What is Cerebral Palsy?

If your child has cerebral palsy and needed neonatal intensive care or cooling after birth or neonatal complications, their cerebral palsy may have been caused by negligent maternity or medical care.

During pregnancy and childbirth, you trust your midwives and doctors to provide mother and baby with safe, skilled and competent care. When their care falls short of those standards, certain kinds of mistakes and delays can result in severe injury to the baby’s brain and lifelong disability from cerebral palsy.

If your child has suffered a birth injury or has been diagnosed with cerebral palsy, you may be feeling shocked, numb or overwhelmed with worry about what that means for their future. You may be struggling to obtain open and honest information about mistakes in their care from their hospital maternity or neonatal team, or from the NHS’s defence organisation, NHS Resolution. This can leave parents feeling guilty or responsible for their child’s injury but, in our experience, parental feelings of guilt are usually unjustified.

On this page you will find the answers to many of the questions that families have about cerebral palsy from birth injury: how it happens, what it means, and when you should seek help.

Our birth injury solicitors have helped countless families of children with cerebral palsy from negligent birth injury to understand how their injury occurred. We understand the causes and lifelong impact of cerebral palsy on a child and their family. We can help you answer your questions with advice from trusted, independent medical experts, and secure the compensation and practical support that your baby deserves. If you would like to find out more about your baby’s cerebral palsy birth injury, and what that means for your baby and family, or you have been contacted by MNSI or NHS Resolution, contact us to talk, free and confidentially, to one of our experienced birth injury solicitors.

Cerebral palsy is a neurological condition which affects muscle coordination and movement. You may also have heard it described as a motor disorder.

Cerebral palsy is caused by damage to the brain which occurs around the time of birth (perinatally), such as during pregnancy, labour and delivery or in the neonatal (newborn) period soon after birth.

Cerebral palsy brain injury is non-progressive, but as your child grows and develops, their disability and its effect on their muscles and ways of moving may become more apparent or change over time. A formal diagnosis of cerebral palsy may not be made for several months or even years following birth, depending on the severity of the symptoms.

Each child with cerebral palsy has their own individual ‘presentation’ or unique set of cerebral palsy disabilities, which reflect the timing, duration, location and level of injury to their brain. The severity of their movement disability from cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). GMFCS is an age-adjusted system for describing the individual’s level of mobility and ability to use wheelchairs and other mobility aids, on a scale from Level 1 (most able) to Level 5 (most severely disabled). Other scales and systems may also be used to assess their ability to participate in activities at home, at school or in the community.

In addition to their movement disability, children with cerebral palsy from brain injury sometimes have additional health concerns and disabilities, such as epilepsy, visual or hearing impairment, language and communication and learning disabilities.

What are the types of cerebral palsy?

You may have heard words such as ‘dyskinetic’, ‘dystonic’, ‘spastic’ or ‘ataxic’ used to describe different types of cerebral palsy. These describe the type of movement difficulty experienced by the child, depending on which part of their brain has been injured. Children can have a mixture of these types of cerebral palsy, or have cerebral palsy disability which mostly falls under one pattern of injury with additional features of another type.

The most common types of cerebral palsy are:

Spastic cerebral palsy

Spastic cerebral palsy is the most common type of cerebral palsy. ‘Spastic’ muscles are stiff and tight, with too much muscle tone (hypertonia). This makes it difficult to move and reduces the child’s range of movement.

Children with spastic cerebral palsy have difficulty with movement, such as:

contractures (permanent shortening of muscles or tightening of joints), restricting extension of their joints;
abnormal reflexes;
altered gait (way of walking);
exaggerated movements;
walking on tip-toes.

Cerebral palsy disability from muscle spasticity is caused by an injury to the motor cortex of the brain. Children with spastic cerebral palsy can also have other types of disability arising from their brain injury, such as learning disability.

