Cerebral palsy diagnosis and management: The state of the art

Prematurity, an important risk factor for cerebral palsy, is not diminishing. Critical steps in development of the cortical brain occur between the 22nd and 36th weeks after conception, and research is ongoing to identify which practices optimize outcomes. Prematurity, however, is not the only risk factor, and current evidence supports a multifactorial basis for the disorder. Since presently we can neither prevent nor cure cerebral palsy, we need to optimally manage it. Parents of children with cerebral palsy look to their pediatrician for information, medical treatment, guidance, and support over years of developmental and functional transitions. However, pediatricians report a lack of training and confidence in caring for children with disabilities. More than 70% report having received no training in the prescription of durable medical equipment and more than 50% lacked training in prescribing specific therapies. Anticipatory guidance for the child and family is critical, from the time of diagnosis and throughout the child's life. Parents need to know that although cerebral palsy is defined as static encephalopathy, it is not a clinically static condition. They need to know that musculoskeletal, cardiopulmonary, and digestive systems may be affected as their child grows and that children with chronic health conditions are 3 times more likely to be hospitalized when compared with the general pediatric population. Functionally dependent children with severe cerebral palsy and feeding tube dependency have the lowest estimated mental age, use the most medications, encounter the most respiratory problems, and miss more days of usual activities. The parents are the experts regarding their child and need to be empowered with knowledge and support to make the best decisions possible. The pediatrician, in cooperation with the child, family, and interdisciplinary team, can coordinate a complex care system to the maximal benefit of each child.