Content on this page:
- When Medical Malpractice Leads to CP
- Known Risk Factors
- Is CP Preventable?
- Diagnosis, Tests and Missed Milestones
- Types of Cerebral Palsy
- How is CP Classified
First, let's define cerebral palsy.
Cerebral palsy is a disorder that affects body movement and posture. It is caused by brain damage that occurs either before, during or immediately after birth. CP can be caused by genetic, environmental factors as well as prematurity. However, because hypoxia (lack of oxygen) to the baby’s brain during labor and delivery is a known cause of cerebral palsy it is important for the doctors and nurses to identify the signs on the fetal monitor and timely intervene to help the baby.
The type and timing of the injury to the brain determines the severity of cerebral palsy. Some children are mildly affected while others may be completely unable to move and require assistance to eat and even breathe.
Cerebral palsy can cause the following movement disorders:
- Spasticity (stiff muscles), which is referred to as spastic cerebral palsy
- Dyskinesia (uncontrollable movements), referred to as dyskinetic cerebral palsy
- Ataxia (poor balance and coordination), referred to as ataxic cerebral palsy
- A combination of movement disorders, referred to as mixed cerebral palsy
Signs and symptoms of cerebral palsy may take months or even years to become apparent. If your child has been diagnosed with cerebral palsy, it is important to answer the question: could this have been prevented? Cerebral palsy attorney Michael H. Bereston can talk to you about the circumstances surrounding your pregnancy, labor and your child’s birth and review medical records to determine whether malpractice may have been involved. Working with top-notch medical experts, he and our team can work to expose wrongdoing and help you pursue much-needed financial compensation.
To learn more, call (410) 220-6581. Your consultation is free! We serve clients across Maryland and throughout the country from our offices in Annapolis.
What Causes Cerebral Palsy?
In the broadest terms, cerebral palsy is caused by asphyxia-related brain damage. When a developing baby or newborn child does not receive adequate oxygen and blood to the brain, he or she can suffer serious and permanent brain damage as brain cells begin to die. In some cases, this leads to cerebral palsy.
There are many ways in which an unborn or just-born baby could suffer oxygen deprivation. For example, if labor is not progressing quickly enough and the delivery room doctor fails to order an emergency cesarean section (C-section), causing the baby to experience hypoxemia (low oxygen levels in the blood) which, in turn, can lead to hypoxia (low oxygen levels in tissues, including brain tissue). Additionally, problems with the umbilical cord, such as umbilical prolapse or an umbilical cord that is wrapped around the baby in the womb, could result in asphyxia.
These are just some examples of how oxygen deprivation before, during, or immediately after birth can occur; any time a baby suffers dangerous oxygen deprivation, they are at risk of developing a number of birth defects and related conditions, including cerebral palsy.
When a parent is first informed that their baby has been diagnosed with Cerebral Palsy, it’s common for their first thought to be “how did this happen?” The truth is, Cerebral Palsy can be caused by many different factors.
Cerebral Palsy may also be caused by the negligence of healthcare providers before, during or after birth.
Some examples of this include:
Asphyxia or hypoxia during pregnancy, labor, and delivery - the baby had an injurious lack of oxygen to the brain during pregnancy or labor and delivery that went undiagnosed or untreated
Birth trauma - excessive force or injury to the brain during delivery
Forceps and/or vacuum extractor misuse
Umbilical cord issues
Inadequate or incorrect interpretation of fetal monitoring tracings showing fetal compromise
Missed diagnosis of high-risk problems in pregnancy
These issues do not mean that your child will have Cerebral Palsy. If the healthcare providers are diligent and provide care to you and your baby in the safest manner possible, it will help to diminish the risk of Cerebral Palsy from these conditions.
What Are the Symptoms of Cerebral Palsy?
The symptoms of CP may be different for each affected individual and can vary in severity, ranging from mild to severe. For example, one individual with CP may have trouble sitting and walking, while another individual suffering from CP may have trouble with their grip strength, rendering them unable to pick up objects.
