least 1 in 10 need augmentative and alternative communication (AAC), such as signs, symbols or a speech-generating device.⁠⁷

Speech is more often affected in bilateral spastic, dyskinetic or ataxic CP than in unilateral spastic CP, and the more severe the overall impairment, the more likely speech and language difficulties are.⁠⁷

Speech therapy for cerebral palsy

Speech and language therapy can improve a child’s ability to speak and help with swallowing problems, and it can teach new ways to communicate, such as sign language or a communication device.⁠¹⁴ Literacy interventions are rated effective,⁠⁴ and NICE advises considering AAC for children who need support understanding or producing speech.⁠⁷ In a Swedish study, 44.4% of children with CP used some form of AAC, alone or alongside speech.⁠³⁰

Read more: Speech therapy for cerebral palsy. Find a speech-language pathologist.

Does AAC stop a child with cerebral palsy from learning to talk?

No. AAC may help improve natural speech when it is used alongside other ways of communicating, and early AAC use can help develop speech and language.⁠³⁰ There are no prerequisites: a child does not have to show certain skills first, and impaired cognition does not rule out communication.⁠³⁰

Feeding and swallowing problems in cerebral palsy

They are common. About half of children with CP have swallowing problems (50.4% in the review ASHA cites) and feeding problems (53.5%).⁠³¹ About 1 in 15 will need tube feeding.⁠⁴ Swallowing safety matters because food or drink going into the airway (aspiration) is a leading cause of death in CP.⁠⁴

Ask for a feeding and swallowing assessment if your child:

• coughs or clears the throat when eating or drinking;⁠³¹
• has a wet-sounding voice, gulping swallows, or needs several swallows per mouthful;⁠³¹
• has chronic congestion or frequent chest infections;⁠³¹
• has trouble eating enough to gain or keep weight.⁠²⁴

Treatment considers how quickly a child tires, the best way to feed, and positioning for safe swallowing.⁠³¹ For babies, the guideline suggests softened food textures to make feeding safer and more efficient.⁠⁵ The 2020 review rates oral sensorimotor therapy effective for children with CP,⁠⁴ while ASHA notes limited high-quality evidence for oral motor exercises used on their own in children’s feeding problems generally.⁠³¹

What helps with drooling in cerebral palsy?

About 1 in 5 children with CP drool.⁠¹⁵ Doctors first look at positioning, medicines, reflux and dental problems; they may then consider anticholinergic medicine and, if that does not help enough, botulinum toxin injections into the salivary glands.⁠⁷

What medicines treat spasticity in cerebral palsy?

Spasticity means stiff or tight muscles with exaggerated reflexes.⁠¹⁴ Medicines that relax stiff muscles include diazepam, baclofen, dantrolene and tizanidine. They work best in children who need only a mild reduction in muscle tone or who have stiffness all over the body, and they may also ease pain.⁠¹⁴

• Botulinum toxin (Botox). Injected into specific muscles, it is an effective, generally safe treatment for localized spasticity (Level A in the American Academy of Neurology review), though the evidence on improved function is conflicting.⁠³² Relief lasts about 3 months and works best with physical therapy and splints.⁠¹⁴
• Diazepam may be used short term for widespread spasticity, with caution about side effects, and tizanidine may also be considered.⁠³²
• Intrathecal baclofen, from an implanted pump that delivers the drug into the fluid around the spinal cord, is for severe, widespread stiffness or uncontrolled movement.⁠¹⁴ The 2010 neurology review found too little evidence to support or refute it, while the 2020 systematic review rates it effective.⁠^4,32

After botulinum toxin, a baclofen pump, orthopedic surgery or rhizotomy, an adapted physical therapy program is an essential part of care.⁠²⁹

What surgery is done for cerebral palsy?

Surgery is often recommended when spasticity and stiffness make walking difficult or painful. Surgeons can lengthen muscles and tendons to improve mobility and reduce pain, and can correct spinal curves.⁠¹⁴ Tendon surgery may help some children but can also have negative long-term consequences.⁠¹⁴

Timely orthopedic surgery can prevent deterioration and improve function. When a child needs several operations at different sites to improve walking, they are done together when possible, in single-event multilevel surgery.⁠²⁹ Scoliosis correction is rated effective (see scoliosis).⁠⁴

What is selective dorsal rhizotomy?

Selective dorsal rhizotomy (SDR) is an operation that cuts nerves in the lower spine to reduce muscle stiffness.⁠³³ NICE suggests considering it to improve walking in children with spasticity at GMFCS level II or III,⁠²⁹ and the 2020 review rates it effective.⁠⁴

It cannot be undone. Families should know that walking or bladder function can get worse, that spinal deformity can develop later, and that long physical therapy and aftercare are needed; a specialist team chooses which children it suits.⁠³³

What is hip surveillance in cerebral palsy?

Hip surveillance means regular checks, with exams and hip X-rays, to catch hip displacement early.⁠¹² It matters because displacement is common: in an Australian population study it affected 35% of children with CP, from 0% at GMFCS level I to 90% at level V.⁠¹¹ Displacement and dislocation can cause pain and reduce function and quality of life,⁠¹² and surveillance programs have reduced dislocations.⁠¹⁰

When to start, and how often:

• The US care pathway says surveillance should ideally start by age 2, or when CP is diagnosed or suspected, with checks more often at higher GMFCS levels.⁠¹²
• The 2017 international guideline recommends pelvic X-rays every 6 to 12 months from age 12 months.⁠²
• UK guidance offers an X-ray at 24 months in bilateral CP, and suggests repeating it every year at GMFCS levels III to V.⁠²⁹
• Teens with risk factors should stay in surveillance into adulthood.⁠¹⁰

A migration percentage (how far the top of the thighbone has moved out of the socket) over 30%, or less than 30 degrees of hip abduction, should prompt referral to a pediatric orthopedic surgeon, and hip pain is also a reason for referral.⁠¹²

What are the signs of a hip problem in cerebral palsy?

