Neurodivergence, Birth Injury & Cerebral Palsy: What Parents Should Know

Can traumatic birth cause cerebral palsy? What exactly is cerebral palsy? Can it be prevented or cured?

In this deeply personal episode, paediatric physiotherapist Lisa Rogers Sergeant shares a side of her career she has rarely spoken about publicly.

After spending more than 25 years working with babies and children including children with complex neurological conditions, Lisa explains how cerebral palsy can be linked to traumatic birth, how neurological disorders can affect movement and development, and why there is always hope.

Rather than creating fear, this episode aims to build understanding, compassion and awareness for children living with neurological disabilities and their families.

Lisa also explains:

• What happens when the brain is injured before, during or shortly after birth
• The incredible ability of a baby's brain to adapt through neuroplasticity
• How physiotherapy and early intervention can dramatically influence outcomes
• What EHCPs (Education, Health and Care Plans) are and how they support children in school
• CMV (cytomegalovirus) infection during pregnancy and why every expectant parent should know about it
• Why she chose an elective caesarean section after years of working with children affected by birth injuries

This episode is also the introduction to a special two-part series.
Next week, Lisa is joined by childbirth attorney Gina Mundy, who explains practical ways parents can reduce the risk of birth injury and discusses what every family should know before labour begins.

Whether you're pregnant, planning a family, or simply want a better understanding of childhood neurological conditions, this is an episode filled with compassion, education and hope.

Mentioned in this episode
Gina Mundy : The Childbirth Attorney Podcast : https://www.youtube.com/@UCWk3fI8M6sQyXRuolBn5IFw 

If you had a traumatic birth and would like to discuss this with Lisa, see how she can help here:
https://physiobaby.co.uk/neuro-physio

Connect with Lisa here!

For help on: 

Baby Flat Head Syndrome (Plagiocephaly and Torticollis), click here!

Positional Talipes (Correctable Club Foot), click here!