The part of the brain affected determines the symptoms suffered.
Some of the more common symptoms of Cerebral Palsy include:
Missed milestones including, rolling over, moving toys from one hand to the other, crawling, walking, kicking a ball
Abnormal muscle tone - increased muscle tone or decreased muscle tone
Consistent poor coordination
In-toeing/Out-toeing - toes pointing inward/outward
Neurological issues - seizures, blindness, intellectual disability
When Medical Malpractice Leads to Cerebral Palsy
While it is possible for a child to develop cerebral palsy as a result of completely unforeseeable complications or unpreventable conditions, many cerebral palsy diagnoses are the result of medical malpractice. When a child suffers a birth injury due to the negligent or careless actions of an obstetrician, delivery room nurse doctor, midwife, or any other medical professional, and that birth injury leads to permanent brain damage and cerebral palsy, the child’s parent/guardian may take legal action. While nothing can undo what has happened to your child, a birth injury claim can allow you to recover financial compensation, allowing you to get the critical treatment for your child that he or she needs.
So, when is medical malpractice responsible for a child’s cerebral palsy diagnosis? Some common examples include instances in which medical professionals:
- Fail to recognize/diagnose a high-risk pregnancy
- Fail to monitor or respond to signs of fetal distress
- Do not detect or treat maternal infections
- Allow labor to continue for a prolonged amount of time
- Do not order a timely C-section
- Misuse assistive birth devices, such as forceps or vacuum extractors
- Extend labor/delivery unnecessarily
In short, any time a medical professional does not uphold the standard duty of care—both to the mother and the baby—that doctor may be liable for any injuries either the mother or child suffers.
There are some known risk factors for cerebral palsy.
Birth weight less than 2,500 grams at birth and there is an additional risk if birth weight is less than 1,500 grams
Prematurity especially if born prior to 32 weeks gestation
Twins, triplets or multiple births
Infections—viral infections such as chickenpox, rubella, cytomegalovirus as well as bacterial infections of the placenta, uterus or other maternal organs
Medical conditions of mother that are undiagnosed or not treated may affect the blood and oxygen flow to the baby
Is Cerebral Palsy preventable?
Cerebral palsy that is due to genetics is not preventable. However, during the process of birthing the lack of oxygen may cause Cerebral Palsy. This can most times be prevented by the labor and delivery staff at the hospital.
Congenital CP vs. Acquired CP
Congenital CP makes up the vast majority of CP (85%-90%). This kind of CP is affiliated with brain damage that occurred prior to or during childbirth. Oftentimes, the distinct source is unknown.
Acquired CP makes up a very low percentage of CP patients. It is attributed to brain damage occurring over 28 days after the baby is born. This type of CP is widely attributed to infection (like meningitis) or head injury.
Lowering the Risks
In order to lower the risk factors for cerebral palsy, keep yourself healthy before and during your pregnancy.
- Before becoming pregnant, make sure you are as healthy as possible. Be sure to treat any infections before getting pregnant.
- Attain vaccines for diseases that could harm the baby before you become pregnant.
- If assistive reproductive technology (ART) infertility treatments are utilized in order to become pregnant, do what is possible to decrease your chance of a multiple pregnancy (twins, triplets, etc.).
During your pregnancy, have open discussions with your healthcare providers regarding any risk factors you may have and follow the advice of your healthcare providers to promote a healthy environment for the baby.
As labor and delivery approaches, make sure that healthcare providers and the hospital you select for labor and delivery are equipped with staff educated in the signs and symptoms your baby may show if hypoxia occurs in order to prevent injury from hypoxia and/or ischemia. If you have questions, before, during or after the labor and delivery, ASK QUESTIONS of the staff and your healthcare provider.
When is Cerebral Palsy Diagnosed?