Pain from the hip, a difference in leg length, less movement at the hip, rising muscle tone around the hip, worse sitting or standing, and more difficulty with diapering or personal hygiene can all be signs of hip displacement.⁠²⁹

What equipment helps children with cerebral palsy?

Mobility devices, including orthotics, braces and splints, special chairs, walkers and wheelchairs, help people with CP move more easily and sit more comfortably.⁠¹⁴ Communication aids such as computer software, voice synthesizers and picture books can improve communication, and some children need glasses or hearing aids.⁠¹⁴ Physical therapists recommend braces and other equipment, and help families get equipment for school and the community.⁠¹⁸

• Ankle-foot orthoses (AFOs). The early intervention guideline suggests them to improve or keep ankle range of motion.⁠⁵ For children at GMFCS level IV or V they can improve foot position for sitting, transfers and assisted standing, and a brace meant to hold a stretch works better when worn at least 6 hours a day.⁠²⁹
• Standing equipment. Used regularly as part of an active program, it may reduce hip migration and keep the hips’ range of motion.⁠⁵
• Walkers and wheelchairs. Mobility training is rated effective,⁠⁴ and moving can take people with CP up to five times as much energy as other people use.⁠¹⁴

Adaptive equipment and special communication systems can also be part of a child’s school plan.⁠³

Does stem cell therapy work for cerebral palsy?

Not as a treatment you can buy. In research studies, umbilical cord blood cell therapy combined with rehabilitation was slightly more effective than rehabilitation alone for motor skills, on moderate-quality evidence,⁠⁴ and NINDS describes stem cell therapy for CP as still being investigated.⁠¹⁴

The FDA says no regenerative medicine therapy is approved for any neurological disorder. The only FDA-approved stem cell products are blood-forming stem cells from umbilical cord blood, approved for blood disorders. If you are charged for a stem cell product, or offered one outside a clinical trial, you are likely being deceived and offered a product illegally, and the FDA has received reports of blindness, tumors and infections from unapproved products.⁠³⁴

If you are interested in stem cell research, ask your child’s neurologist about registered clinical trials.

Will a child with cerebral palsy walk?

Most do. In high-income countries, about three in four children with CP now walk.⁠⁴ Sitting at age 2 is the best simple guide: a child who can sit at 2 will likely, but not certainly, walk without help by 6; a child who can roll but not sit at 2 may; and a child who can neither sit nor roll at 2 is unlikely to walk without help.⁠⁷

The GMFCS level shapes the path. Children with CP reach about 90% of their gross motor function by around age 5 or younger, depending on their level, and the curves level off by about age 7.⁠⁹ Among California children not yet walking at 2 to 3½, being able to sit or to pull to stand strongly predicted walking later.⁠³⁵

Walking can change in adulthood: a large share of people who walked eventually stop, because of fatigue, an inefficient gait, or muscle and joint pain.⁠³⁶

What is the life expectancy of someone with cerebral palsy?

It depends mostly on how severe the CP is: the more severe a child’s physical, functional or cognitive impairment, the greater the chance of a shorter life.⁠⁷ In a Western Australian study that followed people with CP into their late 50s, the 22% with the mildest impairment survived to 58 at rates similar to the general population, and mortality rose with severity.⁠³⁷

Breathing problems are the main danger. In the same study, 58.6% of deaths with a known cause were respiratory, mostly pneumonia, and 45% of the pneumonia deaths were attributed to aspiration.⁠³⁷ Tube feeding is linked with shorter life expectancy, but that reflects how severe the swallowing problem is, not the tube itself.⁠⁷ See feeding and swallowing.

Since 1990, deaths among people with severe CP in Western Australia have shifted from childhood toward early adulthood.⁠³⁷

Cerebral palsy in adults

CP lasts a lifetime, and adults face new problems. Many people with CP show signs of premature aging by their 40s because of the extra stress and strain on their bodies.⁠^14,24 Post-impairment syndrome combines pain, fatigue and weakness from muscle and bone problems, repetitive strain and arthritis.⁠¹⁴ Depression is three to four times as common as in the general population.⁠^14,24

In US survey data, adults with CP had higher rates of diabetes, asthma, high blood pressure, heart conditions, stroke, emphysema, joint pain and arthritis than adults without CP; joint pain affected 43.6% and arthritis 31.4%.⁠³⁶

Many adults with CP live highly functional lives, with careers and families. Physical therapy in adulthood focuses on managing pain, conserving energy, adaptive equipment and changes at home and work, and therapists may work with the same person over many years.⁠¹⁸

How do teens with cerebral palsy move to adult care?

Through a planned transition. The American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians publish guidance on transition planning, transfer and integration into adult care for all young people.⁠³⁸ With CP, that includes keeping up hip surveillance into adulthood for teens with risk factors,⁠¹⁰ and continuing to check swallowing safety, which ASHA advises throughout adulthood for people with feeding and swallowing problems.⁠³¹

Does a child with cerebral palsy qualify for early intervention or an IEP?