Transcript

Over the 25 years I have been working as a physiotherapist, I have had the immense privilege of working with children with all types of neurological difficulties and disorders. And I say privilege because there is no other word to describe it. These are children that I've been able to spend time with, to get to know, and to love with all my heart. These are children whose stories should be told and a spotlight shone on their journeys. However, I don't often speak about it because it's hard not to put fear into the hearts of a pregnant person when discussing these things. Today starts a mini-series on this very topic, and it's one for me that is full of hope. Hope to bring about awareness of these children , and their families, and perhaps more understanding for your children when they are at school with children who have something called an EHCP, if you are in England, or who are being supported by therapists and healthcare professionals so that they can access the education they deserve. Not only do I want to make you aware of this but in the hopes, that with increased understanding and awareness, we can increase integration of these children, and build up friendships and peer groups for them when they are placed in mainstream schools. But not only that, for those of you who are pregnant or are planning on having more children, if this is an episode you feel might make you feel fearful or a bit upset, I'd like to tell you the very exciting news that next week, the second part of this miniseries, I will be interviewing Gina Mundy, who is a childbirth attorney. She has spent her career working with parents who have had childbirth injuries leading to neurological conditions, and she has worked with families where there's a child who has had a neurological difficulty caused during pregnancy or during childbirth. And so she is going to be here, um, to give us ways to minimize these risks. So it's going to be really interesting, perhaps a little emotional, but definitely worth a listen. I hope you enjoy. . Hello, hello, and welcome back to the Best for Baby podcast. I'm your host, Lisa Rogers Sergeant, and as you know, today starts our two-part miniseries, looking at children who have neurological difficulties and disorders and neurodivergence. And as I said it's something I have chosen not to speak about on this podcast because I know I'm speaking to pregnant people and people with little babies. Um, and it can make you really fearful, and I know that firsthand. And if you have been listening to this podcast, you will know that I'd been working as a pediatric physiotherapist for 20 years before I had my own child. And what I don't talk a lot about is the fact that for the last 15 years of my career, it's been very much baby-orientated, and babies without major diagnoses, little things here and there that we can quite easily rectify a lot of the time. But before that, for the 10 years preceding that, nearly all of my work was with children with significant disability, and that is something that, as pediatric physiotherapists, we tend to work the most with. Um, and it wasn't just work. Um, it was a passion. It was a love, and it was something I couldn't keep doing because as I got older, it was really, really physical and exhausting, and I had problems with my back and my hands, and so I purposely started to move towards children who were more able-bodied and smaller and less physically taxing on my body. But for most young pediatric physiotherapists, this is a huge part of their caseload and a huge part of their thoughts, their loves, their passions, what makes that therapist who they are is their relationships with these little children. And so it's always felt a bit odd that I don't talk about that. It doesn't feel honest. It doesn't feel true, um, when I'm focusing on slightly happier things and things that I can give you advice to so we can just correct it and help you. But I think it's a really essential part of who I am as a person and my experiences and my knowledge. And also- These little people I worked with are people, as I say, I have loved.. You know, when ... When children have neurological difficulties, you don't see them once or twice, you see them for years. And some physiotherapists will have seen children from the time they were born right through until they transition into adult services, because they need ongoing therapy. And in the 10 years preceding me working for myself, most of that time was spent working in one hospital, so I stayed there, so I did see children for years. And even when I started to work for myself, initially I did see a lot of children, um, with, you know, older children with neurological difficulties. And as I say, I've been doing it for 12 years, so some of the children I've seen for many, many years. And with these children, you're always working with the family. You- Because you are physical with them, you, you know, you're moving them, you're helping them to crawl, you're helping them to stand, you're on the floor with them, you're lifting them. There's ... It's so close. The contact is close. The conversations are close. You become part of their family, and they feel like part of your family. And so it is time that we speak about this. But also, uh, this is, after all, an educational podcast, so I want it to be something that is helpful for parents, full stop, and people who are expecting to have more children. And I think the second part of that will come more next week when we speak to Gina Mundy, who, as I said, this is her expert field. Um, it is children who have sustained difficulties, who have sustained