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Cerebral palsy (CP) is a neurological condition that affects movement, posture, and muscle tone. For many years, CP was believed to be caused almost exclusively by birth complications or injury to the developing brain. However, recent research, including new insights from whole-genome sequencing, is changing how we understand this condition, raising the question many parents are now asking: is cerebral palsy genetic?

What Causes Cerebral Palsy?

Cerebral palsy is caused by abnormal brain development or damage to the developing brain, typically before, during, or shortly after birth. Common known risk factors include:

• Lack of oxygen during birth (asphyxia)
• Premature birth or low birth weight
• Infections during pregnancy
• Traumatic brain injury in infancy
• Stroke or bleeding in the brain before or shortly after birth

However, despite these known causes, many cases of cerebral palsy cannot be explained by birth trauma or medical complications alone. This has led researchers to explore whether genetic factors may also play a role.

Can Cerebral Palsy Be Genetic?

Recent studies suggest that genetics may contribute to the development of cerebral palsy in a significant number of cases. A Canadian-led study published in Nature Genetics in 2024 found that more than one in ten children with CP had a gene variant associated with their condition. An additional 17% of children had variants of unknown significance that may be linked to CP after further research.

These findings suggest that for some children, genetic mutations affecting brain development may be a contributing factor to CP or increase vulnerability to brain injury before or during birth.

What Does This Mean for Families?

The discovery of a genetic link does not mean that CP is always inherited or passed down through families. In fact, many of the gene changes identified in recent studies are de novo mutations (spontaneous changes that occur for the first time in the child and are not present in either parent)

However, in some families, especially those with multiple children affected by neurological disorders, inherited genetic patterns may play a role.

At this stage, we can say that while cerebral palsy is not typically a genetic disorder, it can have genetic contributions in some cases, and these may be more common than previously understood.

The Value of Genetic Testing

As more is learned about the connection between genetics and cerebral palsy, genetic testing is becoming an increasingly valuable tool in diagnosing and managing the condition. Testing can:

• Help explain the underlying cause of CP in certain children
• Identify associated conditions (such as autism or epilepsy) that may share a genetic basis
• Guide more personalized treatment and care plans
• Provide clarity for families who may be planning future pregnancies

Dr. Siambanes’ Role in Advanced Cerebral Palsy Care

Dr. Siambanes is a board-certified orthopedic surgeon, fellowship-trained in pediatric orthopedics and spinal deformities. As director of the Motion Analysis Lab at St. Joseph’s Children’s Hospital, he helps families understand how neuromuscular challenges affect a child’s movement and function and how interventions such as bracing, physical therapy, or surgery can improve quality of life.

Although he does not perform genetic testing himself, Dr. Siambanes is deeply involved in guiding the comprehensive treatment of children with cerebral palsy, regardless of its cause. Whether a child’s CP is linked to a birth injury, genetic factor, or unknown cause, his goal remains the same: improve mobility, reduce pain, and support independence.

Click here to request a consultation with Dr. Siambanes today.

Toe walking is a common issue seen in children with cerebral palsy, especially those with spasticity affecting the lower legs. While many toddlers briefly go through a phase of walking on their toes, persistent toe walking — particularly in children with cerebral palsy — often indicates an underlying muscular or neurological cause.

If your child is frequently walking on their toes, it’s important to understand why it’s happening and what treatment options are available. At Children’s Cerebral Palsy, Dr. David Siambanes offers expert orthopedic care to help address the causes of toe walking and guide families toward the most effective solutions.

What is Toe Walking?

Toe walking refers to a walking pattern where the heel does not touch the ground. Instead, the child walks on the balls of their feet or their toes. In cerebral palsy, this walking pattern is typically due to muscle tightness or imbalances that limit flexibility in the lower leg and foot.

Persistent toe walking can cause pain, instability, and long-term changes in foot and joint structure if left untreated. It can also affect balance, coordination, and energy levels during walking, making daily activities more difficult for your child.

Why Does Toe Walking Happen in Children with Cerebral Palsy?

Toe walking in cerebral palsy is most commonly caused by spasticity, which is the involuntary tightening or stiffness of muscles. Children with spastic cerebral palsy often have increased tone in the calf muscles (gastrocnemius and soleus), which prevents the heel from touching the ground during walking.

Other contributing factors include:

• Shortened Achilles tendon or calf muscles
• Poor muscle coordination
• Weakness in opposing muscle groups
• Balance or sensory challenges
• Delayed motor development

Over time, untreated toe walking can lead to joint contractures (permanent tightening of the muscles and tendons), abnormal gait patterns, and even pain in the feet, knees, or hips.

When to Seek Help for Toe Walking

If your child consistently walks on their toes, especially past the toddler years, it’s worth getting an evaluation, particularly if they have cerebral palsy or other neuromuscular conditions. Early intervention can help prevent complications and support better long-term outcomes.