Often, yes, and you do not need a diagnosis to ask. If your child is under 3, contact your local early intervention system; from age 3, contact your local public school system.⁠³ You do not need a doctor’s referral or a diagnosis to call, and a child who has not been diagnosed with CP may still be eligible.⁠^3,13

Early intervention serves children from birth through 36 months, and its services include physical, occupational and speech therapy and assistive technology.⁠³ The evaluation is free or reduced cost.⁠¹³ See early intervention or private therapy to compare the two.

At school, IDEA names cerebral palsy as an example of an orthopedic impairment, one of its disability categories, when the impairment is severe and adversely affects a child’s educational performance.⁠³⁹ Public schools must make a free appropriate public education available to eligible children aged 3 through 21,⁠⁴⁰ and the related services in an IEP include physical therapy, occupational therapy and speech-language pathology.⁠⁴¹ An IEP can also add supplementary aids, such as adaptive equipment or a special communication system.⁠³

Can a child with cerebral palsy have a 504 plan?

Yes, when CP substantially limits a major life activity. A child who needs only a related service, such as physical therapy, and not special education generally does not qualify under IDEA,⁠³⁹ but Section 504 covers anyone with a physical impairment that substantially limits a major life activity, such as walking, caring for oneself, manual tasks or learning.⁠⁴² Our resources for teachers include material you can share with your child’s school.

Does Medicaid or SSI help pay for cerebral palsy care?

Often. Medicaid covers children under 21 through its EPSDT benefit, which requires states to provide any medically necessary service Medicaid can cover to correct or improve a condition, even if the state plan does not otherwise cover it; states decide medical necessity case by case.⁠⁴³

Some states offer the optional Katie Beckett group, for children under 19 with a disability who would qualify for Medicaid if they lived in an institution. Eligibility is judged without counting the parents’ income or resources, so check whether your state offers it.⁠⁴⁴

For SSI, a child under 18 is considered disabled when an impairment causes marked and severe functional limitations that have lasted, or are expected to last, at least 12 months, or are expected to cause death.⁠⁴⁵ Social Security’s childhood listing for cerebral palsy (111.07) looks for disorganized movement in two limbs that causes an extreme limitation in standing up from a seat, balancing while standing or walking, or using the arms; when CP affects both physical and mental functioning, Social Security uses its functional equivalence rules.⁠⁴⁶

Does private insurance cover therapy for cerebral palsy?

Marketplace plans must: all of them cover rehabilitative and habilitative services and devices as essential health benefits, though the specific services vary by state, and large employers that self-insure do not have to provide them.⁠⁴⁷ Habilitative services help a person keep, learn or improve skills for daily living, such as therapy for a child who is not walking or talking at the expected age, and may include physical and occupational therapy and speech-language pathology.⁠⁴⁸ Read more: Does insurance cover therapy for kids?

What are the myths about cerebral palsy?

• Myth: most cerebral palsy is caused by lack of oxygen at birth. Scientists now think lack of oxygen during birth causes only a small number of cases.⁠¹
• Myth: cerebral palsy gets worse over time. The brain injury does not, though symptoms can change, and muscle and joint problems need ongoing care.⁠^1,6
• Myth: every child with cerebral palsy has an intellectual disability. About half of children with CP have normal intelligence.⁠²
• Myth: you have to wait until age 2 for a diagnosis. CP can now be diagnosed before 6 months’ corrected age.⁠²
• Myth: a communication device will stop a child from talking. AAC may help improve natural speech.⁠³⁰
• Myth: therapy works best when the therapist moves the child. Passive approaches are less effective, and the guideline for babies recommends against passive, therapist-controlled handling.⁠^4,5
• Myth: stem cell clinics offer a cure. No regenerative medicine therapy is FDA-approved for any neurological disorder.⁠³⁴

Find a cerebral palsy therapist near you

Physical therapists work alongside occupational therapists, speech-language therapists and doctors as a team for a child with cerebral palsy.⁠¹⁸ Each practice below lists cerebral palsy among the conditions it treats. Ask about its experience with CP, and whether a physical therapist is a board-certified clinical specialist or has training in pediatric or neurologic physical therapy.⁠¹⁸

349 clinics in the DrSensory directory name cerebral palsy among the conditions they treat — 253 PT, 62 OT, 34 SLP — across 50 states and the District of Columbia. They are grouped by state below.

Each clinic appears here because its own listing names this among what it treats. A listing is not an endorsement or a referral, and inclusion does not mean we have verified a clinic’s credentials, licensure or insurance — check those directly. Browse all physical therapy clinics.

RelatedPhysical therapyOccupational therapySpeech therapyPhysical Therapy for Cerebral Palsy in ChildrenOccupational Therapy for Cerebral Palsy in ChildrenSpeech Therapy for Cerebral Palsy: A Parent's Guide