disability as a result of the childbirth process and pregnancies, and so we're gonna look at minimizing risk there. But today, I want to build awareness, and I want to explain to you, because particularly in this country, we have a wonderful process, um, called the Education Health Care Plan, and this is a plan that, um, is statutory for children who have difficulties. It's all gonna change soon, but at this stage, this is the way it is. And in that plan, any, any healthcare professional who is involved with a child and their teachers come together, and they create a plan .. of , what that child needs in order to have access to their education. So if a child can't move effectively, they might need a special seat. They might need a standing frame. They might need a wheelchair. They might need physiotherapy in order to be able to access all the parts of the classroom and to participate in learning. And so that gets documented and put into this , EHCP plan. Now,, in this country, we always try to place children in schools that are appropriate for them, that can meet their needs. and help them to get the best education they possibly can, but also have a peer group so that they can participate and they can have friends, um, because we know how important that is. So very often children might have one or two difficulties, difficulties in the way they socialize, the way they see the world as in the neurodivergent child, or a child has a movement difficulty, so their body doesn't move the way they want it to, but there's no problem with their cognition and understanding and learning. So very often these children are placed in mainstream schools where they could be in your child's class, and they might have a one-to-one support assistant helping them to access education. Um, they might have other things in place and pieces of equipment. So it's good to have awareness and understanding of this and to speak to our children so that we can help these children to feel integrated and a part of that class and a part of it all so that they can have healthy, supportive friendships. Now, to start, just to kind of, um, ex- put it into categories almost so that I can explain a bit better. If we look at the neurodivergent side, this is children who have ADHD or autism, maybe dyslexia, um, these sorts of difficulties. And this can be a barrier to learning and a barrier to education. And so they will need one of these EHCP plans to help them access, uh, learning effectively. And usually these children need the input of occupational therapists and speech therapists, but less commonly will they need really intensive input from physiotherapists because usually even if there is a delay in attaining their milestones, so very often, um, autistic children may walk very late,, some of them significantly later than, you know, I always talk about the hypermobile child or children with slight delays that may be walking at two years. These children might walk up to the age of five years perhaps, but once they walk, they can walk. , Some of them might walk on time. And, you know, some of them don't have very clear physical difficulties, but often they will have difficulties with stability, or they might walk with , what we call foot slapping, or they might walk up on their toes, or they might, um, you know, just walk slightly differently. And very often a physiotherapist can come in and analyze any physical factors contributing to this and work on that. And usually as physiotherapists, we work on the core. And so a block of physiotherapy to strengthen up that core usually helps things quite nicely. Um, so as physios, we don't tend to do a huge amount of ongoing work with a neurodivergent child, although you, there may be cases where you do, because some are more physically affected than others. Um, but certainly as a physiotherapist, I get involved with these children. I've worked with them, giving them therapy in the past, and now I work, um, when the EHCP plan is being appealed by parents, when parents say, "Actually, my child needs more physiotherapy than has been put in this plan. This plan says the child only needs physiotherapy once a term. And actually my child has been benefiting from having more regular physiotherapy, and so they appeal it. And then I come in and I assess the child, and I might say to the parents, "Actually, once a term is plenty for your child." And that's the end of my involvement. Or I come in and I say, "Actually, this child definitely, based on their w- how they present, they need more input." So as physiotherapists, we also get involved in this EHCP appeal work, and sometimes that can go to tribunal, where we sit and we have a discussion, and there will be a physiotherapist, um, who has, you know, that I'm disagreeing with, and we discuss, and we try and get to something that makes sense in the best interests of the child. And of course, this is for all specialties. So it'll be for the occupational therapists, the speech therapists. Um, the teachers might be there, where they might be, um, contesting the school placement, which place, uh, you know, where the child is going to be sent to school. So that's a big part of our work, um, EHCP appeal work and creating EHCPS, um, in the first place and contributing to them. , But traditionally in the private sector,- it's appealing those EHCPs. And we also do this for children who have got clearer movement difficulties and movement disorders. But usually these children, um, it's more obvious that they need physiotherapy, so there's not so much appeal work being done. I don't do quite so much appeal work. I do more treatment of these