What is Cerebral Palsy?

Cerebral palsy in children is also called cerebral palsy in children, commonly known as cerebral palsy. It refers to the syndrome that is mainly caused by non-progressive brain injury due to non-progressive brain injury within one month after birth. It is a common CNS syndrome in childhood. The lesions are in the brain and involve the limbs. They are often accompanied by mental retardation, epilepsy, behavioral abnormalities, mental disorders and visual, auditory, and speech disorders.

Basic Information

nickname: Cerebral palsy in children
English name: pediatric cerebral palsy
Visiting department: Pediatrics
Multiple groups: Children
Common locations: Brain involving limbs

Common causes: Parents smoking, drinking, drug abuse, mother suffering from mental illness, diabetes during pregnancy, vaginal bleeding, hypertension during pregnancy, etc.
Common symptoms: Soft body and reduced spontaneous movement, stiff body, unresponsiveness, abnormal head circumference, weak breastfeeding, unsmiling, holding fists, unstable head, strabismus, etc.

Causes of cerebral palsy in children

There are many causes of pediatric cerebral palsy, which can be summarized as follows: parents smoking, alcohol, drug abuse, maternal mental illness, diabetes during pregnancy, vaginal bleeding, hypertension during pregnancy, placenta previa, threatened abortion or taking contraceptives Medicines for treating infertility, birth-prevention drugs, etc .; high births, premature births, miscarriage history, twin or multiple births, delayed fetal development, intrauterine infection, intrauterine distress, placental abruption, placental dysfunction, umbilical cord around the neck, forceps Childbirth, long breech delivery, low birth weight infants with premature or expired babies, postnatal asphyxia aspiration pneumonia, hypoxic-ischemic encephalopathy, nuclear jaundice, intracranial hemorrhage, infection, poisoning, and malnutrition.

Clinical manifestations of cerebral palsy in children

Sudden stiffness of the child: difficulty in certain positions, such as dressing the child in a supine position, flexing his body or hugging him. Flabby: The baby's head and neck are soft and can't lift his head. When he was hung in the air, his limbs drooped. Babies rarely move. Stunting: Learn to look up, sit and use your hands but not later than your peers. You may use one part of the body more than the other. For example, some children often use one hand instead of two. Poor eating: Poor suction and swallowing. The tongue often pushes milk and food. Shut up is difficult. Abnormal behavior: May be crying, irritable, poor sleep, or very quiet, sleeping too much, or not smiling at 3 months.

Early symptoms

(1) Newborns or infants in March are frightened, crying, tired, and have difficulty sleeping.

(2) Early feeding, eating and chewing, drinking water, difficulty swallowing, and drooling and breathing problems.

(3) The sensory threshold is low, which shows that it is easy to be surprised by noise or change of body position, and the hug reflection is enhanced with crying.

(4) Normal babies shortly after birth, due to the effect of step reflection, when two feet are upright, interactive steps can be seen. Although it may fade once at the age of 3 months, if there is still no standing indication or stepping by 3 months, it is necessary to suspect infantile cerebral palsy.

(5) Babies who have passed the "hundred days" are not yet able to raise their heads, and their heads are still vacillating when they stand up from April to May.

(6) Fist: Generally, the baby can not fist within 3 months after birth. If the thumb is still adducted within 4 months, the child's cerebral palsy should be suspected if the hand is not open.

(7) Normal infants should reach out and grab their hands when they see it in 3 to 5 months. If it is not possible after 5 months, it is suspected as infantile cerebral palsy.

(8) Usually laugh 4 to 6 weeks after birth and recognize people later. Children with convulsive cerebral palsy have indifferent expressions, and their hands and feet are often frowning.

(9) The muscles are soft and cannot turn over, and the movement is slow. When the child touches the inside of the thigh, or when the child is on the bed or jumping up and down, the lower limbs stretch and cross.

(10) Stiffness, especially when dressing, the upper limbs are difficult to wear into the cuffs; the thighs are not easy to abduct when changing diapers and washing; the limbs are stiff when rubbing the palms and bathing. Babies don't like bathing.

(11) Premature development: Children with cerebral palsy may turn over prematurely, but a sudden reflexive turn over, and the whole body turns like a log, instead of a conscious segmental turn. Infants with spastic diplegia can have stiff legs and sit on tiptoes like ballet dancers before sitting firmly.

