A pregnant woman in her 30th week of pregnancy got infected with German measles or Rubella. After delivery the baby was found to have severe jaundice. As the months progressed, the infant started showing developmental delays. The infant had difficulty in swallowing, crawling, and later on, in walking and also speech development. After series of diagnostic tests conducted by the doctor, the child was confirmed to be having cerebral palsy.
Understanding Cerebral Palsy
Cerebral palsy is not a disease but it is a group of disabilities that affect children very early in life. It may be mild or severe in nature. Children with cerebral palsy have weak or stiff muscles resulting in uncoordinated muscle movements and difficulty in controlling the muscle movements.
Cerebral palsy can occur at any stage- in the fetus stage, during delivery or after birth of the child. During pregnancy, if infections like chicken pox or rubella affect the mother, then there is a chance that there can be brain damage to the developing fetus, resulting in cerebral palsy. If there is disruption of blood supply to the developing fetus, then a fetus stroke occurs resulting in cerebral palsy.
In case of a difficult delivery, there can be lack of oxygen to the baby’s brain resulting in its damage leading to cerebral palsy. Severe jaundice (yellow discoloration of skin due to bile pigment), meningitis (swelling of membranes around brain and spinal cord), and viral encephalitis (swelling of brain due to viral infection) can cause cerebral palsy in infants. The other causes of cerebral palsy in infants include malnutrition, lead poisoning, shaken baby syndrome (baby shaken as an infant), and trauma to head during a car accident.
Types of Cerebral palsy
There are three types of cerebral palsy. In Spastic Cerebral Palsy, a single leg on one side or both legs and arms can be affected, and the child may have difficulty in movement as the muscles become stiff. In Athetotic Cerebral Palsy, the entire body is affected and the body shows slow movements which are not controlled. Ataxic Cerebral Palsy is the least common of the three types. In this type, there is no coordination and balance in the body.
A child with cerebral palsy may have stiff or floppy muscles with no muscle coordination (ataxia), and involuntary movements or tremors. The reflexes may be exaggerated, a condition called as spasticity, and there could be writhing movements that are slow (athetosis). The child may have delay in sitting up or crawling, and face difficulty in walking, eating or sucking, and speaking. The child may use only one side of body like reaching things with only one hand. The other problems associated with cerebral palsy included mental retardation, disability in learning, difficulty in hearing, vision problems, seizures, dental problems, and involuntary leakage of urine.
The doctor may conduct a series of tests to check for brain damage. To get 3D cross sectional image of the brain, a magnetic resonance imaging procedure is done in which radio waves and a magnetic field is used to produce required images of the brain. This is a painless procedure and takes about one hour to complete. The child is given a mild sedative for the procedure. Another procedure that is used is cranial ultrasound in which sound waves of high frequency are used to produce detailed images of the brain. In a procedure known as computerized tomography (CT scan), X rays are used to get cross sectional images of the child’s brain. It takes about 20 minutes for this procedure and the child is given a mild sedative so that he or she remains still during the procedure. If the child has seizures, then an EEG (electro encephalogram) is taken to check for the electrical activity of the child’s brain.
To rule out underlying problems that can cause cerebral palsy, lab tests like blood tests and assessment tests by specialists are done. The tests are done to find out if the child has any problems like blood clotting disorders, hearing impairment, vision problem, speech delays, mental retardation, and developmental delays.
There is no cure for cerebral palsy. However, the doctor may advise therapies that are beneficial for the child. Physical therapy involves muscle training and exercise to help the child develop balance, coordination, flexibility, and strength of muscles. The child also learns to sit on a wheel chair, use crutches, braces, and splints which will improve the child’s walking ability. In occupational therapy, the child is taught how to do normal activities at home and school like writing and improving on motor skills. In speech therapy, the child is taught how to speak in words or sign language and how to eat and swallow.
Muscle relaxants may be prescribed to reduce the stiffness of muscles. They include drugs like baclofen, dantrolene (dantrium), tizanidine (zanaflex), diazepam (diazepam, intensol, valium). In case of seizures, the doctor prescribes anticonvulsant. To reduce spasticity of muscle, Botox injections are directly given into the muscle or nerve.
Orthopedic surgery is recommended in children who have deformed bones and joints. The surgery helps in placing bones and joints in correct positions, and also to lengthen muscles and tendons that become too short due to contractures. Nerves that innervate the spastic muscles are surgically cut to relax the muscles and reduce pain.