children. Well, historically, when I was younger, more treatment of these children, and then I would contribute to making that plan for them and saying how much physiotherapy and what equipment they would need in order to, you know, do their very best. Um, so with these children, where movement is primarily the difficulty, that's more where physios- therapists are working hands-on and strengthening them and, and going through what difficulties do they have. K- is it a little one, and they can't yet sit, or they can't yet crawl? Then those are our goals. Um, if they are two years old, they're not yet standing, then we put them in a standing frame, and we make sure they spend time standing so they can get all the good effects of weight bearing that they're not getting because they're not yet walking and standing themselves. And so we come in and we do therapy for whatever is missing that is a result of that movement disorder or that movement difficulty that the child may have. Um, and when we look at those, there are lots of reasons for it. You know, children can be born with genetic conditions, there can be a number of other neurological conditions that cause these difficulties. And if we were to look at it, it's very much How we treat the child and also what is going to happen to the child, what their journey is going to look like is dependent on where that injury lies. And what I mean by that is if you just oversimplify it, if we take an action, a movement like reaching out to grab something, the brain has to create a message that says, you know, bend, lift the arm, stretch the arm forward, bend the muscle, you know, but it's really, really complicated, exact instructions. So that gets formulated in a certain part of the brain that is responsible for creating those messages. That message then gets sent down the spinal cord, and then it goes out the spinal cord to nerves and a series of nerves going forward, and then it goes to the muscle, and the muscle has a little receptor that the message comes down the nerves into the receptor, and that receptor then tells the muscle, contract like this. This muscle must relax. That one must slightly contract. This one must twist. This one must turn, and it's very complicated. But in the end, the muscle gets the message. The muscle does what it's told, and it grabs the object. So injury or illness or disorders can occur to any parts along the way. So you can have , something happening in the brain, and that is responsible for creating those messages, suddenly those messages aren't going to be created, or they're going to be created scrambled, um, slightly differently to if there hadn't been an injury or an illness or something happening in that part of the brain. It can obviously occur in the spinal cord, and this is very often in car accidents. You know, we've all heard about people who have been paralyzed. Um, and when you have a spinal cord injury, it tends to present the same depending on the level. People, you know, have very similar type of injuries and mobility , and abilities after the injury, depending on what level the injury took place. Then, of course, we have the nerves, and these all become now very different conditions, very often things that children are born with, genetic conditions that then happen in the nerves and then in the receptors of the muscles. Some of these conditions, of course, even in the spinal cord, can be degenerative, and so the child tends to Look a certain way, and then they deteriorate. They get worse, and they may, you know, start off walking, get to be in ... at an age and stage where they can walk, and then they deteriorate to the point where they need to use a wheelchair. Some of them, you know, deterioration can go further, and it affects their breathing, and then they need to be on ventilators that they take around with them in their wheelchairs. And of course, uh, you know, some of them will also very sadly die as a result of deterioration of these conditions. Um, And so it's hard to put this into words. It's hard to say the correct thing. Um, I have never felt that pain firsthand. You know, I'm not a parent of a child going through this, but I've loved children going through this, and I've, I've seen it in action. Um, but I still don't have the right words to explain it, and so I'm not going to try. But I think what I want to do here is to raise awareness because, um, not just to generate understanding. I think parents are understanding people anyway. You're probably the wrong audience to say, you know, "Be kind to these children." What I want to do is kind of get people talking because recently, m- well, in the past year, I think, Jesy Nelson has come out, the lady from Little Mix, um, and she has raised amazing awareness about one of these degenerative conditions. And because of this, she has managed to get, um, a test for this specific condition included in the heel prick, um, in this country, and that's a major victory because this is a really, really severe condition that can be picked up and tested for at birth that wasn't being picked up or tested for at birth. Because in the past, we didn't have treatments for it. In, in the past, in the recent years, we have now developed treatments, and if they are given as soon as a baby is born, um, the earlier they are given, the better. It can be life-changing for these little children. Um, and sadly, when Jesy had her children, , this wasn't m- m- being done. There was no h- there was no test being done at birth, and so treatment has been delayed for her children. But she fantastically has raised enough awareness to bring about this heel prick