2. The main symptoms

(1) Dyskinesias Poor self-control ability in sports. In severe cases, they will not grasp things with their hands, their feet will not walk, some will not turn over, they will not sit up, they will not stand, they will not chew and swallow normally.

(2) Posture disorders All kinds of postures are abnormal, the stability of the posture is poor, the head cannot be straight for 3 months, and it is used to lean to one side, or shake left and right, left and right. Children do not like to take a bath, and it is not easy to open their fists when washing their hands.

(3) Intellectual disorders Normal children account for about 1/4, mild intelligence and moderate deficiency account for about 1/2, and severe mental retardation accounts for about 1/4.

(4) Language barriers Difficult language expression, articulation or stuttering.

(5) Hearing and hearing disorders The most common are esotropia and difficulty in distinguishing the rhythm of sound.

(6) Growth and developmental disorders are short.

(7) Disorders of tooth development Loose texture and easy to fold. Oral and facial dysfunction, facial and lingual muscles are sometimes cramped or contracted uncoordinated, difficulty chewing and swallowing, difficulty closing the mouth, and drooling.

(8) Emotional and behavioral disorders Stubborn, willful, irritable, lonely, emotionally fluctuating, and sometimes compulsive, self-harming, and aggressive behaviors.

(9) 39% to 50% of children with cerebral palsy induce epilepsy due to fixed lesions in the brain, especially children with severe mental retardation.

Diagnosis of cerebral palsy in children

The manifestations of cerebral palsy vary depending on the cause and type, but they are more common in the early stages: early symptoms of infants with cerebral palsy (within 6 months).

1. Soft body and reduced spontaneous movement

This is a symptom of hypotonicity that can be seen in a month. If it lasts for more than 4 months, it can be diagnosed as severe brain damage, mental retardation, or muscular system disease.

2. The body is stiff

This is a symptom of hypertonicity that can be seen in a month. Cerebral palsy can be diagnosed if it lasts more than 4 months.

3. Slow response and no response

This is an early manifestation of mental retardation. Generally, it is considered that the patient is unresponsive at 4 months and called unresponsive at 6 months, which can be diagnosed as mental retardation.

4. Abnormal head circumference

Head circumference is an objective indicator of brain morphological development. Children with brain injury often have abnormal head circumference.

5. Poor weight gain and weak breastfeeding.

6. Fixed posture

It is often caused by abnormal brain tension caused by brain injury, such as angled bow retension, frog position, inverted U-shape posture and so on. Visible one month after birth.

7. don't laugh

If you can't smile for 2 months and laugh out loud for 4 months, it can be diagnosed as mental retardation.

8. Hand fist

If it is not open for 4 months, or the thumb is adducted, especially the presence of one upper limb, it has important diagnostic significance.

9. Body twist

If the baby is 3 to 4 months old, if the body is twisted, it often indicates that the pituitary is damaged.

10. Unstable head

For example, the head cannot be raised for 4 months or the head cannot be vertical when sitting, which is often an important sign of brain injury.

11. Strabismus

Infants aged 3 to 4 months have strabismus and poor eye movement, suggesting the presence of brain damage.

12. Can't reach for grasping things

If 4 to 5 months can not reach out to grasp, can be diagnosed as mental retardation or cerebral palsy.

13. Watching hands

It persists after 6 months and can be considered mentally retarded. Some brain injuries are mild and often have no obvious symptoms in early infancy, but in the second half (6-12 months).

Differential diagnosis of cerebral palsy in children

Progressive spinal muscular atrophy

The onset of the disease occurs in infancy, and symptoms occur after more than 3 to 6 months. A few patients have abnormalities after birth, showing symmetry weakness in the upper and lower limbs, progressive increase in muscle weakness, obvious muscle atrophy, and decreased tendon reflex. Or disappear, often due to respiratory muscle insufficiency and repeated respiratory infections, children with low crying, cough weakness, muscle biopsy can help confirm the diagnosis, the disease is not associated with mental retardation, facial expressions are alert, eye movements are flexible.

2. Motor retardation

Some children's motor development is slightly behind that of their normal peers, especially premature babies. However, it was not accompanied by abnormal muscle tone and posture reflexes, no abnormal movement patterns, and no other neurological abnormal reflexes. Symptoms of dyskinetic motor development can increase in children with age and focus on exercise training, and symptoms can disappear in a short period of time.

3. Congenital muscle relaxation

After birth, the child has obvious low muscle tone, muscle weakness, deep tendon reflexes, or disappear. Recurrent respiratory tract infections are often prone. The disease is sometimes misdiagnosed as hypotonic cerebral palsy, but tendon reflexes are usually elicited.

