Synopsis
Recognise cerebral palsy early, define motor type and functional effect, investigate atypical progression and build a child-centred multidisciplinary plan for tone, pain, feeding, communication, hips and participation.
- Cerebral palsy describes permanent disorders of movement and posture caused by a non-progressive disturbance in the developing brain; the child's manifestations and musculoskeletal consequences can change over time.
- Classify the predominant motor pattern as spastic, dyskinetic, ataxic or mixed, then describe distribution, Gross Motor Function Classification System level and practical participation.
- Early warning signs include abnormal fidgety movements, persistent fisting, early asymmetry, delayed milestones, abnormal tone and hand preference before one year.
- MRI helps define timing and pattern when the cause is uncertain, but normal imaging does not exclude cerebral palsy; regression or progression demands reconsideration and often genetic or metabolic assessment.
- Management begins with family goals, physiotherapy, occupational therapy, communication access, pain identification, nutrition, hearing, vision and education rather than reducing tone as an isolated target.
- Before increasing tone treatment, look for pain, constipation, urinary retention, reflux, skin injury, poor seating and intercurrent infection that may be driving spasm or dystonia.
- NICE uses oral diazepam when a rapid effect is needed and oral baclofen when a sustained effect is desired for generalised spasticity causing pain, spasm or disability.
- Botulinum toxin type A is considered for focal spasticity impairing function, care, comfort or orthosis tolerance; combine it with goal-directed therapy and review effect.
- Hip surveillance is systematic and based on clinical and radiographic risk, not merely reported pain; reduced abduction and asymmetry should accelerate orthopaedic review.
- Assess swallowing and nutrition actively, offer augmentative communication early and plan transition before adolescence rather than waiting for paediatric services to end.
Key red flags
Loss of acquired skills, steadily progressive weakness, new sensory loss or increasing ataxia is inconsistent with the non-progressive brain disturbance defining cerebral palsy and requires diagnostic review.
Persistent feeding cough, recurrent chest infection, wet voice, prolonged meals or faltering growth suggests dysphagia and aspiration risk.
Pain, reduced hip abduction, asymmetric posture, difficulty with hygiene or declining transfers can indicate hip migration or dislocation before a child can localise pain.
Rapid worsening of generalised dystonia with fever, dehydration, pain or medicine withdrawal may evolve into life-threatening status dystonicus.
Early hand preference before 12 months, fisting, asymmetric movement, persistent primitive reflexes or delayed sitting and walking should trigger developmental assessment.
Constipation, urinary retention, reflux, dental pain, fracture and poor sleep commonly worsen tone; exclude these triggers before escalating antispastic medicines.
Investigation priorities
Define motor type, distribution, functional level, associated impairment and family priorities.
Management branches
An infant or child shows asymmetry, abnormal tone or delayed motor development.
- Refer for developmental and neurological assessment without waiting for a definitive label.
- Arrange early therapy, hearing, vision and communication support while investigations proceed.
- Use MRI and phenotype-led genetics when history and examination leave cause uncertain.