test so that future babies will be tested, um, and i- and diagnosed at birth, and then treatment started very, very quickly. So I think the more people are talking about this, the more, you know, the more the correct ears it lands into, and the more things are happening and being done. But that has never been a field that I've worked a lot in, shall we say. It's not been the greatest percentage of my caseload, so I'm not going to talk too much about it. I'm going to talk more about children where the injury has taken place in the brain, and that was something I did a lot of. Um, I did a lot of post-graduate training for it. Um, and as I say, it was a great, great passion of mine. And the children , who I worked with, um, changed me, changed my life. I will never forget any of them, and there have been hundreds. Um, and so with brain injury, we look when it happens. So if it happens when the brain is still being developed, a baby can be born where that development has been arrested, so the, the brain hasn't developed as it should. It's underdeveloped, or it's developed differently for whatever reason. Um, it can also be that there's an actual injury or insult to the brain , during the birthing process, soon after birth. And in fact, in the first kind of two years, really, of life, the brain is still forming. It's still developing. And so if an injury happens to the brain in the first two years of life, very often the child presents quite similarly to a child who has had a brain injury during birth or when they were still in the womb. And so a lot of these brain injury conditions fall under the umbrella of cerebral palsy, even though they're not true cerebral palsy. Um, and cerebral palsy is when we have a lack of oxygen coming to the brain, and it damages usually one type of matter inside the brain, and it causes a child to have difficulties with movement. Traditionally, it shouldn't have an effect on their understanding or learning. Um, it's just the way they move. However, we know that the more profound the injury is, it can also affect the part of the brain that is responsible for learning and understanding. So we can have cognitive difficulties in these children too, in the more severely affected children. We also know children who have difficulty in moving, um, will have their learning affected because they're not learning the same way as a child who is able-bodied and crawling, exploring, uh, you know, babies learn through movement for the first years of life. And so that has a massive knock-on effect if they're not moving, even though the part of the brain responsible for learning and understanding has not been affected. So with cerebral palsy also, um, we tend to divide it into five levels, and they are descriptions of how a child presents. So if you have a child diagnosed at the age of between birth and two years, we-- there are descriptors, and you can look on the five categories and see, what is the child doing between birth and two years, and where do they fit? Aha, they can do X, Y, and Z, therefore they are level three. You can then look at the next chart, which will be two to four years, and predict what the child will be doing, in that age. And so it goes on for each age range. And that kind of gives clarity for what you can work to. Children don't tend to move out of those categories, although I have seen it happen. So with cerebral palsy, it's kind of given us like a pathway and a way of understanding brain injuries in children, um, and being able to work with them. Now, as I said, usually cerebral palsy happens when, um, birth has gone wrong or, you know, birth can be very, very long. We all know birth is, childbirth is brutal, um, and it's very long. And sometimes baby gets tired, and eventually the little heart slows down, and it's not pumping efficiently or, and we're not getting sufficient oxygen to the brain. Um, - there are other reasons why oxygen isn't coming to the brain during or just before childbirth, and that can be like when the placenta fails, when it's no longer attached. Um, we can also find that we talk about meconium. You know, when a baby passes meconium, that should only happen once the baby is out, once the baby has been born. But meconium can be passed before the baby's born, often when a baby is distressed, so when labor is already very long and difficult. And then the baby inhales that into the lungs, and that sticky tar-like substance, which is basically ... It's come out of the baby's gut. It's like their first poo is meconium. If that goes into the lungs, then we can find that when the baby comes out and they now need to be breathing and using their lungs, their lungs aren't working in those first hours of life, and so they're not getting oxygen to the brain. Um, and something else to be very aware of is actually during pregnancy, maternal infections can affect the development of the brain, and one I would like to talk about and make people aware of is something called CMV, cytomegalovirus. Now, this is a virus that is relatively meaningless in adults and little children. Um, adults, you don't even look like you have a virus. You don't look sick at all when you have it, and little toddlers and children can have it and might have a snotty nose, might have a bit of a temperature, or they might not have anything. The issue is, though, that we can shed the virus in our saliva and our urine, and so we have, um, toddlers spreading the virus, like, wildly because obviously they're always putting things in their mouth, and then they're at nursery and their little friend comes and picks it up and puts it in their mouth, and so it