Signs it may be time to seek help include:

• Toe walking that persists beyond age 2 or 3
• Your child avoids putting their heels down entirely
• Toe walking is accompanied by pain, falls, or poor balance
• Tightness in the calves or reduced range of motion in the ankle
• Toe walking that worsens over time

Treatments for Toe Walking in Cerebral Palsy

The goal of treatment is to address the root cause of toe walking — usually muscle tightness or imbalance — and help your child develop a more natural, functional walking pattern. Dr. Siambanes, a fellowship-trained pediatric orthopedic surgeon, takes a personalized approach to care based on your child’s specific needs and mobility goals.

1. Physical Therapy

Targeted stretching and strengthening exercises can help lengthen tight calf muscles and improve ankle flexibility. Physical therapists may also work on balance, posture, and walking mechanics.

2. Orthotic Devices and Bracing

Ankle-foot orthoses (AFOs) are commonly used to support proper foot alignment and prevent toe walking. Rigid or hinged AFOs can hold the foot in a more neutral position and reduce the strain on tight muscles.

3. Botox Injections

Botulinum toxin (Botox) can be injected into overly tight muscles to temporarily reduce spasticity and allow for improved range of motion. This is often paired with physical therapy or bracing to maximize results.

4. Serial Casting

In some cases, a series of casts may be applied over several weeks to gradually stretch and lengthen tight calf muscles. This non-surgical approach is especially useful when the goal is to improve flexibility without permanent intervention.

5. Surgical Intervention

If conservative treatments are not successful, surgery may be necessary. Dr. Siambanes specializes in procedures such as tendon lengthening, which can release tight calf muscles or adjust foot alignment. Surgical correction is often recommended when toe walking causes pain, impairs function, or leads to contractures.

Advanced Care with Dr. Siambanes

As the director of the Motion Analysis Center at St. Joseph’s Children’s Hospital, Dr. Siambanes uses 3D gait analysis to precisely assess walking patterns and identify the physical barriers contributing to toe walking. This advanced tool allows him to develop highly targeted treatment plans and ensure your child is receiving the most effective care.

Dr. Siambanes has performed countless procedures to help children walk more comfortably and confidently. His experience in managing cerebral palsy-related deformities, combined with his compassionate approach to care, makes him a trusted partner for families navigating complex mobility challenges.

Improving Mobility, One Step at a Time

Toe walking may seem like a small issue, but it can have a big impact on a child’s comfort, confidence, and ability to participate in daily life. With early intervention and expert care, most children with cerebral palsy can make significant improvements in their gait and overall mobility.

If your child is toe walking, don’t wait to seek support. Click here to contact Children’s Cerebral Palsy to schedule an evaluation with Dr. Siambanes and take the first step toward better movement, improved function, and greater independence.

Children with cerebral palsy often face a range of orthopedic challenges, and one of the most common complications is hip dysplasia. This condition occurs when the hip joint does not develop properly, leading to instability, misalignment, and in some cases, severe pain.

In children with cerebral palsy, especially those with spastic quadriplegia, muscle imbalances can pull the hip out of its socket over time, increasing the risk of dislocation. Early recognition of hip dysplasia is essential to prevent pain, improve mobility, and avoid long-term complications.

Dr. David Siambanes, a board-certified orthopedic surgeon specializing in pediatric orthopedics and spinal deformities, has extensive experience diagnosing and treating hip dysplasia in children with cerebral palsy. His expertise helps children maintain comfort, improve sitting tolerance, and reduce the risk of future mobility issues.

What is Hip Dysplasia?

The hip is a ball-and-socket joint, where the top of the thigh bone (femoral head) fits into the curved part of the pelvis (acetabulum). In children with hip dysplasia, this joint doesn’t form correctly. The ball may sit loosely in the socket or move partially — or completely — out of place.

For children with cerebral palsy, muscle tightness and imbalances can pull the hip out of alignment, gradually leading to hip subluxation (partial dislocation) or hip dislocation (complete separation of the ball from the socket). Without treatment, hip dysplasia can cause chronic pain, reduced mobility, and difficulties with sitting or standing.

Why Children with Cerebral Palsy Are at Higher Risk

Cerebral palsy affects muscle tone and control, often leading to spasticity (increased muscle stiffness) or hypotonia (decreased muscle tone). In children with spastic cerebral palsy, tight muscles can pull unevenly on the hip joint, gradually leading to misalignment.

Children who are non-ambulatory or spend much of their time in a seated position, such as those with spastic quadriplegia, are especially at risk. The lack of weight-bearing activities, like walking, can limit proper hip development, making dislocation more likely over time.

Common Symptoms of Hip Dysplasia in Children with Cerebral Palsy

Hip dysplasia symptoms can sometimes be difficult to detect, especially in non-verbal children who cannot express their discomfort. However, there are signs that parents and caregivers can watch for:

1. Pain and Discomfort

Pain is often the most noticeable symptom of hip dysplasia. Children may experience:

• Discomfort during diaper changes or when legs are moved
• Pain when sitting, especially for extended periods
• Crying or irritability when the hip is manipulated or under pressure
• Pain even while at rest in severe cases

Non-verbal children may express pain through agitation, crying, or changes in behavior.