Examples of birth or neonatal injury claims for spastic cerebral palsy brain injury include:

delayed delivery of a baby with chronic partial hypoxia (HIE) (a long period of reduced oxygen) during labour;
delayed delivery of a baby at risk of brain injury from intrauterine infection, chorioamnionitis, or premature and/or preterm rupture of the membranes (PROM/PPROM);
traumatic brain injury during delivery;
kernicterus brain injury from failure to treat neonatal jaundice.

Dyskinetic cerebral palsy

Dyskinetic cerebral palsy is the second most common type of cerebral palsy. It is also known as athetoid cerebral palsy.

Dyskinesia refers to involuntary muscle movements but you may have also heard other words used to describe features of your child’s dyskinetic cerebral palsy, such as:

athetosis or athetoid, meaning slow writhing movements;
chorea, meaning movements which are dance-like, fast or repetitive;
choreoathetosis or choreoathetoid, a combination of sudden spasms, fast twitching movements (chorea) and slow (athetoid) movements;
dystonia or dystonic, meaning slow, twisting movements of the limbs or torso;
rigidity, or restricted ability to move.

Children with dyskinetic cerebral palsy have involuntary, random movements or spasms, which they are unable to control, as their muscle tone fluctuates between stiffness and floppiness. These involuntary movements affect their ability to carry out simple, everyday activities, such as getting dressed. Their difficulties with coordination also impair their ability to communicate, affecting their ability to interact with the world around them, which can lead to learning difficulties even for those who have retained intellect and cognition (thinking).

Dyskinetic cerebral palsy is caused by injury to the basal ganglia, thalamus and cerebellum areas of the brain.

Examples of birth and neonatal injury claims involving dyskinetic cerebral palsy include:

HIE birth injury, (fetal heart rate monitoring (CTG or IA) mistakes, delayed delivery);
delayed neonatal resuscitation;
Syntocinon, VBAC and hyperstimulation errors;
kernicterus brain injury from failure to treat neonatal jaundice.

Ataxic cerebral palsy

Ataxic cerebral palsy is less common than spastic, dyskinetic or athetoid cerebral palsy. Ataxic cerebral palsy or ataxia affects balance and coordination, causing shaky or clumsy movements and tremors.

Children with ataxic cerebral palsy have difficulty coordinating fine muscle movements which can affect their posture, balance, walking and communication. They may have:

difficulty with walking and balance;
problems with accurately perceiving depth;
impaired speech;
tremors;
difficulties with grasping and holding objects.

Ataxia is caused by damage to the cerebellum, the part of your child’s brain that regulates movement and coordination.

Examples of birth and neonatal injury claims involving ataxic cerebral palsy include:

injury to the brain from infection;
traumatic brain injury;
stroke, from brain bleeding or ischaemia.

Quadriplegic, diplegic and hemiplegic cerebral palsy

You may also hear your child’s cerebral palsy described in a way that identifies not only the type of cerebral palsy, but also which parts of their body are affected. For example, a child whose whole body is affected by spastic cerebral palsy might be described as having ‘ spastic quadriplegia’, or ‘whole body spastic cerebral palsy’.

The most commonly-used terms to describe which parts of the body are affected by cerebral palsy disability are:

‘four-limb’, ‘whole body’ or ‘quadriplegic/ quadriplegia’ affecting the whole body, and control of the head, torso, facial muscles (and mouth);
‘bilateral’ – affecting both sides of the body;
‘hemiplegic/hemiplegia’ – affecting one side of the body;
‘diplegic/ diplegia’ – mainly affecting the legs.

Understanding the type or features of your child’s cerebral palsy disability can help identify its cause, but this takes specialist expertise. Our highly experienced cerebral palsy solicitors work with a multidisciplinary team of medical experts, including obstetricians, midwives, neonatologists, paediatricians, neurologists and neuroradiologists, who help us identify the cause of your child’s cerebral palsy and advise on how the condition will affect them in future.

What disability is caused by cerebral palsy?