4. mental retardation

The disease often has poor motor development, uncoordinated movements, abnormalities in primitive reflexes, vojta posture reflexes, corrective responses, and balanced responses. It is easy to be misdiagnosed as cerebral palsy in early infants, but the symptoms of mental retardation are more prominent and muscle tone is basically normal. No abnormal posture.

Pediatric cerebral palsy treatment

Comprehensive rehabilitation medicine

Such as sports (sports) therapy, including coarse exercise, fine exercise, balance and coordination training; such as crawling, purposeful identification (nose, ear, etc.), training grips, holding objects, sitting up, swinging, walking (back Leaning against the wall, facing the wall), in-situ exercise (bend over to pick up objects, train your feet, stand on one foot, take off in place), walk, run; physical therapy, including electrical nerve stimulation therapy, thermotherapy, hydrotherapy ; There is also occupational therapy that is ability training, but the effect is average. Modern medical treatment methods are as follows: surgery; orthosis; water, electricity, light and sound therapy; language and communication treatment; motor function treatment; ADL training.

2. Drug therapy

Oral or injectable related drugs: brain neurotrophic drugs, muscle relaxants, blood circulation drugs, etc. Including drugs that build and repair brain tissues (cells), such as lecithin (including phosphatidylcholine, cerebral phospholipid, sphingomyelin, etc.), can repair brain cell membrane damage caused by trauma, bleeding, and hypoxia, protect nerve cells, and accelerate Nerve excitation conduction, improve learning and memory function. You can also choose drugs that can promote brain cell DNA synthesis, promote the utilization of oxygen by brain cells, improve brain cell energy metabolism, enhance brain function, supply various amino acids needed for brain tissue repair and regeneration, and regulate brain nerve activity, such as ancient Lixi (brain enzyme hydrolysis tablets), spirulina tablets (capsules). Then there are active supplements of multiple vitamins, such as 21-Gold Vitamin. Alternative hospital injections are available for conditional hospitals (the effect is the same as tablets): Cerebrolysin, Brain Peptide, Acetylglutamine, Citicoline, etc.

3. Chinese Medicine Law

Including acupuncture (cerebral palsy with high muscle tone), massage therapy, Chinese medicine therapy.

4. Pediatric cerebral palsy exercise therapy

Children's cerebral palsy exercise therapy: Exercise therapy is based on kinematics and neurophysiology, using equipment or therapist's freehand technique or using the child's own strength, through active and passive exercise, to restore and treat systemic and local functions.

(1) Common goals of exercise therapy for children with cerebral palsy Try to exercise in the normal way. Use both sides of the body. Keep upright when lying, sitting, kneeling and standing. Actions and activities related to daily life. Prevent deformity.

(2) Training goals for children with cerebral palsy of various types Spastic type Relax the stiff muscles, avoid the movement of the spastic position, and prevent deformity. Hand, foot, and slow-moving type Hand-grip movement training to stabilize involuntary movements. If the abnormal posture changes, follow the goal of spasm type. Ataxia type Improve the balance ability of kneeling position, standing position and walking, standing and walking stably, controlling unstable shaking, especially both hands.

Prevention of cerebral palsy in children

During pregnancy

Rubella virus infection should be prevented.

After pregnancy

Perform regular health check-ups: take care to rule out dystocia, and actively treat hypertension and diabetes. Ensure nutrition and prevent premature birth. Avoid unnecessary medication. Select the maternity home according to the expected delivery date and prepare for safe delivery.

3. After the baby is born

Focus on protecting immature infants, suffocating and severely jaundiced infants, and perform necessary treatments, such as inhaling oxygen and entering incubators. Children with brain injury should be followed up and screened regularly.

4. Encourage breastfeeding

Immunize infants with one-two-three vaccines, polio, rubella or tuberculosis.

5. Educate parents to identify early symptoms of meningitis

Such as fever, stiff neck, drowsiness, etc., once found, timely treatment.

6. Fever

Take off your clothes, wipe yourself with ice water, drink plenty of water, and treat in time.

7. Educate parents to pay attention to hydration for children with diarrhea

If diarrhea is severe, see your doctor promptly.

8. For those with backward motor development, abnormal posture, poor breastfeeding, screaming or not sleeping, and muscles that are too soft or too hard

Attention should be paid to brain lesions.