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Birth defects

  • Birth defects are health conditions present at birth.
  • They can cause problems in how the body works.
  • About 120,000 babies born each year have a birth defect.
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Cerebral palsy

Cerebral palsy (also called CP) is a group of conditions that affects the parts of your brain that control your muscles. This can cause problems with movement, posture (standing up straight) and balance. 

Some but not all children with CP also may have other conditions, like intellectual and developmental disabilities. These  are problems with how the brain works that can cause a person to have trouble or delays in physical development, learning, communicating, taking care of himself or getting along with others.

About 1 in 300 children (less than 1 percent) has CP. Most children are diagnosed by the time they’re 2 years old. 

CP is the most common cause of movement problems in childhood. There are four kinds of CP that are based on the type of movement problems a child has. 

What is spastic CP?

Spastic means tight or stiff muscles, or muscles that spasm (get tight). This is the most common kind of CP. About 4 in 5 children (80 percent) with CP have spastic CP. These children have stiff muscles and may have awkward body movements. 

Signs and symptoms of spastic CP include:

  • Tight muscles that do not stretch
  • Trouble walking, crossing knees, having a scissor-like walk or walking on toes
  • Tight joints
  • Weak muscles or no movement in a group of muscles

There are three kinds of spastic CP: 

  1. Spastic diplegia. Children with this kind have muscle stiffness mostly in the legs. They may have trouble walking because tight muscles in the hips and legs cause their legs to turn inward and cross at the knees (also called scissoring). These children may need a walker or leg braces to help them move from place to place. 
  2. Spastic hemiplegia. This kind usually affects one side of the body. The arm and leg on the affected side may be shorter and thinner than the other side of the body. These children often walk later than others and may walk on tip-toe. Some have a curved spine (also call scoliosis), seizures or speech problems.
  3. Spastic quadriplegia. This is the most serious kind of spastic cerebral palsy. It affects most of the body, including all arms and legs, the torso (the body’s midsection) and the face. These children usually can’t walk and they often have intellectual disabilities, trouble speaking and seizures. 

Are there other kinds of CP?

Yes. Other kinds of CP include: 

  • Dyskinetic CP (includes athetoid CP, choreoathetoid CP and dystonic CP). Children with this kind of CP have muscle tone that ranges from being too tight to too loose. This can cause uncontrolled movements that can be slow and twisting or quick and jerky. Children with dyskinetic CP may have problems controlling the movements of their hands, arms, feet and legs. This makes it hard to sit and walk. Some of these children also have trouble speaking. Problems in their face and tongue muscles may make them frown or drool. 
  • Ataxic CP. This type of CP is rare. These children have problems with balance and coordination. They may be unsteady when they walk. They also may have tremors (shaking muscles) when they make quick movements or movements that need a lot of control, like writing. 
  • Mixed CP. This is when a child shows symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

How do you know if your baby has CP?

CP can be different in each child. Some children have mild CP. They may have some awkward body movements and need little or no special help. Other children have more serious CP. They may need a lot of special care their whole lives. CP doesn’t get worse over time, but its symptoms can change.

Some but not all babies with CP often have developmental delays. This means your child doesn't reach developmental milestones when expected. A developmental milestone is a skill or activity that most children can do at a certain age. Milestones include sitting, walking, talking, having social skills and having thinking skills. Tell your child’s health care provider if you notice any of these signs in your baby at these ages: 

Younger than 6 months

  • His head falls back when you pick him up from lying on his back.
  • He feels stiff or floppy.
  • He seems to push away when you hold him.
  • His legs get stiff legs and cross or “scissor” when you pick him up.

Older than 6 months

  • He doesn't roll over.
  • He can’t bring his hands together.
  • He has trouble bringing his hands to his mouth.
  • He reaches with only one hand while keeping his other hand in a fist.

Older than 10 months

  • He crawls by pushing off with one hand and one leg while dragging the other hand and leg.
  • He scoots around on his bottom or hops on his knees, but does not crawl on all fours.

Older than 1 year

  • He can’t crawl.
  • He can’t stand up with support.

If you think your baby has developmental delays or other signs of CP, talk to her provider. Diagnosing CP usually happens in three steps. 

