Sign and Symptoms of Cerebral Palsy in Infants

Cerebral palsy, as the name indicates, is paralysis caused by the damaged brain. But the sign and symptoms of cerebral palsy in infants may vary greatly depending on the type and severity of the lesion in the brain. It is not always full-blown paralysis. The brain damage, although it is non-progressive but the clinical sign and symptoms of cerebral palsy in infants can progress with time. But if treated early, the life of more than 80% children can be independent and productive.

Recent advances have significantly increased the survival of LBW & premature infants. Premature children are more susceptible to brain injury, so we have a larger number of children having neurological developmental delay, and they develop full-blown cerebral palsy. Therefore, it is very important to detect it at the earliest and treat it with the right combination of cerebral palsy treatment.

A newly born cerebral palsy baby with any unwanted event in prenatal, perinatal, and postnatal life, like intrauterine infection, fetal distress, congenital brain anomalies, birth asphyxia, low birth weight, prematurity, severe jaundice, etc., leads to a high risk of manifesting symptoms of cerebral palsy.

Management of high risk of cerebral palsy must begin as soon as the injury is recognized in the cerebral palsy newborn nursery during the first week of life and should continue up to 1year. Symptoms for developing cerebral palsy can include lethargy, refusal to feed (eating, sucking, swallowing), low muscle tone, seizures, abdominal distension or lack of alertness it can be a sign.

We should also check for normal reflexes according to age and other normal developmental milestones. Abnormal reflexes can give an early indication of abnormality.  Delay in developmental milestones can be very easily identified and must not be ignored.

Early intervention can not only prevent the advancement of the condition but also make the child independent in the future. For this, high-risk cerebral palsy babies must be identified at the earliest and should be provided with remedial measures to lessen the handicaps. A simple home-based stimulation program is effective. Neuro-developmental treatment normalizes the muscle tone by inhibiting pathologic tonic reflex activity and repetitive facilitation of normal postural reflexes.

Goals are to educate mothers in handling, positioning, and daily living activities, to maintain muscle strength, and to improve sensation in order to improve milestones. The mother is the best therapist since she is handling the child all day through; the only thing that she must be trained properly for handling the problems of her own child by a trained therapist.

The role of the therapist is to assess the present neurological status and provisional future disability, provide overall sensory motor stimulation, follow-up assessment, home-based cerebral palsy therapy program, and parents’ counseling.  It is better if the detection and management start in the ICU itself in high-risk cerebral palsy infants.

Intervention: Correct positioning is very important for neurodevelopmental outcomes; a baby should be with the mother in accordance with the kangaroo mother care. Any process that involves touching should be gentle, and tone management should be done according to the type, viz. Hypotonia, Hypertonia, Dystonia, along with general NICU care.

Sensory stimulation such as  Proprioceptive, vestibular, visual stimulation,  auditory stimulation, Chest & respiratory stimulation, and Oromotor function should be given as per requirement. Follow-up should be done at two months and after 6 months.