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Cerebral Palsy

A group of lifelong conditions that affect movement, balance and posture, caused by differences in the developing brain. CP does not get worse over time, and early therapy, the right equipment and good support help children and adults live full lives.

What is cerebral palsy?

Cerebral palsy (CP) is a group of disorders that affect movement, balance and posture. It is caused by the brain developing differently or by damage to the developing brain (CDC). This can happen before birth, during birth, within the first month after birth, or in the first years of life (CDC). CP does not get worse over time, though symptoms can change throughout a person’s life. There is no cure, but treatment can improve quality of life (CDC).

CP looks very different from person to person. Someone with mild CP may need no help at all, while someone with severe CP may need special equipment or lifelong care (NINDS).

How common is it?

CP is the most common motor disability in childhood (CDC). A review of the research puts it at about 1 in 500 live births (Novak et al., JAMA Pediatrics, 2017). CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network restarted tracking CP in 2023, at sites in Georgia, Minnesota, Missouri, Tennessee and Utah (CDC). Its 2022 data found CP in about 2.4 per 1,000 eight-year-olds and 2.2 per 1,000 four-year-olds; nearly 58 percent of the children could walk on their own, and children born in 2018 were diagnosed earlier than those born in 2014 (Vanderbilt University Medical Center, 2026).

Causes and risk factors

Most CP (85 to 90 percent) is congenital — it begins before or during birth, and often the exact cause is unknown (CDC). Lack of oxygen during birth was once thought to be a main cause, but it now appears to explain only a small number of cases (CDC). Factors that raise the risk include (CDC):

  • Low birthweight (under 5 lb 8 oz, and more so under 3 lb 5 oz) and premature birth (before 37 weeks, and more so before 32 weeks);
  • twins, triplets and other multiple births;
  • infections during pregnancy, such as chickenpox, rubella or cytomegalovirus (CMV), and infections of the placenta;
  • severe, untreated newborn jaundice, which can cause a brain injury called kernicterus;
  • problems during birth, such as the placenta detaching or umbilical cord problems, that cut off the baby’s oxygen supply.

Acquired CP starts more than 28 days after birth and is much less common; it is usually linked to an infection such as meningitis, or a head injury (CDC). Some causes can be prevented — for example with vaccines before pregnancy, prenatal care, a newborn jaundice check, and car seats and helmets (CDC, NINDS). Most children born with risk factors don’t develop CP (NINDS), and parents should not blame themselves.

Types of CP

  • Spastic CP — stiff muscles — is the most common type, affecting about 80 percent of people with CP. It is described by the body parts affected: mainly the legs (diplegia), one side of the body (hemiplegia), or all four limbs, the trunk and the face (quadriplegia, the most severe form) (CDC).
  • Dyskinetic CP causes slow, writhing or fast, jerky movements that are hard to control, which can make sitting, walking, swallowing and talking harder (CDC).
  • Ataxic CP affects balance and coordination, making quick or precise movements such as writing hard (CDC).
  • Mixed CP combines more than one type; spastic-dyskinetic is the most common mix (CDC).

GMFCS: describing how a child moves

Care teams often use the Gross Motor Function Classification System (GMFCS), a five-level scale of how a child or young person usually sits, walks and gets around at home, school and in the community (CanChild). The levels are: I, walks without limitations; II, walks with limitations; III, walks using a hand-held mobility device; IV, self-mobility with limitations, may use powered mobility; and V, transported in a manual wheelchair. It describes what a child usually does, not what they can do at their best, and it is not a judgment about future improvement (GMFCS – E&R, CanChild). Teams also use it to plan care such as hip checks (AACPDM).

Early signs by age

Babies with CP are often slower to roll over, sit, crawl or walk. They may feel floppy or stiff, or favor one side of the body (NINDS). NINDS describes signs such as:

  • Under 6 months: the baby feels floppy or stiff, the head lags when you pick the baby up from lying on the back, or the legs stiffen and cross (scissor) when lifted;
  • Over 6 months: the baby can’t roll over in either direction, can’t bring the hands together or to the mouth, or reaches with only one hand while the other stays in a fist;
  • Over 10 months: the baby crawls in a lopsided way, pushing off with one hand and leg while dragging the other, or can’t stand even with support (NINDS).