If your child has cerebral palsy, they may experience one or more of a range of physical effects from their brain injury. The type and combination of these effects will determine their disability and its impact on the different areas of their life.

Cerebral palsy is non-progressive. This means that the severity of the child’s condition stays constant but the full extent and impact of their disability may only become apparent at later stages of their growth and development.

Children with cerebral palsy often experience physical disability, such as:

delay in reaching developmental milestones, such as sitting or walking;
muscle tone which is too weak or too tight/stiff;
weakness in limbs (arms, legs, hands);
movements which are uncontrolled, clumsy or jerky;
walking on tip-toes;
swallowing difficulties;
problems with speech.

Your child’s difficulties with muscle control and coordination, muscle tone, reflexes, posture and balance may affect their mobility, dexterity, feeding, communication and independence.

Cerebral palsy is primarily a motor (muscle movement) disorder, and many children with cerebral palsy retain their cognitive (thinking) and intellectual abilities. With support, they are able to study at school, college or university and then go on to work. However, for some, the severe brain injury which caused their cerebral palsy can also result in cortical blindness, epilepsy, severe learning disability and/or a total inability to communicate.

Can medical negligence cause cerebral palsy?

Medical negligence in the care that the mother and baby receive before, during and after birth can cause cerebral palsy. Negligent medical care can also significantly worsen or contribute to a baby’s unavoidable brain injury, resulting in additional or more severe disability.

If your child has cerebral palsy, or needed neonatal intensive care for brain injury after a difficult or complicated birth, our legal and medical experts can help you understand the cause of their condition. If their cerebral palsy disability was caused by negligent maternity or neonatal medical care, we can help you ensure that their lifelong needs arising from their disability will be met by claiming the compensation they deserve for their injury.

If you are contacted by MNSI or NHS Resolution after your baby’s birth injury, we advise you to seek independent legal advice from our claimant (acting for the patient) specialist birth injury solicitors straight away. It is important that you understand that NHS Resolution is the NHS’s legal defence team. Their primary purpose in investigating the cause of your child’s birth injury will be to defend the NHS from any potential medical negligence claim and reduce the amount of compensation that the NHS has to pay. They cannot independently advise you about the cause of your child’s injury.

NHS Resolution does NOT provide an early or easy route to compensation for birth injury for families who do not have their own legal representation. In fact, the vast majority of the cerebral palsy birth injury claims in which we have secured life-changing compensation settlements for our clients began with NHS Resolution denying that medical negligence caused the child’s injury.

What are the most common cerebral palsy compensation claims?

There are many ways in which negligent antenatal, maternity or neonatal care can cause a cerebral palsy birth injury, but the following types of birth or neonatal injury commonly feature in successful cerebral palsy claims.

Hypoxic ischaemic encephalopathy (HIE)

HIE birth injury can be caused by an acute episode of oxygen deprivation (hypoxia) in the minutes immediately before, during or immediately after birth, or a longer period of chronic partial hypoxia during pregnancy and labour, or a combination of both.

HIE cerebral palsy claims commonly involve:

fetal heart rate monitoring (CTG or IA) failures, errors or misinterpretation;
delayed delivery of a baby who is not getting enough oxygen during labour (fetal distress);
delayed delivery of a baby who is at risk of HIE injury owing to:
- maternal pre-eclampsia or hypertension (high blood pressure);
- intrauterine growth restriction (IUGR);
- conditions affecting the placenta or amniotic fluid;
uterine hyperstimulation or rupture (Syntocinon or VBAC errors);
errors or delays in resuscitation;
meconium aspiration;
cooling delays or errors.

Read more about HIE birth injury claims.

Obstructed labour and traumatic injury

Cerebral palsy birth injury claims also commonly arise after a baby’s brain suffers traumatic injury caused by excessive force, poor delivery technique or negligent response to an obstructed labour. Cerebral palsy claims for traumatic birth injury or obstructed labour often involve:

impacted fetal head (IFH);

shoulder dystocia or large baby (maternal diabetes);
breech birth or delivery of twins;
forceps injuries (excessive force, poor technique).

