The following are common risk factors for developing cerebral palsy. The presence of one or more risk factors does not ensure a child will develop cerebral palsy; it means chances are higher than if that risk factor was not present. Likewise, the absence of risk factors does not ensure that a child will not develop cerebral palsy. Risk factors merely identify possible cause for concern.
Avoiding risk factors will help prevent a child from developing cerebral palsy; any exposure to risk factors prior to conception and during pregnancy should be discussed with a doctor in order to effectively treat and manage risk. This list is not meant to be all-inclusive; other risk factors may contribute to the development of cerebral palsy, as well.
What is a Risk Factor?
Cerebral palsy risk factors are events, substances or circumstances that increase the chances of a child developing cerebral palsy. Events that create a greater risk for a child to develop cerebral palsy include accidents, traumatic brain injury, medical malpractice, and shaken-baby syndrome. Events could also include infections, complicated birth, maternal seizures, inflammation and improperly managed chronic health conditions. Risks can be avoidable, or unavoidable.
A mother’s intake of or exposure to toxins from cigarette smoke, illegal drugs, pesticides, hair dye, and even the use of some prescription medications during pregnancy can increase the likelihood that a child conceived later will develop cerebral palsy. An expectant mother’s exposure to illnesses such as Rubella or the chicken pox virus also place the fetus at risk for developing cerebral palsy.
Parental health and habits are known contributing risk factors. For example, parents younger than 18 or older than 34 are more likely to have a child with cerebral palsy. Mothers with eating disorders that aren’t managed properly during pregnancy can contribute risk.
A risk factor does not ensure a child will develop cerebral palsy; it means chances are higher than if that risk factor was not present. Likewise, the absence of risk factors does not ensure that a child will not develop cerebral palsy.
Cerebral palsy risk factors are often confused with signs, symptoms or causes of cerebral palsy; they are different. To clarify, risk factors increase the odds of cerebral palsy occurring. They effect the causal pathway that leads to brain injury or brain malformation. Symptoms, on the other hand, are the experiences of the individual, which may indicate a condition exists, and signs are clinical proof of the condition. The cause of cerebral palsy is one of four types of brain damage:
- Periventricular Leukomalacia (PVL) – damage to white matter tissue in the brain
- Cerebral Dysgenesis - brain malformation or abnormal brain eevelopment
- Intracranial Hemorrhage (IVH) – brain hemorrhage
- Hypoxic-Ischemic Encephalopathy (HIE) or Intrapartum Asphyxia – lack of oxygen to the brain or asphyxia
Although risk factors increase chances of a child developing cerebral palsy, the likelihood is still low. Approximately two to four in every 1,000 infants develop cerebral palsy in the United States. Even when risk factors are present, the probability of a child developing cerebral palsy is low.
What is a Risk Factor Causal Pathway?
Recent research suggests that a combination of risk factors — possibly occurring at just the right time in just the right order — may create a significant correlation toward the development of cerebral palsy. This concept is called a “causal pathway.”
No single casual pathway is known to result in cerebral palsy. Instead, it is thought that certain risk factors magnify or lead to other risks. Doctors and researchers are working to understand how each risk factor affects others.
A possible, hypothetical example of a causal pathway might occur like this: A mother may be exposed to a certain toxin, which causes slight mutations in some of the genes thought to influence cerebral palsy. This does not cause cerebral palsy, but later, the genetic mutation makes the growing fetus vulnerable to other risk factors. If infection sets in later in development, the body’s response is inflammation and production of cytokines. These are thought to decrease a fetal tolerance to oxygen deprivation. During delivery, the fetus presents with a prolapsed cord that momentarily causes asphyxiation. The exposure to environmental risk factors, and asphyxiation can, together or separately, lead to brain injury or malformation that results in cerebral palsy. This is an example of a causal pathway to cerebral palsy.
