Cerebral Palsy

• Treatment customized for your child

  Every child with CP is different. We follow best available evidence and established guidelines and customize care to help your child and family manage CP and give your child the best possible function and quality of life now and as they grow.

  Seattle Children’s provides a full range of treatments including: medicines, orthotics, surgery, and occupational, physical and speech therapies.

• Your child and family get support

  We offer several groups at Seattle Children’s to support families and caregivers of children with CP and other special health and developmental needs. For a complete list of those support groups, please visit our patient and family resources.

Sometimes it is obvious from birth that a child has CP but, in many cases, it is not. There are certain risk factors for CP that help providers make a diagnosis. However, sometimes you or your child’s doctor may only become concerned about CP when developmental milestones are delayed or missed.

• Causes of CP

  CP occurs when the developing brain experiences an injury that does not get worse over time and cannot be cured. This can happen because of:

  • Bleeding in the brain before, during or after birth
  • Traumatic brain injury
  • Lack of oxygen to the brain
  • Lack of blood supply to the brain (stroke)
  • Seizures
  • Infections of the brain or spinal fluid
  • Certain genetic conditions
• Risk factors for CP

  A risk factor is something that makes you more likely to develop CP. Risk factors for CP include:

  • Early (preterm) birth and low birth weight (less than 5.5 pounds)
  • Pregnancy and birth complications (such as lack of oxygen to the brain)
  • Stroke before, during or after birth
  • Mothers with serious health concerns including blood disorders, seizure disorders and infections (viral or bacterial)
  • Exposure to harmful substances during pregnancy
• Early signs of CP

  Missing or delayed development of milestones can be a sign of CP. You may notice your baby is slow to reach certain developmental milestones, including:

  • Rolling over
  • Sitting up
  • Crawling
  • Walking
  • Grabbing onto toys
  • Talking

  Babies with CP may also have trouble feeding, swallowing, hearing or seeing.

• How CP affects a child’s body and abilities

  There are 3 main ways to classify CP:

  1. Area of the body affected (topography) (PDF) (Spanish)
  2. Atypical body movements and postures (movement disorder) (PDF) (Spanish)
  3. How they use their body to get around (gross motor function or functional mobility, GMFCS). All flyers are PDFs.
     • GMFCS – Level 1 (Spanish)
     • GMFCS – Level 2 (Spanish)
     • GMFCS – Level 3 (Spanish)
     • GMFCS – Level 4 (Spanish)
     • GMFCS – Level 5 (Spanish)

  The handouts above detail how to describe your child’s condition. It is important to know how your child’s CP is classified and what other related conditions they have (if any) to help determine medical treatment and therapy for your child.

• Imaging studies

  The doctor may schedule imaging studies to help rule out other disorders and look for brain changes that are typical of CP. These tests include:

  • CT (computed tomography) scan to look for bleeding, fracture or signs of high pressure in the brain.
  • MRI (magnetic resonance imaging) to look for areas of damage in the brain.
  • Cranial ultrasound to show the brain’s structure. It is often used with babies born early because it is easier on the baby than other tests.
• Evaluation by specialists

  After testing, your child’s doctor may ask you to see specialists who can help confirm a diagnosis of CP and plan your child’s treatment.

  At Seattle Children’s, we have specialists who can address all of your child’s needs. These may include doctors who specialize in:

  • The central nervous system (neurologist)
  • How the nervous system develops (neurodevelopmental pediatrician)
  • Eyes (ophthalmologist)
  • Ears (otologist)
  • Helping children improve their function (rehabilitation medicine physician)

Neurosurgery may be an option if your child needs more relief from spasticity or dystonia than they can get with nonsurgical treatments.

The Tone Management Program evaluates and treats children with spasticity who might benefit from neurosurgery. Our Rehabilitation Medicine and Neurosurgery teams work together to understand your child’s needs and to plan and provide their care. This includes planning the therapy they will need after surgery.

Neurosurgeons at Seattle Children’s do 2 surgeries to lessen spasticity in children with CP:

• Baclofen pump surgery

  During this surgery, the neurosurgeon places a pump (about the size of the palm of an adult’s hand) under the skin in your child’s belly (abdomen). The pump constantly delivers a small amount of a medicine called baclofen into the fluid around your child’s spine.

  Baclofen relaxes muscles and reduces spasticity and dystonia throughout your child’s body. Since the medicine goes straight into your child’s spinal fluid, your child can have a much lower dose than if they took baclofen by mouth. A lower dose reduces side effects, such as feeling too relaxed or sleepy. It also works better than baclofen by mouth.