spreads. We have teachers changing nappies, um, in nurseries and, and young children, and then we have obviously parents. The little toddler has now picked up CMV at home. Mum has no idea. The baby does- The toddler doesn't seem ill, but mum is pregnant, and then mum contracts the virus, um, when she changes her baby's nappy or, you know I- I mean, there's just so many ways a mother can get a virus from a child who has the virus in their saliva and their urine. Um, and this particular virus, if it's caught during pregnancy, can cause quite profound brain damage, um, and affect the way the brain then develops. And so this is also quite a common, um, cause of children presenting with this cerebral palsy type presentation. ... And then we can also have spontaneous bleeds in the brain. We can have swelling happening in the brain. We've got ventricles inside our brains, uh, that are like little water balloons I suppose if you want to call it. And if th- they get too much water in there, if there's a blockage somewhere in one of the ducts , connecting all of them, the fluid isn't being properly absorbed, and that can swell. Um, and that can put pressure on the brain tissue surrounding those ventricles. Um, you know, you can have actual brain bleeds that I think I've said. There are so many reasons why we can have brain injury in the early stages. And then of course there's trauma, like car accidents, and falls, and head injuries of any sort, and as I said, if it's in the first two or so years of life, these can lead to the cerebral palsy presentation. Um, so just for me, from my personal experience, when I was pregnant with my daughter, I was treating a child who had a cerebral palsy type presentation, um, due to the mother being infected with, uh, CMV while she was pregnant. And I treated the child in my home actually, and days later, I found out I was pregnant and didn't think about it. Um, I didn't put the connection there. And so a few months later when I was going to review the child, I suddenly, I suddenly clicked, um, I probably shouldn't be seeing this child, but also I had already seen the child when I was already pregnant. Um, and I got into quite a panic about it and I was so lucky, um, because I then phoned the hospital and at that stage I was-- we had moved house, so I was still-- I started off my pregnancy care with St. George's in London and then I moved to Kingston Hospital and both were amazing. I loved my experience at Kingston Hospital, I really did. Um, but at this stage I was still with St. George's and I phoned them and I told them and they got, um I feel like it was a virologist or a geneticist, I don't know, um, an immunologist, uh, uh, like a, a really clever consultant to phone me. And I had recently had , a blood test, and so they had my blood sample and he tested it. And then he called me, and what he explained to me was that he had tested to see if I had been infected with the CMV whilst, now, whilst I was pregnant and treating the child, and he could see that had not happened, but he could see I had CMV antibodies in my blood that were old, and this was because I'd been infected with CMV in the past. And in fact, I remember treating a child with CMV in the hospital, um, and at that stage, you know, being so careful because he was a newborn and really, really, really unwell, , and so he could actually see the immunity. Now I may have gotten immunity any time before. I may have had the virus at any stage. It might not have only been the child in the hospital. Um, and I may have seen, in the course of my career, seeing children so much, I may have picked up immunity along the way. But he warned me. He said, "Look, it's not a forever immunity, but the fact is you did have these cells, you did have im- you know, antibodies to the virus in your blood, so which is probably why you didn't contract it seeing that child. But that doesn't mean you're forever immune, so go forwards and practice excellent hand washing. Be really careful." So if you are pregnant with a little one, have it in your mind, you know? Just make sure you're washing. Be a little bit careful in that nine months that you're pregnant if you do have a toddler, because you can get very profound types of, uh, cerebral palsy , presentations, um, from this infection. Now, obviously I've spoken about, you know, birth trauma, difficult births also lead to it, and, um, that doesn't mean you have to be terrified of childbirth. It just means knowing and understanding the childbirth process better, having a good advocate for yourself if that's... I would never say rely on yourself to speak for yourself. It might be your partner. It might be a doula. And just having someone who knows this is my threshold, when things get to this stage, they need to take me in for a cesarean. You might be very anti-cesareans and therefore you want to keep going for longer. That's fine. But my advice here is, and , we'll look at this more next week with Gina, but have a, a birth plan where you know your thresholds. Because, and this is a very, uh- hard for me to talk about because I'm, um, I may be judged for it. But as I've said, after working for so many years with children who had cerebral palsy as a result of, you know, traumatic births, I elected to have a cesarean. So it was an elective C-section that I had for my daughter because at that stage of my life, I also had anxiety. I used to have really bad anxiety, which amazingly, touch wood, uh, no longer do have. Um, but I was very, very anxious in my late 30s and still at the age of 41. I remember it starting in my late 30s. Um, and at 41 when I was heavily pregnant, I