Sources

1. Centers for Disease Control and Prevention. About cerebral palsy (last reviewed June 12, 2026). Checked October 6, 2026.
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   CP “is a group of disorders that affect a person's ability to move and maintain balance and posture”; “CP is the most common motor disability in childhood”; “CP does not get worse over time, though the exact symptoms can change over a person's lifetime”; “Spastic CP affects about 80% of people with CP”; the types (spastic diplegia, hemiplegia and quadriplegia; dyskinetic; ataxic; mixed, most often “spastic-dyskinetic CP”); the signs by age (younger than 6 months, older than 6 months, older than 10 months); “The majority of CP (85% to 90%) is congenital”; lack of oxygen during birth “causes only a small number of CP cases”; “Common treatments include medicines; surgery; braces; and physical, occupational, and speech therapy”; “No single treatment is the best one for all children with CP.”
2. Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatrics. 2017;171(9):897–907. doi:10.1001/jamapediatrics.2017.1689 (PMID 28715518). International clinical practice guideline.
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   Cerebral palsy “occurs in 1 in 500 live births” and is “a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain”; “Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months’ corrected age”; before 5 months’ corrected age the most predictive tools are “term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity)”; the interim diagnosis of high risk of cerebral palsy requires “motor dysfunction (essential criterion) and at least one of the other 2 additional criteria” (abnormal neuroimaging, or a clinical history indicating risk); “Experts now consider the silent period as outdated”; “For hips, anteroposterior pelvic radiographs every 6 to 12 months are recommended commencing at age 12 months”; “In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.”
3. Centers for Disease Control and Prevention. Treatment and intervention for cerebral palsy (last reviewed February 26, 2026). Checked October 6, 2026.
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   “There is no cure for cerebral palsy (CP), but early identification and treatment can improve the lives of those who have the condition”; “If your child is not yet 3 years old, contact your local early intervention system”; “If your child is 3 years of age or older, contact your local public school system”; “Even if your child has not been diagnosed with CP, they may be eligible for IDEA services”; early intervention serves children “from birth through 36 months of age” and includes therapy and assistive technology; school services can include “Supplementary aids and services, such as adaptive equipment or special communication systems”.
4. Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Current Neurology and Neuroscience Reports. 2020;20(2):3. doi:10.1007/s11910-020-1022-z (PMID 32086598).
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   “Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening”; the rate “has fallen by 30% in some high-income countries, bringing the prevalence down to 1.4 per 1000”; “Babies born preterm constitute 43% of all cerebral palsy”; “Three in four will now walk”; “Eighty-five percent of children with cerebral palsy have spasticity as their primary motor type and 7% have dyskinesia”; “A genetic contribution is likely in one-third of all children with cerebral palsy”; antenatal magnesium sulfate before 30 weeks “prevents 30% of cerebral palsy”, and hypothermia “prevents 15% of cerebral palsy associated with intrapartum hypoxia”; the green-light (effective) interventions, named in full, include hippotherapy “for increasing symmetry”; “bottom-up, generic, and/or passive motor interventions are less effective and sometimes clearly ineffective”, among them craniosacral therapy, hyperbaric oxygen, passive neurodevelopmental therapy and “sensory integration” (red lights); “Half of all children with cerebral palsy have dysphagia”; “One in 15 will require non-oral tube feeding”; aspiration is “a leading cause of death”; “Almost half of all children with cerebral palsy have co-occurring intellectual disability (46%)”, and that is declining; umbilical cord blood with rehabilitation is “slightly more effective than rehabilitation alone for improving motor skills”; of 398 outcomes graded, 3% were “don’t do it”.
5. Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, et al. Early intervention for children aged 0 to 2 years with or at high risk of cerebral palsy: international clinical practice guideline based on systematic reviews. JAMA Pediatrics. 2021;175(8):846–858. doi:10.1001/jamapediatrics.2021.0878 (PMID 33999106).
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   “When a child meets the criteria of high risk of CP, intervention should start as soon as possible”; best-practice principles include “parental goal-setting at the commencement of intervention”; “we recommend against waiting and seeing”; “We recommend task-specific motor training that includes self-discovery of the environment and solutions to overcome movement challenges”; “We recommend against passive, therapist-controlled handling techniques”; “We recommend CIMT and/or bimanual training as soon as a unilateral CP diagnosis is suspected”, with “short intervals of CIMT (30–60 min of therapist-supervised home programs for 6 wk) in early infancy, increasing in intensity with age”; “We suggest softened food consistencies to enhance feeding safety and efficiency”; standing equipment “to potentially decrease hip migration percentage and maintain hip abduction range of motion”; “We suggest ankle-foot orthoses should be worn to improve or maintain dorsiflexion range of motion”; associated conditions “may have a greater effect on function and quality of life than motor impairment”; “Children with CP are 5 times more likely to have a sleep disorder than children developing typically.”
6. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Developmental Medicine & Child Neurology Supplement. 2007;109:8–14. doi:10.1111/j.1469-8749.2007.tb12610.x (PMID 17370477).
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   The international definition (Novak and colleagues’ guideline, also listed here, quotes it word for word). Earlier definitions had not given enough prominence to “the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age”.
7. National Institute for Health and Care Excellence (UK). Cerebral palsy in under 25s: assessment and management (NG62, published January 25, 2017; last reviewed September 19, 2024). Checked October 6, 2026.