  1. Developmental monitoring. Your baby’s provider checks her growth and development over time. If your baby shows signs and symptoms of CP, her provider recommends developmental screening.
  2. Developmental screening. These tests check for developmental delays, like problems with movement. The American Academy of Pediatrics recommends that all children have developmental screening tests during their well-baby visits at 9 months, 18 months and 24 or 30 months.
  3. Developmental and medical evaluations. If results of your baby’s screening tests aren't normal, your baby’s provider recommends developmental and medical evaluations. These can be done by your baby’s provider or by a child neurologist. This is doctor with special training in treating brain conditions in babies and children.

Your baby’s provider also may recommend these tests for your baby: 

  • Blood tests
  • Computed tomography (also called CT scan). This test uses special X-rays to make a picture of your baby’s brain. 
  • Electroencephalogram (also called EEG). This test records electrical activity in your baby’s brain. It can help diagnose epilepsy, which sometimes happens in children with CP. Epilepsy is a seizure disorder that affects how the nerve cells in your brain work.
  • Magnetic resonance imaging (also called MRI). This test uses radio waves and magnets to make a picture of your baby’s brain.
  • Ultrasound. This test uses sound waves to make a picture of your baby’s brain. 

How is CP treated? 

You can work with a team of health care providers to figure out your child’s needs and come up with a treatment plan. Members of the team can include:

  • Pediatrician. This is a doctor who has special training to take care of babies and children.
  • Child neurologist. This is a doctor who has special training in treating brain conditions in babies and children.
  • Social worker. This is a person with special training to help people solve problems and make their lives better. 
  • Psychologist. This is a person with special training to take care of people with emotional or mental health problems, like depression.
  • Orthopedic surgeon. This is a doctor with special training do surgery on bones and muscles.
  • Physical therapist. This is a person with special training to create exercise programs for your child. 
  • Occupational therapist. This is a person who can teach your child how to do everyday things, like eating, getting dressed and writing.
  • Speech and language pathologist. This professional can help your child speak more clearly or communicate in other ways.
  • Special education teacher. This person has special training to help your child with learning.

Your child’s treatment plan may include special equipment to help with movement and getting around. These can include a walker, leg or arm braces, a wheelchair or scooter. He may also need a special computer to help him communicate.

Your child may need medicines to help relax muscle spasms, including: 

  • Diazepam (Valium®), baclofen (Lioresal®), dantrolene (Dantrium®) and tizanidine (Zanaflex®). Your child takes these by mouth.
  • Baclofen, a medicine that your child gets through a pump placed under his skin. The pump releases the medicine into the fluid that surrounds the spinal cord.
  • Botox® (also called botulinum toxin). Your child gets this through a needle.

If your child has severe spasms and medicines don’t help, your baby’s provider may recommend surgery called selective dorsal rhizotomy. This is when a surgeon cuts some of the nerves at the base of the spine. It may help with muscle spasms and help your child sit, stand, walk or move around more easily. 

What health problems are common for people with CP?

People with CP may have these health problems: 

  • Constipation. This is when you have painful gas or it's hard to have a bowel movement.
  • Drooling
  • Feeling pain, especially in adults. Pain is most common in the hips, knees, ankles and back.
  • Problems urinating
  • Seizures
  • Throwing up 
  • Trouble breathing
  • Trouble swallowing, sucking or eating
  • Trouble talking, seeing or hearing 

What causes CP?

CP happens when your baby has brain damage or there are problems in how your baby’s brain develops. Most children with CP have congenital CP. This means they have CP at birth. In many of these children, we don’t know what the exact cause of CP is. 

Changes in genes that affect brain development may play a role in causing CP. Genes are a part of your body's cells that stores instructions for the way your body grows and works. Genes are passed from parents to children. A gene change (also called mutation) is a change to the instructions that are stored in a gene. 