These signs don’t always mean CP, but talk with your child’s doctor if you notice them. If any of these signs appear suddenly, call 911, because they could be signs of a stroke (NINDS).

Early detection and diagnosis

Doctors watch development at every well-child visit, and the American Academy of Pediatrics recommends developmental screening at 9, 18 and 24 or 30 months — or any time parents are concerned (CDC). CP is generally diagnosed in the first or second year of life, although mild CP can take a few years to confirm (CDC).

Earlier is now possible. Using a combination of standardized tools, CP or “high risk of CP” can be detected accurately and early (AACPDM). Before 5 months’ corrected age, the most predictive tools are a brain MRI, the General Movements Assessment and the Hammersmith Infant Neurological Examination, and diagnosis can now be made before 6 months’ corrected age rather than at 12 to 24 months (Novak et al., 2017). The American Academy for Cerebral Palsy and Developmental Medicine advises against “wait and see” when clear signs exist, and says a parent’s concern is a valid reason to start testing and refer to early intervention (AACPDM). Tests can also look for a cause and rule out other conditions; if a child keeps losing movement skills, the problem is likely not CP (NINDS).

Conditions that often come with CP

Everyone with CP has movement and posture differences, and many also have other conditions (CDC). Among children with CP, a large review found that 3 in 4 had pain; 1 in 2 had an intellectual disability; 1 in 3 could not walk; 1 in 3 had hip displacement; 1 in 4 could not talk; 1 in 4 had epilepsy; 1 in 4 had bladder control problems; 1 in 5 had a sleep disorder; 1 in 5 drooled; 1 in 10 were blind; 1 in 15 were tube-fed; and 1 in 25 were deaf (Novak et al., Pediatrics, 2012). Half of all children with CP have swallowing difficulties (dysphagia) (Novak et al., 2020). Turned the other way: in high-income countries, 2 in 3 people with CP will walk, 3 in 4 will talk, and 1 in 2 will have typical intelligence (Novak et al., 2017).

Adult life and outlook

CP is lifelong, and long-term care may be needed. Many adults live in the community, on their own or with varying help; outlook varies a great deal with the type of CP and related health problems, such as swallowing difficulties, so ask your care team what to expect (MedlinePlus). Adults can face new challenges with age: premature aging, pain, fatigue and weakness (post-impairment syndrome), osteoarthritis, and higher rates of depression, high blood pressure, bladder problems and swallowing difficulties. Adults with CP have sex drives and can have an active sexual life, and many keep working, some with accommodations (NINDS). Regular neurological follow-up in adulthood helps reduce late complications (MedlinePlus).

Call 911 if a seizure lasts longer than 5 minutes, another seizure follows soon after, the person has trouble breathing or waking up afterward, is injured, or the seizure happens in water (CDC). Call 911 too if someone is choking and can’t speak or breathe, makes high-pitched sounds, or turns bluish (MedlinePlus).

Baclofen pump users: stopping intrathecal baclofen suddenly — for example from a catheter problem, an empty pump or a dead battery — can cause high fever, confusion, severe rebound stiffness and muscle rigidity, and in rare cases organ failure and death. Early warning signs include returning stiffness, itching, low blood pressure and tingling. Withdrawal needs fast treatment in an emergency room or intensive care, so call the pump team right away or go to the ER, and never miss a refill visit or ignore a pump alarm (FDA-approved drug label).

Get prompt care for feeding trouble. Coughing or gagging during meals, a wet or hoarse voice, or breathing trouble while eating can be signs of a swallowing problem, which can let food or drink enter the airway and lead to pneumonia (ASHA). After a choking episode, contact a doctor promptly for a cough that won’t go away, fever, shortness of breath or wheezing (MedlinePlus).