Infection

Cerebral palsy claims also arise from brain injury caused by negligent antenatal, intrapartum (during birth) and neonatal management of infection, such as:

maternal GBS infection;
premature or prolonged rupture of membranes (PROM/PPROM) and chorioamnionitis;
neonatal meningitis or encephalitis;
delayed diagnosis and treatment of neonatal infection (GBS, HSV).

Read more about neonatal infection birth injury claims.

Complications of twin pregnancy

Cerebral palsy claims can involve negligent management of twin pregnancies and their complications, such as:

twin-to-twin transfusion syndrome (TTTS);
vaginal delivery of twins and breech birth;
delayed delivery of the second twin.

Read more about twin pregnancy birth injury claims.

Neonatal brain injury

Cerebral palsy claims often relate to brain injury caused by negligent neonatal care of a newborn baby. Common cerebral palsy claims involving neonatal brain injury include claims arising from:

kernicterus brain injury caused by negligent treatment of neonatal jaundice;
neonatal hypoglycaemia;
neonatal infection;
hypocarbia;
vitamin K deficiency bleeding (VKDB).

Read more about neonatal brain injury claims.

Valproate injury

Cerebral palsy claims can also arise from medication errors involving negligent prescription of the anti-epileptic drug, sodium valproate which, if given to a pregnant mother, can cause cerebral palsy and other forms of severe disability to the unborn child.

Read more about valproate injury claims.

What is the treatment for cerebral palsy?

Cerebral palsy is a non-progressive but permanent condition. The full extent of the child’s cerebral palsy disability and its impact on their life will usually become more apparent over time as the child grows and develops.

The best known ‘treatment’ for birth injury which could result in cerebral palsy disability is cooling, but this is a preventative measure that is used to limit further damage to the brain of a baby who is known to be suffering from hypoxic brain injury. Where a baby is born with hypoxic ischaemic encephalopathy (HIE), their expected gross motor disability (physical disability affecting their movement) can often be significantly reduced or prevented by specialist neonatal intensive care treatment with cooling.

Read more about neonatal cooling after HIE birth injury.

If your child has a diagnosis of cerebral palsy, their health and development will be overseen by their paediatrician with input from a multi-disciplinary team of other medical specialists, as needed.

Your child’s disability should also be managed with regular therapies which help them maximise their mobility, independence and ability to interact with the people, technologies and opportunities that surround them.

Based on our experience of working with medical experts, therapists and the families of children with cerebral palsy disability, we usually recommend that the child will benefit from regular support from the following types of therapy:

physiotherapy – using exercises, stretching and positioning, as well as supportive equipment, to maximise your child’s physical movement, posture and function;
occupational therapy (OT) – using strategies, equipment and adaptations to increase your child’s independence at home, school and in other environments;
speech and language therapy (SALT) – to support safe feeding and maximise your child’s ability to communicate;
hydrotherapy – to reduce muscle stiffness and improve muscle control and movement;
neuropsychology – to provide behavioural, emotional support and strategies to support learning .

In addition, our experts usually recommend that the family is supported in meeting their child’s additional needs, such as for:

help or support with care;
home adaptations or a move to a more suitable home;
adapted vehicles, wheelchairs and specialist equipment;
assistive technology and IT;
support with special educational needs (SEN).

We carry out a full assessment of your child’s needs, based on the advice from our trusted team of medical experts and therapists, to ensure that the costs of meeting your child’s lifelong needs arising from their disability are included in their cerebral palsy claim. In most cases, as soon as we have secured an admission of liability (responsibility) for their injury, we are able to secure substantial interim payments to begin meeting these needs, long before we reach final settlement of their claim.

Read more about care in cerebral palsy claims.

Read more about compensation in cerebral palsy claims.