The brain damage that leads to CP can happen before birth, during labor and birth or after birth, while the brain is still developing. Your baby may be more likely than other babies to develop CP before birth if: 

  • You’re pregnant with multiples (twins, triplets or more). The more babies you’re pregnant with, the greater the risk of CP.
  • You have certain infections during pregnancy. Infections that can lead to CP include chickenpox, rubella (also called German measles), cytomegalovirus (also called CMV), toxoplasmosis, chorioamnioitis (an infection in the uterus) and infections in the placenta. The placenta grows in your uterus (womb) and supplies your baby with food and oxygen through the umbilical cord.
  • You have a health condition, like seizures or a thyroid condition. The thyroid is a gland in your neck that makes hormones that help your body store and use energy from food. 
  • Your blood and your baby’s blood are incompatible (can’t be together). This puts your baby at risk of Rh disease, which can cause serious problems — even death — for your baby. You can get a blood test during pregnancy to see if your blood and your baby’s blood are incompatible.
  • You come in contact with a harmful substance, like mercury. During pregnancy, don’t eat fish with high levels of mercury, like swordfish, king mackerel, shark and tilefish. 
  • Your baby doesn't get enough oxygen in the womb. This can happen if the placenta isn't working properly or it tears away from the wall of the uterus before birth. 
  • Your baby has bleeding in the brain. Sometimes a baby has a stroke in the womb that causes bleeding in her brain. Stroke happens when a blood clot (a mass or clump of blood) blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open. Blood clots in the placenta, weak blood vessels and high blood pressure during pregnancy can cause a baby to have a stroke in the womb. 

Your baby may be more likely than other babies to develop CP during labor and birth if:

  • He’s in the breech position at the start of labor. This is when your baby’s bottom or feet are facing down right before birth.
  • He doesn't get enough oxygen during labor and birth. This can happen if there are problems with the umbilical cord or you have a health condition, like uterine rupture. Uterine rupture is when the uterus tears during labor. This happens very rarely.
  • He’s born prematurely. This is when a baby is born too early, before 37 weeks of pregnancy.
  • He’s born with low birthweight or he’s born small for gestational age (also called SGA). Low birthweight means a baby weighs less than 5 pounds, 8 ounces at birth. SGA means a baby is smaller than normal based on the number of weeks he’s been in the womb.  

Babies who have certain health conditions after birth are more likely than others to develop CP. These conditions include:

  • Severe jaundice, especially if it’s not treated early. Jaundice is when your baby’s eyes and skin look yellow. A baby has jaundice when her liver isn’t fully developed or isn’t working well. Some blood diseases, like Rh disease, can cause severe jaundice and brain damage in babies. 
  • Head injuries. A baby may get a head injury from being in a car accident or falling and hitting her head.  
  • Brain infections, like encephalitis and meningitis. Encephalitis is swelling of the brain; it’s usually caused by a virus. Meningitis is an infection that causes swelling in the brain and spinal cord.
  • Seizures

Last reviewed July 2014

Call your provider now if your baby

  • Has a temperature above 100.4º F
  • Has trouble breathing or is hard to waken
  • Has blood in her vomit or stool
  • Has yellowish skin or eyes
  • Is having a seizure

Most common questions

Can dad's exposure to chemicals harm his future kids?

Dad's exposure to harmful chemicals and substances before conception or during his partner's pregnancy can affect his children. Harmful exposures can include drugs (prescription, over-the-counter and illegal drugs), alcohol, cigarettes, cigarette smoke, chemotherapy and radiation. They also include exposure to lead, mercury and pesticides.

Unlike mom's exposures, dad's exposures do not appear to cause birth defects. They can, however, damage a man's sperm quality, causing fertility problems and miscarriage. Some exposures may cause genetic changes in sperm that may increase the risk of childhood cancer. Cancer treatments, like chemotherapy and radiation, can seriously alter sperm, at least for a few months post treatment. Some men choose to bank their sperm to preserve its integrity before they receive treatment. If you have a question about a specific exposure, contact the Organization of Teratology Information Specialists at www.otispregnancy.org.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

Does cleft lip or cleft palate cause dental problems?