Be wary of “cures”. Alternative therapies have not been approved by the FDA for treating CP (NINDS). The FDA warns that there is a lot of misleading information online about stem cell products; generally all stem cell products need FDA approval, and the only approved ones are cord-blood stem cells for certain blood disorders (FDA). Stem cell therapy for CP is still being studied (NINDS); in clinical trials, umbilical cord blood cells given with rehabilitation were slightly more effective than rehabilitation alone, but access is limited (Novak et al., 2020). Research studies are not the same as paying a clinic for an unapproved product. Hyperbaric oxygen chambers are FDA-cleared only for specific uses, such as decompression sickness and carbon monoxide poisoning — CP is not one of them (FDA (archived)) — and in trials for CP, hyperbaric oxygen showed no motor-skill benefit over comparison groups, while serious side effects occurred (Novak et al., 2020). Talk with your child’s doctor about any therapy or supplement (NINDS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A family-centered team from early on: physical, occupational and speech therapy; braces and mobility devices; spasticity treatments such as botulinum toxin injections, oral medicines, an intrathecal baclofen pump, selective dorsal rhizotomy and orthopedic surgery; seizure, pain, feeding and hip care; and early intervention and school services. Without insurance, physical therapy runs about $50–$350+ a session, speech therapy $100–$250 an hour and occupational therapy $50–$400 an hour. Early intervention under age 3 is free or reduced-cost; school services are free under IDEA; Medicaid covers medically necessary care for enrolled children. Equipment, injections and surgery: cost estimate being researched. No cure, and CP doesn’t get worse, though needs change with age. Early, steady therapy builds skills; in high-income countries 2 in 3 people with CP walk and 3 in 4 talk, and many adults live in the community.
Chiropractic We found no trials of chiropractic care for CP. A review of manual therapy in children found only osteopathic studies in CP, with unclear results. Not applicable. Not a treatment for CP. Hip and spine problems need medical follow-up; ask your team before any spinal manipulation.
Acupuncture Sometimes used alongside rehabilitation. Nearly all trials come from China; most are small and of unclear quality. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Reviews report modest gains in motor scores and muscle tone when added to therapy, but a U.S. pilot trial found no benefit. Treat it as unproven.
Herbal medicine No herb or supplement has been shown to treat CP. Not applicable. Some herbs can make seizures more likely or clash with seizure medicines. Always check with your doctor and pharmacist first.
Massage therapy Gentle massage for comfort and relaxation, alongside — not instead of — therapy. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics. Parent massage at home is free. Small studies suggest short-term easing of tight muscles, pain and constipation; massage probably doesn’t improve motor skills.
MBHA Wellness Coach Family-centered support: early intervention and school plans, feeding and nutrition, sleep, adaptive sports and play, respite and caregiver well-being, the move to adult care, and help paying for care (Medicaid waivers, SSI, California regional centers). Cost estimate being researched. Many supports named here — early intervention evaluations, regional center intake, Parent Centers — are free. Supports — never replaces — your child’s medical and therapy team.

Approach 1 of 6

Conventional medicine (AMA)

CP care works best as a team. After diagnosis, health professionals work with the family to identify the child’s needs and build a plan; there is no single therapy that works for everyone, and the earlier treatment begins, the better (NINDS). The team may include primary care, therapists, a neurologist, a rehabilitation physician, a gastroenterologist, a dentist and a social worker, and the goal is the greatest possible independence (MedlinePlus). We name treatments but never doses — your team will tailor them.

1. Therapy

  • Physical therapy — stretching, strength and activity programs — can keep or improve strength, balance and movement and help prevent contractures (permanently shortened muscles) (NINDS).
  • Occupational therapy helps with everyday routines at home, school and in the community; speech and language therapy helps with speaking, eating and swallowing, and with other ways to communicate, such as sign language or devices that speak (NINDS).
  • What works best: a 2020 review graded the evidence on CP interventions. Active, goal-focused approaches had good evidence — for example goal-directed and task-specific training, constraint-induced movement therapy, bimanual training, strength and fitness training, treadmill training and home programs. Passive approaches, such as craniosacral therapy, hyperbaric oxygen and sensory integration, were found ineffective for improving function (Novak et al., 2020).

