Pediatric Paralysis

Pediatric paralysis means a child cannot move one or more muscles, such as a finger, an arm or both legs. Children can have partial paralysis, which means they might not be able to move their muscles with full strength. Or they might have complete paralysis, which means the given muscle can’t move at all. Paralysis in children is rare.

Pediatric paralysis is a syndrome, not a specific disease. That means that a child can lose the ability to move or control their muscles for a wide variety of reasons. There might be a problem with the:

• Brain
• Spinal cord
• Nerves
• Muscles

Paralysis can be caused by genetic conditions or acquired conditions. Common conditions that can involve paralysis include:

• Acute flaccid myelitis
• Botulism
• Cerebral palsy
• Guillain-Barre syndrome
• Muscular dystrophy
• Myasthenia gravis
• Neuromyelitis optica
• Spinal muscular atrophy
• Spinal trauma
• Stroke
• Transverse myelitis

There are many types of pediatric paralysis, and it can happen in different parts of the body:

Localized paralysis

Localized paralysis only affects a single area of the body. It can affect the face, vocal cords, arms, hands, legs or feet.

Generalized paralysis

Generalized paralysis affects more than one part of the body:

• Monoplegia, which affects just one limb, such as a leg or an arm
• Hemiplegia, which affects one side of the body, as may be seen after a stroke, which can affect the arm and leg on the same side of the body
• Diplegia, which affects the same parts on both sides of the body, such as both legs or both arms
• Paraplegia, which affects the legs and sometimes the middle of the body (torso or trunk)
• Quadriplegia, which affects both legs and both arms. This type of paralysis can affect the whole torso from the neck and below. Organs such as the lungs and heart can also be affected.

The signs and symptoms can vary depending on the type of paralysis and what caused it. The condition can be:

• Partial, which means that a child will have some muscle control remaining
• Complete, which means that a child will not be able to move their muscles
• Temporary, which means that a child will regain some or all control over their muscles
• Permanent, which means that a child will not regain muscle control

In each type of paralysis, the muscles may be:

• Loose and floppy (flaccid)
• Tight and hard (spastic)

The symptoms also can start in different ways. They can be:

• Acute, which means the symptoms began very suddenly
• Subacute, if the paralysis started over a period of days
• Chronic, if the paralysis is persistent over weeks, months or longer.

The testing that our care team does will depend on what the medical history and physical exam show. Once the care team figures out the source of the problem, they can look for the underlying cause. Tests that your child might have include:

• MRI, which can identify some causes of paralysis
• Nerve conduction studies, which test how well a child’s nerves can send electrical signals from one site to another
• Tests that look at the connection between the nerve and muscle
• Lumbar puncture spinal tap, which enables the care team to look at the spinal fluid and test for certain causes of paralysis
• Genetic testing, which can help identify an underlying cause that has genetic roots
• Muscle biopsy, which gives information about the muscles
• Blood work

Paralysis in children can have many kinds of causes, including:

• Traumatic injury, which is a sudden and severe injury, such as a car accident. Children’s Health is home to a Level 1 Trauma Center, which certifies us to provide the highest level of care for children who have experienced traumatic injuries.
• Non-traumatic injury, which is usually due to an internal problem, such as a stroke, tumor, inflammation or toxic exposure
• An infection, such as from a virus
• A cause related to nutrition

Your child’s treatment plan will depend on what caused the paralysis. Once we learn the underlying cause, then we can develop a treatment plan. Most treatment includes:

• Limiting inflammation in the spinal cord, which can involve:
  • High doses of steroids
  • Plasma exchange (PLEX) to clean the blood
  • Intravenous immune globulin (IVIG), which can remove antibodies from the blood
• Managing symptoms, such as muscle or nerve pain
• Long-term rehabilitation, which can help children regain muscle function and learn to do their daily tasks while experiencing paralysis