A cleft lip or cleft palate that extends into the upper gums (where top teeth develop) can cause your baby to have certain dental problems, including:

  • Missing teeth
  • Too many teeth
  • Oddly shaped teeth
  • Teeth that are out of position around the cleft

Every baby with a cleft lip or palate should get regular dental checkups by a dentist with experience taking care of children with oral clefts. Dental problems caused by cleft lip or palate usually can be fixed. If needed, your baby can get ongoing care by a team of experts, including:

  • A dentist
  • An orthodontist to move teeth using braces
  • An oral surgeon to reposition parts of the upper jaw, if needed, and to fix the cleft

See also: Cleft lip and cleft palate

 

Does cleft lip or cleft palate cause ear problems?

Cleft lip does not cause ear problems.

Babies with cleft palate, however, are more likely than other babies to have ear infections and, in some cases, hearing loss. This is because cleft palate can cause fluid to build up in your baby’s middle ear. The fluid can become infected and cause fever and earache. If fluid keeps building up with or without infection, it can cause mild to moderate hearing loss.

Without treatment , hearing loss can affect your baby’s language development and may become permanent.

With the right care, this kind of hearing loss is usually temporary. Your baby’s provider may recommend:

  • Having your baby’s ears checked regularly for fluid buildup
  • Medicines for treating fluid buildup and ear infections
  • Ear tubes if your baby has fluid in his ears over and over again. Ear tubes are tiny tubes that are inserted into the eardrum to drain the fluid and help prevent infections.

See also: Cleft lip and cleft palate

Does cleft lip or cleft palate cause problems with breastfeeding?

Babies with only a cleft lip usually don’t have trouble breastfeeding. Most of the time, they can breastfeed just fine. But they may need some extra time to get started.

Babies with cleft lip and palate or with isolated cleft palate can have:

  • Trouble sucking strong enough to draw milk through a nipple
  • Problems with gagging or choking
  • Problems with milk coming through the nose while feeding

Most babies with cleft palate can’t feed from the breast. If your baby has cleft palate, he can still get the health benefits of breastfeeding if you feed him breast milk from a bottle. Your provider can show you how to express (pump) milk from your breasts and store breast milk.

Your baby’s provider can help you start good breastfeeding habits right after your baby is born. She may recommend:

  • Special nipples and bottles that can make feeding breast milk from a bottle easier
  • An obturator. This is a small plastic plate that fits into the roof of your baby’s mouth and covers the cleft opening during feeding.

See also: Cleft lip and cleft palate, Breastfeeding

Does cleft lip or cleft palate cause speech problems?

Children with cleft lip generally have normal speech. Children with cleft lip and palate or isolated cleft palate may:

  • Develop speech more slowly
  • Have a nasal sound when speaking
  • Have trouble making certain sounds

Most children can develop normal speech after having cleft palate repair. However, some children may need speech therapy to help develop normal speech.

See also: Cleft lip and cleft palate

What are choroid plexus cysts?

The choroid plexus is the area of the brain that produces the fluid that surrounds the brain and spinal cord. This is not an area of the brain that involves learning or thinking. Occasionally, one or more cysts can form in the choroid plexus. These cysts are made of blood vessels and tissue. They do not cause intellectual disabilities or learning problems. Using ultrasound, a health care provider can see these cysts in about 1 in 120 pregnancies at 15 to 20 weeks gestation. Most disappear during pregnancy or within several months after birth and are no risk to the baby. They aren't a problem by themselves. But if screening tests show other signs of risk, they may indicate a possible genetic defect. In this case, testing with higher-level ultrasound and/or amniocentesis may be recommended to confirm or rule out serious problems.

What if I didn't take folic acid before pregnancy?

If you didn’t take folic acid before getting pregnant, it doesn't necessarily mean that your baby will be born with birth defects. If women of childbearing age take 400 micrograms of folic acid every day before and during early pregnancy, it may help reduce their baby’s risk for birth defects of the brain and spin called neural tube defects (NTDs). But it only works if you take it before getting pregnant and during the first few weeks of pregnancy, often before you may even know you’re pregnant.

Because nearly half of all pregnancies in the United States are unplanned, it's important that all women of childbearing age (even if they're not trying to get pregnant) get at least 400 micrograms of folic acid every day. Take a multivitamin with folic acid before pregnancy. During pregnancy, switch to a prenatal vitamin, which should have 600 micrograms of folic acid.

Last reviewed November 2012

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