2. Braces, mobility and communication devices

Orthotics (braces and splints), special chairs, walkers and wheelchairs help people with CP move and sit more comfortably; computer software, voice synthesizers and picture books can help with communication. Some people also need glasses, eye surgery or hearing aids (NINDS).

3. Treating stiffness (spasticity)

  • Oral medicines can relax stiff muscles, especially when stiffness is mild or affects the whole body, and may ease pain (NINDS).
  • Botulinum toxin injections into specific muscles are often used in spastic CP. Relief lasts about three months and works best with physical therapy and splints (NINDS).
  • Intrathecal baclofen uses an implanted pump to deliver medicine into the fluid around the spinal cord, for severe stiffness or uncontrolled movement throughout the body (NINDS). Know the warning signs of a pump problem (see the alert at the top of this page).
  • Selective dorsal rhizotomy, a nerve surgery, and the three treatments above all had good evidence for reducing spasticity in the 2020 review (Novak et al., 2020).
  • Orthopedic surgery can lengthen muscles and tendons when stiffness makes walking difficult or painful, and can correct spine curvature (NINDS).

4. Hip surveillance

About 1 in 3 children with CP in high-income countries develop progressive hip displacement, and regular hip surveillance to find it early is strongly recommended (Novak et al., 2020). Surveillance means a clinical exam plus a hip X-ray, ideally starting by age 2 or as soon as CP is diagnosed or suspected, and checks become more frequent at higher GMFCS levels (AACPDM). Ask your team about a hip surveillance schedule.

5. Seizures, pain, feeding and other health needs

  • Seizures are treated with anti-seizure medicines (MedlinePlus). Ask the neurologist for a written seizure plan.
  • Pain is very common (see the overview) and is often felt in the hips, knees, ankles and back. Treating bone and muscle problems early in life may help prevent pain later (NINDS). Tell your team about pain, including signs of pain in children who don’t speak.
  • Feeding and swallowing: a feeding team led by a speech-language pathologist can adjust food textures, liquids and positioning; in severe cases, nutrition may come through a tube (ASHA). Botulinum toxin may be used for drooling, and surgery may be needed for reflux or a feeding tube (MedlinePlus).
  • Bones, bowels and teeth: possible complications include thin bones, bowel problems, falls, pressure sores and pneumonia from choking (MedlinePlus). Dental care had good evidence in the 2020 review (Novak et al., 2020).

6. Early intervention and school

  • Start early. Early intervention can begin before a CP diagnosis, and a doctor’s referral or diagnosis is not needed to contact your state’s program (CDC). Services are free or reduced-cost for eligible children (CDC) and can include physical, occupational and speech therapy, assistive technology, family training and service coordination, planned in an Individualized Family Service Plan (IFSP) (CDC). This is Part C of the federal Individuals with Disabilities Education Act (IDEA) (ECTA Center).
  • Age 3 and up: call your local public elementary school and ask for an evaluation (CDC). Under IDEA Part B, children with disabilities have the right to a free appropriate public education (ECTA Center), with special education, related services such as therapy, and aids such as adaptive equipment or communication systems, planned in an Individualized Education Program (IEP) (CDC). Mainstream schooling is generally recommended where practical, with special education support (MedlinePlus).

7. Growing up: the move to adult care

Adults with CP can develop new health challenges with age (see the overview), so care shouldn’t stop at 18 (NINDS). Got Transition, a national program on moving from pediatric to adult health care, recommends starting to plan at ages 12 to 14, with the transfer of care at ages 18 to 21 (Got Transition).

What it costs

  • Physical therapy without insurance: about $50–$350 or more per session, with higher hospital charges; with insurance, a $10–$75 copay or 10–50 percent coinsurance (CostHelper).
  • Speech therapy without insurance: about $200–$250 for an initial assessment, then about $100–$250 an hour. Many plans limit sessions or cover only short-term therapy, not developmental delays (CostHelper).
  • Occupational therapy without insurance: about $150–$200 for an evaluation, then $50–$400 an hour; hospitals tend to charge more (CostHelper).
  • Free or low-cost routes: early intervention under age 3 (CDC) and school services under IDEA (ECTA Center).
  • Medicaid: children under 21 enrolled in Medicaid are entitled to EPSDT, which covers medically necessary services to correct or ameliorate health conditions (Medicaid.gov). See the Wellness Coach section for waivers, SSI and California regional centers.
  • Braces, wheelchairs and other equipment, botulinum toxin injections, baclofen pumps and surgery: cost estimate being researched.