During the hospitalization at the time of birth, the healthcare providers for the baby will monitor closely for signs of injury if risk factors were present or if there were signs the baby was lacking oxygen or blood supply during the labor and/or birth. The term hypoxic-ischemic encephalopathy or HIE is a term that is used when an injury to the brain of the baby from lack of oxygen and/or blood flow causes brain injury. Other terms used to describe this includes perinatal asphyxia, intrapartum asphyxia, and neonatal encephalopathy.
HIE can cause cerebral palsy, seizures, vision and hearing loss, cognitive and motor difficulties.
As children age from infants to toddlers, they begin to hit certain milestones in their development. One of the most notable is when they are able to smile and push themselves up while laying on their stomachs. Once a child is several months old, they begin to stand and even walk shortly thereafter. If babies are unable to reach expected developmental milestones, doctors can then investigate to determine why this is happening.
Cerebral palsy affects individuals depending on what area of the brain has been injured which means doctors can’t simply look at symptoms and automatically diagnose a child with the condition. It’s necessary to closely examine each child and their development or lack thereof. This includes motor skills, speech, autonomy, and independence.
In some cases, a doctor may tell parents they have a concern about cerebral palsy after childbirth due to certain factors. If there are complications during labor or delivery, the baby might be at a higher risk of developing the condition. Babies who are born prematurely are particularly at risk, especially if they develop jaundice that is left untreated. Other problems that can lead to cerebral palsy include infections like meningitis or trauma during delivery.
Cerebral Palsy and Missing Milestones
However, if there are no risk factors involved, the doctor must closely examine the child’s development. It’s common for parents to note certain issues with their children, such as not learning to crawl during the normal age or a lack of muscle tone. Parents who notice anything unusual must report their observations to their pediatrician immediately. These are known as missed milestones in the child's development.
On average, babies should begin to walk between 12 and 18 months and begin to speak in basic sentences or phrases by two years old. In some cases, cerebral palsy may affect only one side of the body or only the arms or only the legs.
Diagnosis in Children
A definitive cerebral palsy diagnosis generally depends on the child’s age. However, certain factors may determine a diagnosis, including the following:
•Severity: If severe symptoms are present in a child, notably their inability to control their movements, it may be possible for a doctor to diagnose cerebral palsy earlier in the child’s life.
•Parental involvement: In many cases, the doctor will rely on parents to tell them about the symptoms they have witnessed their babies experiencing.
•Type: Certain types of cerebral palsy are easier to diagnose.
Generally speaking, babies with severe cerebral palsy can be diagnosed within only a few months, but some babies are not diagnosed until their first birthday. If the condition is mild, the child may not be diagnosed until around three or four years old.
Tests for Cerebral Palsy
There are certain tests doctors can use to diagnose cerebral palsy in children. Overall, most of these are imaging tests that allow for a view into the brain. Doctors typically see the area in the brain that has suffered trauma and then make a definitive diagnosis. These are a few tests used:
•MRI: An MRI is noninvasive and can produce 3D images of the brain. This is the most common imaging used for this purpose and may be used in combination with an MRA or MRV (spectroscopy) that looks at blood flow in the brain)
•CT scan: A CT scan takes X-rays from many angles and shows images of the brain.
What are the Different Types of Cerebral Palsy?
There are different types of Cerebral Palsy, each of them having different symptoms due to the part of the brain affected. Each of the different types causes a different movement disorder and shows different symptoms.
The different types of CP are:
Spastic Cerebral Palsy
Spastic Cerebral Palsy is caused by damage or developmental differences to the Cerebral Cortex. This is also the most common form of Cerebral Palsy.
Stiff muscles and jerky movements (spasticity) may affect the upper part of the body, the lower part of the body or both upper and lower; one side of the body or both sides.
This can lead to difficulty with:
Walking, crawling, sitting up
Dyskinetic Cerebral Palsy
Dyskinetic Cerebral Palsy is associated with damage to the Basal Ganglia. The Basal Ganglia is essentially the brain’s delivery system between the movement center and the spinal cord, it’s responsible for regulating voluntary movements.