Inspiring Jerry Traylor
‘Twelve individuals have landed on the moon and only one has jogged across America on crutches’. This one sentence says a lot about Jerry Traylor who is a well known motivational speaker with Cerebral palsy. When Jerry was just 6 years of age, he spent a year at the hospital getting 14 corrective surgeries done for his walking disability caused due to cerebral palsy. Jerry went on to participate in 35 marathons and climbing the top of 14,110 foot Pike’s Peak overcoming his disability. In Jerry’s own words he says, “Success is learning to control our limitations, rather than those limitations to gain control over us.”
When the baby is not growing at the normal growth rate inside the womb, then it is termed as intrauterine growth restriction (IUGR). The babies with IGUR have health problems during pregnancy and also at birth. The problems include high risk of being still born, high stress during delivery through vagina, low blood sugar level at birth, low body weight(below 10th percentile for its gestational age), low immunity to fight infections, difficulty in maintaining body temperature and abnormally high red blood cell count.
Intrauterine growth restriction may be due to the mother having kidney disease, infections caused by cytomegalovirus, syphilis, toxoplasmosis and syphilis; heart disease, high blood pressure, diabetes, sickle cell anemia, problem in placenta (tissue that supplies nutrients and oxygen from mother to baby), chromosomal and congenital abnormalities; alcohol abuse, smoking, drugs, prescribed medication, high altitudes, twins and triplets in the womb; low socioeconomic status resulting in poor nutrition; preeclampsia (condition with high blood pressure and protein in urine at 20th week of pregnancy) and eclampsia (seizures during pregnancy).Identifying an IUGR baby
To check the growth of the baby in the womb, the doctor performs ultrasound in which sound waves of high frequency are passed through the abdomen which gives you images of the baby inside. With the help of the ultrasound the doctor measures the baby’s head, abdomen and legs, and checks if the baby is growing normally. In babies with IUGR, the amniotic fluid (protective fluid present in the amniotic sac holding the baby) may be low. This can also be checked with the help of an ultrasound. Only 1/3rd of the babies who are smaller than normal have IUGR. Babies can also be small because of genetic factors (having small babies running in the family).Diagnosis
To check the health of the baby inside the uterus, a test called as fetal monitoring is done. You are made to lie down for 30 minutes and your uterus is strapped. The baby’s heartbeat is then recorded. The doctor can make out if the baby’s heart beat is normal or not, by listening to the recording. A normal heartbeat tells you that the baby is in good health. In a procedure known as amniocentesis, a fine needle is passed into the uterus through the skin and few teaspoons of amniotic fluid is withdrawn which is tested to detect the cause of IUGR, infections, genetic problems and chromosomal abnormalities if any. If the uterus in a pregnant woman is found to be small in size, then the doctor suspects intrauterine growth restriction.Delivering an IUGR baby
If your baby has intrauterine growth restriction, it is not necessary that you have to deliver the baby before the due date. The delivery depends on how well the baby is growing inside. If the baby’s growth is growing but slowly, then the doctor will not consider early delivery, but if the baby‘s growth is completely stopped, then the doctor will induce labor and deliver the baby before term. If the baby is doing well, then normal vaginal delivery is done; but if the baby is weak, then it cannot take the stress of normal vaginal delivery. In such cases, the doctor will perform a cesarean section or (c-section). If you take good care of yourself and prevent illnesses before and during the pregnancy term then you can avoid another IUGR baby.Monitoring IUGR baby after delivery
If your baby was born before time, then it will have to stay in the hospital for longer time than usual. The baby’s heart rate, breathing and growth are monitored by the doctor. The baby is kept in the hospital and monitored till it reaches a weight of 5 pounds. The baby should be able to breathe and feed normally. The baby may grow to normal height when it reaches 2 years of age.Preventing IUGR
The best way you can prevent an intrauterine growth restriction is to take good care of your health during pregnancy, by eating nutritious food and getting adequate rest. You must avoid habits like smoking, drugs and drinking alcohol during pregnancy. Monitor your baby’s movements. If your baby is kicking, then it shows that you have a healthy baby. If you do not feel it moving or kicking then you must at once report it to your doctor. Detecting IUGR early can help in better treatment so do not hesitate to call your doctor.