What to expect

CP can’t be cured, but treatment can help improve a child’s abilities, and many people with CP are able to manage their symptoms (NINDS). Needs change over a lifetime, so plans should be reviewed as children grow and as adults age.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

We found no clinical trials of chiropractic care for cerebral palsy. A 2019 systematic review of manual therapy in children, written by chiropractic researchers, found three trials in CP — all of osteopathic treatment, not chiropractic — and rated the evidence inconclusive (systematic review, BMC Complement Altern Med, 2019). The largest, with 142 children, found no lasting improvement in movement, pain, sleep or quality of life (systematic review, 2019). A 2020 review of CP research rated craniosacral therapy as ineffective for improving function (Novak et al., 2020).

Safety

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Approach 3 of 6

Acupuncture

Acupuncture is widely used for CP in China, and most of the research comes from there.

What the research says

Safety

In the 2024 meta-analysis, no serious side effects were reported (meta-analysis, 2024). Complications are uncommon, but acupuncture done improperly can cause infections, punctured organs or nerve injury; in the U.S., needles must be sterile and single-use (NCCIH). Choose a licensed acupuncturist experienced with children, keep therapy going, and let your child’s team know.

What it costs

Published examples run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit. Insurance coverage varies (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been shown to treat cerebral palsy. Alternative therapies, including dietary supplements, have not been approved by the FDA for CP, and families should discuss every therapy and supplement with their doctor (NINDS). Because about 1 in 4 children with CP has epilepsy (Novak et al., 2012), safety comes first.

Herbs and seizure medicines can clash. The Epilepsy Foundation says none of the traditional herbal remedies for seizures has been proven safe and effective; a few herbs may make seizures more likely, and many can interact with seizure medicines. Never swap an herbal product for a prescribed seizure medicine (Epilepsy Foundation).

  • Many supplements have never been tested in children, so be cautious before giving one to a child (NCCIH).
  • “Natural” doesn’t always mean safe, labels don’t always match what is in the bottle, and some supplements interact with medicines — St. John’s wort, for example, makes many medicines less effective (NCCIH).
  • Show every supplement to your child’s doctor and pharmacist, especially with seizure, muscle-relaxing or reflux medicines. For feeding and growth concerns, ask for a dietitian through the feeding team (ASHA). We don’t list doses here.

Approach 5 of 6

Massage therapy

Many families find gentle massage soothing for tight muscles and stress. It works best as a comfort measure alongside active therapy.

What the research says

  • A 2026 meta-analysis of four small randomized trials (253 people with stroke or CP) found massage reduced spasticity, including in children with CP, but it did not consistently improve everyday function, and most massage was given alongside regular rehabilitation. The authors suggest it as a warm-up before therapy (meta-analysis, NeuroRehabilitation, 2026).
  • The 2020 review of CP interventions found massage probably doesn’t improve motor skills, but it appeared to help reduce constipation, and it may help reduce pain (Novak et al., 2020).

Safety

The risk of harm from massage appears low, though rare serious problems such as blood clots, nerve injury or broken bones have been reported, some with vigorous deep-tissue massage (NCCIH). Thin bones are possible in CP (MedlinePlus), so ask your team which pressure is safe and which areas to avoid (for example after surgery), and don’t use massage to put off seeing a doctor (NCCIH). A therapist can also teach you simple home massage.

What it costs

Private therapists charge about $60–$120 for 45–60 minutes; clinics, gyms and spas about $50–$90 (CostHelper). Massage you learn to give at home is free.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Raising a child with CP is full of love and hard work. An MBHA Wellness Coach can help the whole family with the everyday side of care — alongside, never instead of, your child’s doctors and therapists.