just knew I would be anxious trying to give birth. I was also older. They kept telling me I was a geriatric mother, um, with increased risks. And I thought, "You know, if I go over, everyone's gonna be panicking. Um, I'm gonna be induced. I'm gonna be stressed about that. I'm gonna be ... You know, there's just gonna be too many stresses. If I go into labor, I'm gonna be stressed about it." Um, and you've got to relax during labor. If your body is full of adrenaline and cortisol is the other one, you cannot release the correct birth hormones to enable labor to progress. And I knew I was going to be highly stressed, highly wound up. Um, my husband is amazing in many things, but he's not, going to be loudly shouting the odds and wildly advocating for me. He's more kind of reserved in that. And I just, uh, you know, a doula never crossed my mind, and so I felt the safest thing for me and my baby was therefore to have an elective cesarean section. So someone else, as I say, might be totally anti-cesareans because we know of all the wonderful benefits of, of natural childbirth for a baby. And if that's the case, then you just have to have a birth plan accordingly, and I would always say a good advocate and know, understand that, and we will talk about that more next week. Um, so really that's kind of getting into the the neurology of it. But what I want to tell you is that the children I have worked with , are always remarkable, and their families as well, because when you are dealing with something like that, you become a warrior. You become incredibly resilient, and they find all kinds of compensatory techniques and movement patterns and talents almost. And I would love to do a podcast where I talk about these children, and I hero them, and I tell you about them, and I tell you their names because they, they were that important to me. They were, they were, ja, children that I love dearly, but obviously I can't do that. Um, and maybe I can , randomize their information and change their genders and change the stories and where they're from and I don't know. I don't know if it'll be authentic anymore. But suffice to say, some of the most intelligent children I have ever met, um, have been in wheelchairs and unable to speak because a movement disorder also affects the mouth muscles, and so they can't speak. .. And they can't use their hands at all, so they're not able to use a computer and type things or write things, but they'd use their eyes, and they would use their eyes to lock onto a screen, and the screen would speak for them. And they were highly intelligent, um, children and remarkable characters. Um, you know, I'm seeing all the ... I'm seeing specific faces in my head when I talk about this. Um, and so there is just this very broad picture. I've also seen children who have been mildly, mildly affected, one limb ever so slightly, and you'll have neurologists telling you there's no such thing as one limb cerebral palsy, but I've seen it. Um, and then obviously children who are full body affected and totally reliant for, on, on carers for everything. And  I think here the difficulty is, and this might touch some of you because you might have children who are a few months old, but when children are born, you don't always know that this is the case. If you've had a really risky, tricky labor, um, and, and baby has gone through things or they've had scores that have shown at birth that perhaps something has happened, you will be on a high-risk pathway. You will be monitored. You will be checked. Your baby might have something that is called an ultrasound scan that is done through the anterior fontanel because that's still very wide and open, and you can scan through there and get a vague idea. And from that they might then say you need to go on and have an MRI. Now, an MRI sounds quite scary, but actually they can do it with babies where wrap and swaddle, I think they... Wrap and feed, I think they call it. So they feed the baby, they swaddle the baby, and they can do it while the baby's asleep. Um, and so they don't have to put them under general anesthetic. So it's less invasive than, you know, in the past or with older children that have to go under general anesthetic. And they can do these brain scans, and they can see what damage has been done and the extent of the damage. They can grade damage, you know, according to how bad it is. But what we have learnt is that the MRI doesn't always match the child, and that is because this little brain has not been fully developed. And if you can give the correct input, the correct stimulation, the correct treatments to this child, you can help the brain to develop so much more than what you expected, so that when you look at their MRI, you think this is a child who is going to be massively affected by their brain injury, and in fact, they're not. And so for me, the brain is, like, the most exciting, the most hopeful organ in the body because you can never predict, and the harder you work to improve and to help, the more change you can see and the, the better outcomes you can see. Um, and so yes, with cerebral palsy, , we do have our levels, but first thing I'll say about that is children who are presenting looking like they have cerebral palsy, but perhaps their brain hasn't developed the same, it's not for an injury or an insult to the brain, um, there, it's less predictive. You can't always predict according to that classification system. And the other thing about that classification system is- That kicks in from birth to two years. But in the first, people will say like the first year of life, it's very hard to see where