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   Independent risk factors include preterm birth, chorioamnionitis, low birth weight, neonatal encephalopathy, neonatal sepsis and meningitis; on MRI, “white matter damage: 45%”, basal ganglia or deep gray matter damage 13%, congenital malformation 10%, focal infarcts 7%; after the newborn period, “meningitis: 20%”, other infections 30%, head injury 12%; “it is not always possible to identify a cause”; “MRI will not accurately establish the timing of a hypoxic–ischaemic brain injury”; the most common delayed milestones are “not sitting by 8 months (corrected for gestational age)”, not walking by 18 months, and hand preference “before 1 year”; “Refer children who have persistent toe walking”; red flags for other disorders include “loss of already attained cognitive or developmental abilities”; “If a child can sit at 2 years of age it is likely, but not certain, that they will be able to walk unaided by age 6”; “Around 1 in 3 children have specific difficulties with speech and language”; “at least 1 in 10 need augmentative and alternative communication”; “communication difficulties do not necessarily correlate with learning disability”; around 1 in 2 have some visual impairment; “The more severe the child's physical, functional or cognitive impairment, the greater the likelihood of reduced life expectancy”; recommendations on drooling and pain.
8. CanChild Centre for Childhood Disability Research, McMaster University. GMFCS – E&R. Checked October 6, 2026.
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   A five-level classification of gross motor function in children and youth with cerebral palsy; children at level I “can generally walk without restrictions but tend to be limited in some of the more advanced motor skills”; “GMFCS – E&R levels are quite stable after 2 years of age and children are not likely to change levels even following intervention”; parents of children aged 6 to 12 classify their children accurately with an adapted version; for levels IV and V the emphasis “might be health promotion, prevention of secondary impairments, and use of technology and adapted equipment”.
9. Rosenbaum PL, Walter SD, Hanna SE, Palisano RJ, Russell DJ, Raina P, et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA. 2002;288(11):1357–1363. doi:10.1001/jama.288.11.1357 (PMID 12234229).
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   Five curves by GMFCS level, from 2632 assessments; “the curves appear to reach plateaus by about age 7 years”; “Children, on average, reach about 90% of their motor function” (as measured by the GMFM-66) “by around age 5 years or younger, depending on their GMFCS level”.
10. Wynter M, Gibson N, Willoughby KL, Love S, Kentish M, Thomason P, et al. Australian hip surveillance guidelines for children with cerebral palsy: 5-year review. Developmental Medicine & Child Neurology. 2015;57(9):808–820. doi:10.1111/dmcn.12754 (PMID 25846730).
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    “hip surveillance programmes have decreased the incidence of hip dislocation in populations with CP”; the GMFCS was “confirmed as the best indicator of risk for displacement”; the review supports “continuation of surveillance into adulthood for adolescents with identified risk factors”.
11. Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R, et al. Hip displacement in cerebral palsy. Journal of Bone and Joint Surgery, American Volume. 2006;88(1):121–129. doi:10.2106/JBJS.E.00071 (PMID 16391257).
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    Population-based Australian birth cohort: “The incidence of hip displacement for the entire birth cohort was 35%”; “The incidence of hip displacement was 0% for children with GMFCS level I and 90% for those with GMFCS level V”; displacement was “a migration percentage of >30%”.
12. American Academy for Cerebral Palsy and Developmental Medicine. Hip surveillance in cerebral palsy (care pathway). Checked October 6, 2026.
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    Hip surveillance is “The process of monitoring and identifying the critical early indicators of hip displacement”; “Hip displacement and dislocation can lead to pain, reduced function and reduced quality of life”; “Surveillance is ideally initiated by 2 years of age, when a CP diagnosis is provided, or when CP is suspected”; “Surveillance frequency increases with increasing GMFCS level”; referral to a pediatric orthopedic surgeon is recommended “When the migration percentage is greater than 30% and/or there is less than 30 degrees of hip abduction”, and hip pain is a reason for referral.
13. Centers for Disease Control and Prevention. Screening for cerebral palsy (last reviewed February 27, 2026). Checked October 6, 2026.
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    The AAP recommends developmental screening at 9 months (“Many issues involving movement are seen easily at this age”), 18 months, and 24 or 30 months; the doctor “will look closely at the child's motor skills, muscle tone, reflexes, and posture and take a careful medical history from the parents”; specialists include developmental pediatricians, child neurologists and pediatric physiatrists; tests may include brain imaging, an EEG, “genetic testing, or metabolic testing”; “CP is generally diagnosed during the first or second year after birth. However, if a child's symptoms are mild, it is sometimes difficult to confirm a diagnosis until the child is a few years older”; families can request “a free or reduced cost evaluation” from early intervention, and “You do not need to wait for a doctor's referral or a medical diagnosis to make this call.”
14. National Institute of Neurological Disorders and Stroke. Cerebral palsy (last reviewed March 13, 2026). Checked October 6, 2026.
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    CP “is a brain disorder that appears in infancy or early childhood and permanently affects body movement and muscle coordination”; “While cerebral palsy isn’t a genetic disorder, there are certain genetic factors that are thought to increase the risk of CP”; “If the child continuously loses motor skills, the problem is likely not CP”; muscle relaxants “include diazepam, baclofen, dantrolene sodium, and tizanidine”; botulinum toxin relief “lasts approximately three months after the injection”; the baclofen pump “is most appropriate for people with chronic, severe stiffness or uncontrolled muscle movement throughout the body”; “Tendon surgery may help some children with CP but could also have negative long-term consequences”; alternative therapies “have not been approved by the U.S. Food and Drug Administration (FDA) for the treatment of CP”; “Stem cell therapy is being investigated as a treatment for CP”; people with CP “may use up to five times the amount of energy that other people use when they walk and move”; “The rate of depression is three to four times higher in people with disabilities such as cerebral palsy than the general population.”
15. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics. 2012;130(5):e1285–e1312. doi:10.1542/peds.2012-0924 (PMID 23045562).
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    “Among children with cerebral palsy, 3 in 4 were in pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had a hip displacement; 1 in 4 could not talk;” “1 in 4 had epilepsy; 1 in 4 had a behavior disorder; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder;” “1 in 5 dribbled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf.”
16. Centers for Disease Control and Prevention. Data and statistics for cerebral palsy (archived page, last reviewed May 2, 2022). Checked October 6, 2026.
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    “About 1 in 345 children (3 per 1,000 8-year-old children) in the United States have been identified with CP, according to 2010 estimates”; studies worldwide report “prevalence estimates of CP ranging from 1 to nearly 4 per 1,000 live births or per 1,000 children”.
17. Centers for Disease Control and Prevention. Tracking methods for cerebral palsy (last reviewed June 8, 2026). “CDC conducted population-based surveillance for CP from 2002-2010, and re-established surveillance with updated methodology in 2023”, at “5 sites in Georgia, Minnesota, Missouri, Tennessee and Utah”. Checked October 6, 2026.
18. American Physical Therapy Association. Physical therapy guide to cerebral palsy (ChoosePT, expert review July 31, 2025). Checked October 6, 2026.
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    Monoplegia “is rare”; at an evaluation the PT will “Observe the child in different positions to assess movement patterns” and “Conduct a hands-on assessment of the child's muscle tone, strength, flexibility, and reflexes”; from birth to age 4 PTs “provide hands-on training for positioning, movement, feeding, play, and self-calming”; therapy changes through ages 5 to 18 and adulthood; “Physical therapists recommend braces and other helpful equipment to maintain health and function”; “Many people with CP live highly functional lives as adults. They often enjoy careers and families”; consider “A physical therapist who is a board-certified clinical specialist or who has completed training in pediatric or neurologic physical therapy”; “You can contact a physical therapist directly for an evaluation.”
19. Eunice Kennedy Shriver National Institute of Child Health and Human Development. What causes cerebral palsy? (last reviewed May 11, 2021). Checked October 6, 2026.
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    “Cerebral palsy is caused by damage or abnormal development in the parts of the brain that control movement”; the fetal white matter “is more sensitive to injury between 26 weeks and 34 weeks of pregnancy, but damage can happen at any time during pregnancy”; “Infections, fever, trauma, or gene changes (mutations) can cause the brain to develop abnormally”; acquired cerebral palsy “begins more than 28 days after birth”.
20. Moreno-De-Luca A, Millan F, Pesacreta DR, Elloumi HZ, Oetjens MT, Teigen C, et al. Molecular diagnostic yield of exome sequencing in patients with cerebral palsy. JAMA. 2021;325(5):467–475. doi:10.1001/jama.2020.26148 (PMID 33528536).
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    “recent studies indicate that asphyxia accounts for less than 10% of cerebral palsy cases”; “The molecular diagnostic yield of exome sequencing was 32.7% (95% CI, 30.2%-35.2%) in the clinical laboratory referral cohort and 10.5% (95% CI, 6.0%-15.0%) in the health care-based cohort”, highest in patients with intellectual disability, epilepsy and autism spectrum disorder.
21. Centers for Disease Control and Prevention. Risk factors for cerebral palsy (last reviewed February 26, 2026). Checked October 6, 2026.
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    “It is important to remember that having a risk factor does not mean that a child will have CP”; risk factors include low birthweight (“less than 5 pounds, 8 ounces (2,500 grams)”), premature birth (“before the 37th week of pregnancy, especially if they were born before the 32nd week”), multiple births, some infertility treatments, infections during pregnancy, severe untreated jaundice (kernicterus), a mother’s thyroid problems, intellectual disability or seizures, and birth complications that “can disrupt oxygen supply to the baby and result in CP”; “CP related to genetics is not preventable”; “taking magnesium sulfate before anticipated early preterm birth reduces the risk of CP among surviving infants”; “Kernicterus is a cause of CP that potentially can be prevented”; vaccination against Hib and pneumococcus.
22. Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database of Systematic Reviews. 2026;9:CD004661. doi:10.1002/14651858.CD004661.pub5 (PMID 42689525).
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    “Up to two years’ corrected age, magnesium sulphate compared with placebo reduced cerebral palsy (RR 0.71, 95% CI 0.57 to 0.89; 6 RCTs, 6107 children; number needed to treat for additional beneficial outcome (NNTB) 60”; “Magnesium sulphate may result in little to no difference in outcomes in children at school age.”
23. Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database of Systematic Reviews. 2013;(1):CD003311. doi:10.1002/14651858.CD003311.pub3 (PMID 23440789).
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    Cooling reduced “the combined outcome of mortality or major neurodevelopmental disability to 18 months of age” (NNTB 7; 8 studies, 1344 infants); “Hypothermia should be instituted in term and late preterm infants with moderate-to-severe hypoxic ischaemic encephalopathy if identified before six hours of age.”
24. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Other cerebral palsy FAQs (last reviewed May 11, 2021). Checked October 6, 2026.
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    “good prenatal care and perinatal support may reduce risks”; “it can be hard to get the proper nutrition or eat enough to gain or maintain weight”; “many adults begin to have age-related problems when they reach their 40s”; people with disabilities such as cerebral palsy “are three to four times as likely to have depression as people in the general population”.
25. Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatric Neurology. 2004;31(1):1–8. doi:10.1016/j.pediatrneurol.2004.01.012 (PMID 15246484).
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    “Infants with cerebral palsy have been known to manifest persistence or delay in the disappearance of primitive reflexes and pathologic or absent postural reactions”; the reflexes reviewed include the Moro; “a comprehensive neurologic examination in the context of a motor assessment instrument is preferable to an informal list of items”.
