Complications
Small head suggesting microcephaly reflects poor brain growth.
Increased head circumference is indicative of hydrocephalus requiring a ventriculoperitoneal shunt.
A low visual acuity can be present in up to 75% of patients with CP. Common with premature birth history. Patients with spastic quadriplegia have higher rates of visual impairment.
Around 50% of people with CP have intellectual disability (IQ below 70).[56]
Excessive drooling (sialorrhea) is a common problem, affecting around half of people with CP.[238] It can be treated with oral medication (glycopyrrolate or trihexyphenidyl), scopolamine patches, injection of botulinum toxin into the salivary glands, or surgical procedures.[239][240][241][242][243][244][245][246]
Hearing impairment occurs in around 10% of people with CP, and is more commonly associated with dyskinetic or ataxic CP than spastic CP. Regular ongoing hearing assessment is necessary.[56]
The possibility of cervical myelopathy should be considered in patients with slow, insidious degradation of function in the absence of trauma or other clear antecedent event. Loss of ambulation, upper-extremity function, and bowel or bladder control is not part of the natural history of CP.
Radiographs and cervical magnetic resonance imaging can confirm cervical myelopathy. It is most commonly seen in patients with dyskinesia but has been reported in patients with spasticity.[249][250]
Gastrointestinal and feeding problems are observed in 50% of patients.
Patients with spastic quadriplegia have higher rates of oral-motor impairment.
The patient presents with poor sucking, swallowing, or chewing. An individualized plan should address factors such as posture, food textures, specialized equipment, feeding technique, and the mealtime environment.[56]
If oral intake is insufficient to provide adequate nutrition after assessment and nutritional interventions, percutaneous gastrostomy insertion may be considered. A review of interventions for feeding and nutrition in CP concluded that gastrostomy-fed children gained weight, but the effects on other measures of growth and development were less clear.[226] Substantial numbers of children remained underweight, although normal reference standards for children with CP are lacking.
Special methods may have to be used in the nutritional assessment of CP patients if height and weight cannot easily be measured.[56][232]
Behavior problems are 5 times more likely in children with CP. These are addressed by psychosocial approaches such as parental counseling and more direct interventions with the children themselves.[233]
Frequently observed due to poor oral and pharyngeal motor control secondary to spasticity, weakness, or dyskinesia. Patients with spastic quadriplegia have higher rates of oral-motor impairment.
The child should be assessed for swallowing difficulties while eating (including any choking, coughing, gagging, or vomiting), and for other risk factors.[224] Aspiration may be silent with no symptoms.
Patients suspected of aspiration should undergo swallowing studies. Follow-up requires observation for pneumonia, asthma, or chronic lower respiratory infections.[234]
Poor growth is common in children with CP and particularly in those with quadriplegic involvement. All children should have serial height, weight, and head circumference measured on age- and sex-specific growth charts. Nutritional needs should be addressed.[222]
Observed in up to 40% of patients with CP; more common in dyskinetic than in spastic CP. Patients require treatment with anticonvulsant medications. Electroencephalogram is performed to evaluate patients with epilepsy.[71]
Up to 60% of children and young people with CP have chronic constipation.[56]
Sleep issues are common in patients with CP but are infrequently studied in this population. Sleep hygiene should be optimized. There is some evidence that melatonin may be beneficial in improving sleep patterns.[236] Referral to specialist sleep services should be considered if sleep disturbances are ongoing.[56]
Observed in 25% of patients.
GERD is associated with anemia, malnutrition, recurrent upper respiratory infections, and low bodyweight.[235] Gastrointestinal swallow studies are indicated in patients suspected with GERD.
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