  Before putting in the pump, we check to make sure baclofen is the right medicine for your child. We use a needle to inject a test dose of baclofen into your child’s spinal canal (lumbar puncture). A rehabilitation medicine physician (and sometimes a physical therapist) then watch for several hours to see how the medicine affects your child’s body. Not every child needs to have a baclofen test dose. Some children may be cleared by the team to skip this step.

  If you and your child’s care team agree that your child can benefit from a baclofen pump, the neurosurgeon will:

  • Do the surgery to put the pump under the skin of your child’s belly;
  • Attach a thin tube (catheter) to the pump;
  • Thread the catheter under the skin at waist level to your child’s spine and insert the catheter into the spinal canal; and
  • Fill the pump with baclofen and set it to deliver the medicine.

  The pump will slowly begin releasing the medicine through the tube and into the spinal canal. The dose of baclofen will be slowly increased to the right dose for your child. The baclofen pump must be filled with medicine every 1 to 6 months, depending on your child’s dose. You can refill it at Seattle Children’s Rehabilitation Medicine or at another medical facility. A baclofen pump lasts about 6 to 7 years before needing to be replaced during another surgery.

  Learn more about the Intrathecal Baclofen (ITB) Pump Implant (PDF) and the Intrathecal Baclofen (ITB) Test Dose (PDF) (Spanish).

• Selective dorsal rhizotomy

  Selective dorsal rhizotomy (SDR) is a surgery done on the nerves exiting the lower spinal cord to reduce spasticity in the legs. The neurosurgeon finds those nerves and cuts part of them.

  The goal of SDR is to relax the muscles by finding and cutting the nerves that are causing spasticity. This can improve your child’s ability to move and their quality of movement.

  Our team of providers, surgeons and therapists (physical and occupational) will carefully screen your child, talk with you and get input from your child’s community therapist to decide if this surgery might help your child.

  After SDR, we provide intensive inpatient rehabilitation. We then work with you and your child’s therapists to transition to outpatient therapy to improve your child’s ability to move and control their muscles.

  Learn more about SDR.

Some children with CP may need surgery to: 

• Release muscles, tendonsand ligaments that keep their joints from moving (contractures)
• Prevent contractures from getting worse
• Change the shape of bones deformed by contractures
• Align bones to improve the child’s function, comfort or position, such as how they sit in a wheelchair

The Ortho Rehab Clinic brings together orthopedic surgeons, orthotists, physical therapists and rehabilitation medicine providers to evaluate your child and decide whether orthopedic surgery may be helpful along with medicine, therapy, bracing and other treatment options.

Seattle Children’s provides a full range of orthopedic surgeries for children with CP, including:

• Hand and arm surgery

  Surgery may be an option if daily activities like getting dressed or writing are challenging for your child since CP affects their hands and arms. Orthopedic and plastic surgeons and occupational therapists work as a team in our Hand and Upper Extremity Program to help children with CP use their hands and arms better. This may involve surgeons releasing muscles, tendons and ligaments in your child’s hand and arm to change their hand position, making daily activities easier.

• Hip surgery

  High tone in some muscles and lower tone in other muscles may lead to hip problems that cause pain or make it hard to move or sit. The ball of the hip joint may be loose in the hip socket or come out of the hip socket. Our orthopedic surgeons offer surgeries to reshape and realign where the leg bone meets the hip bone to make your child more comfortable, help with moving or sitting, and keep hip problems from getting worse.

• Single-event multilevel surgery

  If your child has several contractures or deformed bones, such as in their hips, knees, ankles or feet, they may benefit from having surgery to address many or all of these concerns at once. This approach is called single-event multilevel surgery (SEMLS) (PDF) (Arabic) (Chinese) (Russian) (Spanish).

  Our teams in Orthopedics and Sports Medicine, Physical Therapy and Rehabilitation Medicine work together to develop a detailed surgical plan that is right for your child. We map out every part of your child’s surgery as well as the physical therapy, occupational therapy and other care your child will need after surgery to get the best results. Some children stay in our inpatient rehabilitation unit for intensive therapy after SEMLS.

• Spine surgery

  Children with CP often develop a curve in their spine called scoliosis. If the scoliosis is severe, our orthopedic surgeons may offer surgery to stop the curve from getting worse. We may recommend spinal surgery to make sitting easier if your child develops a curve that makes it hard for them to sit in their wheelchair. Read more about scoliosis treatment.