There are three different types of Dyskinetic Cerebral Palsy, based on which area of the Basal Ganglia was damaged, they are as follows:
Dystonia is known for resulting in involuntary muscle contractions that result in a slowly twisting movement or repetitive movement, that is triggered by trying to move.
Unusually awkward posture
Rapid or extremely slow movements which often cause pain
Involuntary, sporadic movement
Sensory ticks to suppress unwanted movement - touching of the face or chin with hands, tucking the hand under chin, sitting on hands
Athetosis shows itself by slow, involuntary movements that are displayed while at rest and amplified by movement. There is also a vast fluctuation in muscle tone, with some being extremely floppy and some being very tight.
Constant slow movements
Drooling due to a lack of facial muscle control
Challenging to hold objects
Unwanted sporadic movements
Chorea stems from a Greek word meaning “dance.” Fittingly, Chorea shows symptoms of restlessness, causing brief movement that is often unpredictable.
Ataxic Cerebral Palsy
Ataxic Cerebral Palsy is caused by damage to the Cerebellum, which is the balance center for our brain. It’s the Cerebellum’s job to fine-tune motor commands to maintain proper posture.
Tremors/shakiness - caused by the brain trying to under/overcorrect movements
Difficult to perform precise hand movements
Walking wide using a “wide-base gait” to try to fix their poor balance
Breathy sound during speech
Hard time tracking movement visually
Mixed Cerebral Palsy
When multiple regions of the brain are damaged, it’s possible for multiple types of CP to be present.
How is Cerebral Palsy Classified?
Cerebral Palsy has been classified according to the Gross Motor Function Classification System (GMFCS) which is broken down into 5 different levels. The GMFCS categorizes the level of CP based on movements and the use of mobility devices.
This tool is helpful because it allows for families to have a clear understanding of their child’s current motor function skills, as well as gives them an idea as to which mobility devices would assist their child.
The five different levels of the GMFCS increase as the mobility decreases, they are as follows:
The child is able to walk without any limitations. They are able to climb stairs without the use of rails, as well as being able to perform gross motor skills (running, jumping, etc.) although their speed and coordination may be limited.
The child is able to walk in most situations and can climb stairs with the use of a rail. In certain situations, like unlevel terrain, long distance or crowded places, the child may have troubles walking. They may also use some form of a handheld mobility device to traverse long distances. Children have a very limited ability to perform gross motor skills.
Whether it’s a short distance indoors stroll or a long walk outside, some form of mobility device is necessary for the child to walk. They are still able to make their way upstairs, as long as they are holding onto a rail along with supervision. Wheeled mobility is necessary when the child is going to travel long distances.
In most cases, the child requires manual assistance or powered mobility. At home or in the comfort of their own time, the child may walk short distances with the assistance of a walker with body support or a powered mobility tool. While the child is in public, they will be in a wheelchair or use powered mobility to get around.
The most severe level of CP, the child must be taken in a wheelchair anywhere they go and their head and neck must remain supported, due to the lack of ability they have to control them on their own. They also must have a support system in place for their trunk as well as their arms and legs.
Recovering Fair Compensation After a Cerebral Palsy Diagnosis
A cerebral palsy diagnosis means that your child will lead a far different life than the one you had envisioned. This does not mean, however, that all of his or her opportunities should be limited. With the right care, therapy, and assistance, your child can lead a more fulfilling and stable life. The financial compensation awarded in a birth injury lawsuit can help ensure you can provide for all of your child’s needs.
As an experienced cerebral palsy lawyer, Michael Bereston knows what it takes to seek justice in birth injury cases involving this serious condition. For more than 30 years Mr. Bereston has been practicing law and using his trial experience to help disabled children and families recover the complete compensation they need – and deserve.
Find out more about recovering fair financial compensation to help your child face a brighter future. Call (410) 220-6581 for your free case evaluation. Our cerebral palsy attorney practices in Maryland and across the U.S.