Clinical update

Cerebral palsy

New guidelines published by National Institute for Health and Care Excellence (NICE) puts the focus on children affected by cerebral palsy. 

New guidelines published by National Institute for Health and Care Excellence (NICE) puts the focus on children affected by cerebral palsy.

One in 400 children in the UK is affected by cerebral palsy     Picture: iStock

Essential facts

Cerebral palsy, the term for several neurological conditions that affect movement and coordination, is the leading cause of physical disability in children and young people in the developed world. About one in 400 children in the UK is affected by the condition which can occur if the brain develops abnormally or is damaged before, during or shortly after birth.

What’s new

Diagnosis and treatment for children with cerebral palsy should be improved by the publication of new guidelines from the National Institute for Health and Care Excellence (NICE).

The new guidelines focus on the causes, early diagnosis and how to treat common comorbidities such as saliva control, pain, mental health and communication issues. Last year 192 of 209 clinical commissioning groups in England, responding to a survey by charity Action Cerebral Palsy, did not have specific care pathways for children and young people with the condition.

Signs and symptoms

Early motor features include unusual fidgety movements or abnormalities of movement and tone, including hypotonia (floppiness), spasticity (stiffness) or dystonia (fluctuating tone). Abnormal motor development, including late head control, rolling and crawling and feeding difficulties can also be signs.

Causes and risk factors

Premature birth, with risk increasing the earlier the child is born, chorioamnionitis (intra-amniotic infection), and respiratory tract or genitourinary infection in the mother can all cause cerebral palsy. Low birth weight, neonatal encephalopathy, neonatal sepsis – particularly with a birth weight below 1.5kg – and meningitis can also cause the condition.

How you can help your patient

Refer children who are at increased risk of developing cerebral palsy and who have any of the symptoms to a child development service for an urgent assessment.

Refer children with delayed motor milestones for further assessment. Some of the most common problems in children with cerebral palsy are not sitting by eight months, not walking by 18 months, or early asymmetry of hand function before one year – all ages should be corrected for gestational age.

Refer children who have persistent toe walking.

Expert comment

Liz Keenan, clinical nurse specialist for spasticity management at the National Hospital for Neurology and Neurosurgery, London

‘Cerebral palsy is a term that describes permanent, non-progressive abnormalities that develop in the fetal and neonatal brain, which can cause problems in movement and posture. Early diagnosis is vital for families and best management of the condition as the child develops.

‘Nurses should know the signs and symptoms so that children can be referred promptly for diagnosis, information and intervention. 

‘The guidance describes the developmental and comorbidities children and young people with cerebral palsy face and the importance of individual identification and tailored management.

‘Personal folders may help highlight individual social and health needs especially around a young person’s communication and learning care needs. The guidelines can help nurses to consider core nursing care and explain the challenges with feeding, particularly with saliva control, regurgitating, vomiting and constipation, sleep and emotional support.’

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