Getting services started

  • Trust your instincts: a parent’s concern is reason enough to ask for testing and an early intervention referral (AACPDM). You can contact the program yourself, without a referral or diagnosis (CDC).
  • Parent Centers — nearly 100 across the U.S. — help families of children with disabilities from birth to 26 take part in their child’s education and development, including IFSP and IEP meetings (CPIR).

Feeding, nutrition and sleep

  • Watch for long feeding times, coughing or gagging at meals, refusing food, or poor weight gain, and ask for a feeding team that can include a speech-language pathologist and a dietitian (ASHA). Home care for CP includes good nutrition, bowel care and the exercises your therapists recommend (MedlinePlus).
  • About 1 in 5 children with CP has a sleep disorder (Novak et al., 2012). A coach can help you keep a sleep and pain diary to share with your team.

Adaptive sports and play

Fitness training, strength training and mobility training all had good evidence in the 2020 review (Novak et al., 2020). For adults with disabilities, CDC says some activity is better than none and suggests options such as swimming and water aerobics, wheelchair basketball, seated volleyball, hand-crank cycling, adaptive skiing and horseback riding — and talking with a doctor about the right amount (CDC). A coach can help your family find inclusive programs nearby.

Growing up and moving to adult care

Start planning the move to adult health care in early adolescence (Got Transition), and look ahead to work, independence and relationships — areas where many adults with CP thrive with the right support (NINDS).

Caring for the caregivers

  • Caregiver stress and burnout are common, and support groups can help (MedlinePlus). Depression is also three to four times more common in people with disabilities such as CP, and emotional support and coping make a real difference (NINDS).
  • NINDS lists family organizations such as the Cerebral Palsy Foundation, United Cerebral Palsy, Easter Seals and the Children’s Hemiplegia and Stroke Association (NINDS).
  • Respite — short breaks while someone else provides care — is one of the services Medicaid home and community-based waivers can cover (Medicaid.gov).

Help paying for care

  • California regional centers: state law names cerebral palsy as a developmental disability. To qualify for ongoing services it must begin before age 18, be expected to last indefinitely, and cause significant limitations in three or more areas such as self-care, language, learning, mobility or self-direction; children under 5 can be provisionally eligible with limitations in two areas. Services are set in an individual program plan and can include physical, occupational and speech therapy, adaptive equipment, respite, recreation, family training and transportation (Cal. Welf. & Inst. Code §4512). Contact the regional center for your county to ask for an intake.
  • Medicaid waivers: states run home and community-based services (HCBS) waivers for people who would otherwise need institutional-level care; states can target groups such as people with cerebral palsy. Waivers can cover case management, personal care, habilitation and respite, and can set aside a parent’s income. Each state caps the number of places (Medicaid.gov), so ask early.
  • SSI for children: Supplemental Security Income can pay a monthly benefit to a child whose condition causes marked and severe functional limitations expected to last at least 12 months. For a child living at home, part of the parents’ income and resources is counted. In most states a child who gets SSI can also get Medicaid (Social Security Administration).
  • Medicaid EPSDT covers medically necessary care for enrolled children under 21 (Medicaid.gov).

Another approach

Hippotherapy (therapeutic horseback riding)

In hippotherapy, a therapist uses the movement of a horse as part of physical, occupational or speech therapy. Many children with CP enjoy it, and the research is encouraging.

What the research says

  • The 2020 review of CP interventions rated hippotherapy as effective, with good evidence that it improves body symmetry (Novak et al., 2020).
  • A 2025 systematic review of 25 studies (602 children, ages 3 to 14) found that 20 of the 22 studies using a standard motor test reported meaningful gains, especially in standing and walking. But the studies were of moderate quality, mostly small and not blinded, and the one study that checked GMFCS level found no change (systematic review, NeuroRehabilitation, 2025).

Before you start

Ask your child’s doctor and therapist whether riding is safe, especially with hip displacement, uncontrolled seizures or recent surgery, and look for sessions led by a licensed therapist. Cost estimate being researched. In California, therapy and recreation are among the services a regional center can include in a person’s plan (Cal. Welf. & Inst. Code §4512), so it is worth asking.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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