26. Palisano R, Rosenbaum P, Bartlett D, Livingston M. GMFCS – E&R: Gross Motor Function Classification System, Expanded and Revised (CanChild, 2007). Checked October 6, 2026.
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    The level descriptions by age band, from walking without limitations (level I) to being transported in a manual wheelchair (level V); children below age 2 are classified at their corrected age if they were premature; W-sitting appears in the level III description between the second and fourth birthdays.
27. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology. 1997;39(4):214–223. doi:10.1111/j.1469-8749.1997.tb07414.x (PMID 9183258).
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    The authors “developed a five-level classification system” after “consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved”.
28. Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine & Child Neurology. 2013;55(10):885–910. doi:10.1111/dmcn.12246 (PMID 23962350).
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    Outcomes graded from “do it” (green) through “probably do it” and “probably do not do it” (yellow) to “do not do it” (red); “All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.”
29. National Institute for Health and Care Excellence (UK). Spasticity in under 19s: management (CG145, published July 25, 2012; last updated November 29, 2016). Checked October 6, 2026.
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    Constraint-induced movement therapy is “temporary restraint of an unaffected arm to encourage use of the other arm”, followed by “bimanual therapy (unrestrained use of both arms)”; possible signs of hip displacement include “pain arising from the hip”, “deterioration in hip abduction or range of hip movement” and “deterioration in sitting or standing”; offer a hip X-ray “at 24 months in children with bilateral cerebral palsy” and “Consider repeating the hip X-ray annually” at GMFCS levels III to V; “Timely surgery can prevent deterioration and improve function”, with several procedures done together when possible (“single-event multilevel surgery”); “Consider selective dorsal rhizotomy to improve walking ability in children and young people with spasticity at GMFCS level II or III”; after botulinum toxin, intrathecal baclofen, surgery or rhizotomy, “provide an adapted physical therapy programme as an essential component of management”; a stretching orthosis works better worn “at least 6 hours a day”; ankle–foot orthoses at GMFCS IV or V “to improve foot position for sitting, transfers between sitting and standing, and assisted standing”.
30. American Speech-Language-Hearing Association. Augmentative and alternative communication (Practice Portal). Checked October 6, 2026.
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    “AAC use may help improve natural speech when used in a multimodal approach”; “early AAC use can help develop speech and language”; “There are no prerequisites for AAC intervention”; “impaired cognition does not preclude communication”; one study found that “44.4% of Swedish children with cerebral palsy used a form of AAC either exclusively or to supplement their speech”.
31. American Speech-Language-Hearing Association. Pediatric feeding and swallowing (Practice Portal). Checked October 6, 2026.
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    In cerebral palsy (ages 0–18 years), “The prevalence of swallowing problems was 50.4%” and of feeding problems “53.5%”; signs include “audible or gulping swallows”, “wet vocalizations”, “multiple swallows per bolus”, “throat clearing or coughing”, “chronic congestion” and “Frequent respiratory illnesses”; treatment for children with conditions affecting movement “needs to consider the length of time to fatigue, optimal feeding methods, and positioning”; “There is limited high-quality evidence supporting the use of oral motor exercises or sensory techniques” on their own; swallow safety should be monitored “throughout adulthood”.
32. Delgado MR, Hirtz D, Aisen M, Ashwal S, Fehlings DL, McLaughlin J, et al. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review). Neurology. 2010;74(4):336–343. doi:10.1212/WNL.0b013e3181cbcd2f (PMID 20101040).
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    American Academy of Neurology and Child Neurology Society: “For localized/segmental spasticity that warrants treatment, botulinum toxin type A should be offered as an effective and generally safe treatment (Level A)”; “There is conflicting evidence regarding functional improvement”; diazepam “should be considered for short-term treatment, with caution regarding toxicity (Level B), and tizanidine may be considered (Level C)”; “There are insufficient data to support or refute use of dantrolene, oral baclofen, or continuous intrathecal baclofen (Level U).”
33. National Institute for Health and Care Excellence (UK). Selective dorsal rhizotomy for spasticity in cerebral palsy (HealthTech guidance HTG245, formerly IPG373; last reviewed December 15, 2010). Checked October 6, 2026.
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    The procedure “involves cutting nerves in the lower spine that are responsible for muscle rigidity”; “The evidence on efficacy is adequate”; families should be told that it “is irreversible, and that patients may experience deterioration in walking ability or bladder function, and later complications including spinal deformity”, and “that prolonged physiotherapy and aftercare will be required”; selection is by “a multidisciplinary team with specialist training”.
34. US Food and Drug Administration. Important patient and consumer information about regenerative medicine therapies (content current as of April 8, 2024). Checked October 6, 2026.
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    “Regenerative medicine therapies have not been approved to treat any neurological disorder”; “the only stem cell products that are FDA-approved for use in the United States consist of blood-forming stem cells” from umbilical cord blood, approved for blood disorders; “if you are being charged for these products or offered these products outside of a clinical trial, you are likely being deceived and offered a product illegally”; “FDA has received reports of blindness, tumor formation, infections”.
35. Wu YW, Day SM, Strauss DJ, Shavelle RM. Prognosis for ambulation in cerebral palsy: a population-based study. Pediatrics. 2004;114(5):1264–1271. doi:10.1542/peds.2004-0114 (PMID 15520106).
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    California children with cerebral palsy “who were not yet walking at 2 to 3(1/2) years of age”: predictors of later walking “included early motor milestones such as sitting (odds ratio: 12.5; 95% confidence interval: 5.8-27.2) and pulling to a stand (odds ratio: 28.5”.