that child's gonna go and to put them in a level. I would say the first like nine months is the time where it's difficult. You can't always tell clearly, and that's when an MRI will tell you there's been a brain injury, but it's not going to be able to put the child into a level, I don't think. Um, and as physiotherapists and other healthcare professionals also can do a special assessment. Now, I've spoken before on these little movements that babies have when they're born. They're called general movements, and we can assess those movements and see what the brain injury is doing to those general movements, how it is affecting those general movements, and based on that, predict what kind of movements they might have later in life. And that's a bit more accurate than looking at a brain scan. Um, however, you have to do it at the right times, and you have to do it repeatedly to really get a reliable, um, assessment. And often the children I see parents come to me because they want extra treatment because they've gone through this tricky patch, but I don't always necessarily see them anymore from birth. Um, and so it's a little bit later on. So sometimes they're a bit too old to do that assessment. And the difficulty is that because it is so hard to predict exactly how their movement function is going to turn out, doctors will often say to a parent, "Look, you've got this level brain injury to the brain. They are likely to have something called cerebral palsy, or they're likely to have a movement disorder, but we can't tell you to what extent it's going to affect your child." And parents always go, "Will my child walk?" And they say, "I don't know. They could, but they might also need a wheelchair." So you are given this massive range of what could happen to your child with very little understanding for the first nine months at least, and even for the first years of life, you may not, until a child is two, you may not be clear as to which level they are fitting in. Um, and so that I find really hard. That's often the, the area I'm dealing with parents, and it's not my place as a physio to kind of give a diagnosis to them. But I can get a feel of things while I'm working with children. Um, but I'm very much ... I believe if I label a child to a parent, the parent will run with whatever label I've given them. So I tend to hold back, even if I might , have a, an idea of what this child is going to look like, I tend to hold that back and we work, we focus on where we're going. It might affect the way I treat but- I'm not gonna necessarily label the child very early on. And I think it's worth knowing, um, this because if this is something you ever go through or have been through, you will know it is the most frustrating thing to be told, "I can't tell you. I can't tell you what your child is going to look like." But I would say if you are in that wait, like there are so many other parents in that waiting period, like reach out, find a support network. But also get, the physiotherapy input you need because it will never be wasted. Even if your child is a lucky one, it will never be wasted. Um, and there are charities out there. There are, you know, your local services, and obviously there's private, there's people who do what I do. But, you know, it doesn't have to just be that way. You can find ... As I say, there are really good charities, um, for children who have had any kind of brain injury. And I would definitely say the sooner the better. If you've had those kind of difficulties, if your child has had some kind of a scan at birth, it is worth accessing all the resources that you can, um, as early as possible. Because the beauty of it is that you might say, " "Oh, but my child, did really well. He's only got minor difficulties, and we had all that therapy maybe unnecessarily." And, you know, the argument is of course, well, maybe because of all that therapy, the stimulation of it in the correct timing and graded the correct way ... And I'm not only talking about physio, I'm talking about all the therapists involved, and all the doctors, and all the resources involved. Maybe that's what's giving you that good outcome because we know that little brain is so plastic, what we call it. It's still developing and can still change so much. So for me, this is a very hopeful, um, area. And I think the younger the child, the more hopeful it is for me, and that's why I love working in this age group. Um, and that said, you know, I loved all the age groups, but this for me is kind of really exciting where I feel we can get stuck in and make a huge difference. . So I hope that's been interesting for you. I hope that gives you a bit more of an idea of where I'm coming from and sets you up for next week's episode, because I think that's going to be incredible. Um, Gina Mandy has her own podcast called The Childbirth Attorney Podcast. Um, so have a listen, beforehand. Um, I'm so excited to speak to her, and I think that's going to be giving you kind of more helpful advice going forward, and this today was the introduction to why we're talking about that and why it's so important. Um, and so with that, as always, uh, stay tuned for the next episode, and please do, um, share the podcast with anyone you, you think may benefit from it. I would love it to grow a little bit more. Um, send me some comments. Send me anything you'd like me to talk about because, um, I'm obviously wanting to keep it current and fresh. So I would appreciate any comments or questions. And with that, I am sending you lots of love and best wishes, and all the best for you, and of course, all the very best for your baby