Another example of causal pathways is when a mother who has had troubled pregnancies, and infact had one live stillbirth, may consult a fertility expert for assistance in getting pregnant. The doctor prescribes infertility treatments that lead to multiple pregnancies. The babies are born with low birth weight and premature. In this example, prior complicated pregnancy, infertility, multiple births, low birth weight and premature birth are all risk factors that individually, or together, pose an increased risk of the child developing cerebral palsy.
Most babies are born healthy and remain healthy despite the presence of many risk factors. The goal is to eliminate or reduce exposure to risk factors whenever possible.
Couples considering pregnancy are urged to see their appropriate health care providers for pre-conception counseling. If the couple is without the luxury of pre-planning their pregnancy, the mother is urged to seek an appointment with the OB/GYN as soon as pregnancy is suspected. An OB/GYN will assess risks, obtain the mother and the father’s medical history, begin the mother on appropriate prenatal care regimin, and monitor the pregnancy to provide the baby with the best possible outcome. During pregnancy it is very important to inform the OB/GYN of any and all exposure to risk factors.
Steps to Take to Avoid and Address Risk Factors
Risk factors merit awareness before conception, during pregnancy and even following delivery. Many experts recommend visiting with a doctor before becoming pregnant to assess reproductive health. A complete assessment will include questions about social habits, medical history, and other factors that may influence pregnancy.
Likewise, a person who is already pregnant may want to become familiar with risk factors and inform her doctor of any exposure to prescription medications with your doctor, and make sure any health problems, such as diabetes, fevers, or infections are treated immediately.
Hair dye, kitty litter, cleaning solutions and lawn and garden products are just a few of the potentially harmful household products. A physician will also need to know about any use of dietary supplements, homeopathic treatments or prescription drugs.
Blood tests should be administered to prevent any ABO or RH blood incompatibilities. An expectant mother should avoid exposure to known toxins – such as pesticides and poisons, cigarette smoke, alcohol and other recreational drugs.
Likewise, events that cause any sort of asphyxia, such as respiratory distress syndrome or medical negligence, are significant risk factors. Seizures, infections (like meningitis and malaria), hypoglycemia, hypothyroidism, and strokes can increase the chance of a child developing cerebral palsy.
Brain injury can occur at any time during the life of a child or adult, and therefore there are known risk factors to be aware of even after the brain is fully developed. Trauma is the leading cause of brain injury after birth.
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A Risk Factor is Not a Symptom or
Sign of Cerebral Palsy
Risk factors are not symptoms. Risk factors increase the likelihood that a child may develop cerebral palsy. However, symptoms are possible evidence that a child may have cerebral palsy.
One early sign of cerebral palsy is a developmental delay. Developmental delay indicates a child has not met the growth milestone established by the medical community and relevant to a his or her age and weight. This delay could be a symptom of cerebral palsy, another condition, or merely attributable to the child developing at a different rate than most other children.
Any signs should be addressed with the child’s doctor. Delayed development does not increase the chances of cerebral palsy, rather it is a sign that, when combined with other signs, causes concern that the child may have cerebral palsy.
A Risk Factor is Not a Cause of
Risk factors are not causes. While risk increases the chance of a child being born with Cerebral Palsy, cause is the action that resulted in development of cerebral palsy.
The cause of cerebral palsy is brain injury or brain malformation, which can usually be detected in MRIs or CT scans during the diagnostic process. Although the actual brain injury or malformation that led to cerebral palsy is identified, it is not always possible to determine a specific event that caused the injury or malformation.
For example, premature birth (before 37 weeks) is a significant risk factor, yet prematurity is not considered a cause of the brain damage that results in cerebral palsy. In fact, many babies are born premature and do not develop any differently than babies born at term. Premature birth does not cause cerebral palsy. However, parents and doctors should be aware that the likelihood of developing cerebral palsy increases when a child is born prematurely.
Risk factors increase the odds of cerebral palsy occurring. Symptoms are possible signs that a condition exists, and causes are the reason a child develops cerebral palsy.