36. Peterson MD, Ryan JM, Hurvitz EA, Mahmoudi E. Chronic conditions in adults with cerebral palsy. JAMA. 2015;314(21):2303–2305. doi:10.1001/jama.2015.11025 (PMID 26624831).
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    US Medical Expenditure Panel Survey: adults with cerebral palsy had higher age-adjusted rates of diabetes (9.2% vs. 6.3%), asthma (20.7% vs. 9.4%), hypertension (30.0% vs. 22.1%), other heart conditions, stroke, emphysema, “joint pain (43.6% vs. 28.0%), and arthritis (31.4% vs. 17.4%)”; “A large percentage of individuals who were once mobile eventually stop ambulating, due to fatigue, inefficiency of gait, and/or muscle and joint pain.”
37. Blair E, Langdon K, McIntyre S, Lawrence D, Watson L. Survival and mortality in cerebral palsy: observations to the sixth decade from a data linkage study of a total population register and National Death Index. BMC Neurology. 2019;19(1):111. doi:10.1186/s12883-019-1343-1 (PMID 31164086).
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    Western Australian register: “For 22% of individuals with cerebral palsy with mild impairment survival to 58 years is similar to that of the general population”; “Mortality increased with increasing severity of impairment”; of deaths with a known cause, “58.6% were attributed to respiratory causes, including 171 (49%) to pneumonia”, 45% of which were attributed to aspiration; “Since 1990 mortality for those with severe cerebral palsy in Western Australia has tended to shift from childhood to early adulthood.”
38. White PH, Cooley WC; Transitions Clinical Report Authoring Group; American Academy of Pediatrics; American Academy of Family Physicians; American College of Physicians. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2018;142(5):e20182587. doi:10.1542/peds.2018-2587 (PMID 30348754).
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    Clinical report giving “guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults.”
39. Code of Federal Regulations, 34 CFR §300.8, Child with a disability (IDEA). Checked October 6, 2026.
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    “Orthopedic impairment means a severe orthopedic impairment that adversely affects a child's educational performance”, including impairments “from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures)”; a child who “only needs a related service and not special education” is not a child with a disability under the part, unless the related service counts as special education under State standards. Text as published in the eCFR (up to date as of October 5, 2026).
40. Code of Federal Regulations, 34 CFR §300.101, Free appropriate public education. Checked October 6, 2026.
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    “A free appropriate public education must be available to all children residing in the State between the ages of 3 and 21, inclusive”, beginning “no later than the child's third birthday”. Text as published in the eCFR (up to date as of October 5, 2026).
41. Code of Federal Regulations, 34 CFR §300.34, Related services. Related services “includes speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy”. Text as published in the eCFR (up to date as of October 5, 2026). Checked October 6, 2026.
42. Code of Federal Regulations, 34 CFR §104.3, Definitions (Section 504 of the Rehabilitation Act). Checked October 6, 2026.
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    The regulation’s term is “handicapped person”: one who “has a physical or mental impairment which substantially limits one or more major life activities”; “Major life activities means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.” Text as published in the eCFR (up to date as of October 5, 2026).
43. Centers for Medicare & Medicaid Services. Early and periodic screening, diagnostic, and treatment (Medicaid.gov). Checked October 6, 2026.
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    EPSDT “provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid”; states must provide medically necessary 1905(a) services “regardless of whether the service is covered in a state's Medicaid plan”; “It is the responsibility of states to determine medical necessity on a case-by-case basis.”
44. Centers for Medicare & Medicaid Services. Implementation guide: Medicaid state plan eligibility, children under age 19 with a disability (PDF). Checked October 6, 2026.
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    “The Children under Age 19 with a Disability group is an optional eligibility group”, for children “who would be eligible for Medicaid if they were living in an institution”; it “is often called the Katie Beckett group”; “an applicant’s financial eligibility is evaluated without regard to the income or resources of a parent”.
45. Code of Federal Regulations, 20 CFR §416.906, Basic definition of disability for children (Supplemental Security Income). Checked October 6, 2026.
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    A child under 18 is disabled if an impairment “causes marked and severe functional limitations” and “can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months”. Text as published in the eCFR (up to date as of October 5, 2026).
46. Social Security Administration, Listing of Impairments, part B (childhood), 20 CFR part 404, subpart P, appendix 1, 111.00 Neurological disorders. Checked October 6, 2026.
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    “111.07 Cerebral palsy, characterized by disorganization of motor function in two extremities”, resulting in “an extreme limitation” in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities; a neurological disorder that affects physical and mental functioning is evaluated under “the rules we use to determine functional equivalence”. Text as published in the eCFR (up to date as of October 5, 2026).
47. HealthCare.gov (Centers for Medicare & Medicaid Services). What Marketplace health insurance plans cover. Checked October 6, 2026.
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    “All plans offered in the Marketplace cover these 10 essential health benefits”, including “Rehabilitative and habilitative services and devices”; “Specific services covered in each broad benefit category can vary based on your state’s requirements”; large employers who self-insure “don’t have to provide essential health benefits.”
48. HealthCare.gov. Habilitative/habilitation services (glossary). Services “that help you keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age”, which “may include physical and occupational therapy, speech-language pathology.” Checked October 6, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. It is not a substitute for evaluation by a clinician who knows your child. If your child has lost skills they previously had, contact their doctor promptly. Poison Control: 1-800-222-1222.