2. Limited Range of Motion

Hip dysplasia can cause stiffness in the hip joint, making it difficult to:

• Spread the legs apart during diaper changes
• Move the hips into different positions
• Sit comfortably without leaning to one side

Parents may notice that one leg appears stiffer or harder to move than the other.

3. Asymmetrical Leg Positioning

Children with hip dysplasia often have one leg that appears longer or shorter due to the misalignment of the hip. Other signs of asymmetry include:

• One hip or buttock appearing higher than the other
• Uneven skin folds on the thighs or buttocks
• A noticeable tilt in the pelvis when sitting

4. Difficulty Sitting or Standing

When the hip is out of alignment, children may struggle to sit upright or balance evenly while standing. In wheelchair-dependent children, poor hip positioning can make it harder to maintain an upright seated posture, increasing the risk of pressure sores and spinal curvature.

5. Audible Clicking or Popping Sounds

In some cases, the hip may make clicking or popping sounds during movement. While not always painful, these sounds can indicate that the hip is unstable or partially dislocated.

The Importance of Early Detection

If left untreated, hip dysplasia can progress to a full dislocation, leading to severe pain and further limitations in mobility. Early detection allows for less invasive treatment options and can prevent long-term complications.

Dr. Siambanes emphasizes the importance of routine orthopedic evaluations for children with cerebral palsy. Using advanced imaging techniques and the Motion Analysis Lab, he can assess your child’s gait, posture, and joint health to catch early signs of hip dysplasia before it becomes more severe.

Treatment Options for Hip Dysplasia Symptoms in Children with Cerebral Palsy

The goal of treatment is to restore proper hip alignment, reduce pain, and improve function. Treatment plans vary based on the severity of the misalignment and the child’s overall mobility.

1. Non-surgical Interventions

• Physical Therapy can help strengthen surrounding muscles and improve hip positioning.
• Bracing or Orthotic Devices may be used to support the hip and prevent further misalignment.
• Botox Injections can reduce muscle spasticity around the hip, making it easier to maintain proper alignment.

2. Surgical Options

For children with significant misalignment or pain, surgery may be necessary. Dr. Siambanes specializes in procedures that relocate the hip joint and stabilize it within the socket. These surgeries are often performed between ages 7 and 12, allowing for optimal hip development as the child grows.

Surgical intervention can dramatically improve a child’s sitting balance, mobility, and overall comfort, especially for those who rely on wheelchairs or spend extended time in seated positions.

Supporting Your Child’s Comfort and Mobility

Recognizing the signs of hip dysplasia early is crucial in helping your child avoid pain and maintain as much independence as possible. If you notice any of the symptoms listed above or have concerns about your child’s hip development, don’t hesitate to reach out to a specialist.

Dr. Siambanes is committed to helping children achieve better mobility, improved sitting tolerance, and a higher quality of life. With expertise in both non-surgical and surgical treatments, Dr. Siambanes provides comprehensive care tailored to your child’s unique needs.

Schedule a Consultation Today

If you’re concerned about your child’s hip health, contact Children’s Cerebral Palsy to schedule a consultation with Dr. Siambanes. Early intervention can make all the difference in preventing pain and supporting your child’s mobility as they grow.

While cerebral palsy is often associated with high muscle tone, muscle stiffness and spasticity, some children experience the opposite — low muscle tone, known as hypotonia. Hypotonic cerebral palsy affects a child’s strength, posture, and movement, making everyday activities more challenging. 

What is Hypotonic Cerebral Palsy?

Hypotonic cerebral palsy is a less common form of cerebral palsy characterized by decreased muscle tone, which makes muscles feel floppy or weak. Unlike spastic cerebral palsy, where muscles are stiff and tight, children with hypotonia have difficulty maintaining muscle control and posture due to reduced muscle tension.

This condition results from damage to the parts of the brain responsible for muscle coordination, often occurring before, during, or shortly after birth. Because muscle tone plays a key role in movement, balance, and strength, children with hypotonic cerebral palsy may experience delays in reaching developmental milestones such as sitting, crawling, or walking.

Signs and Symptoms of Hypotonic Cerebral Palsy

Children with hypotonic cerebral palsy may show symptoms early in life, often appearing “floppy” when held. Some common signs include

• Delayed motor development: Difficulty lifting the head, rolling over, or sitting up without support.
• Poor posture: A tendency to slump forward or struggle to maintain an upright position.
• Weak muscle control: Arms and legs may appear limp, making movements uncoordinated.
• Difficulty swallowing or feeding: Weakened oral muscles can make eating and speaking challenging.
• Loose joints and hypermobility: The child may have excessive flexibility due to a lack of muscle resistance.
• Fatigue and endurance issues: Low muscle tone can make even simple activities tiring.

How Hypotonic Cerebral Palsy Affects Daily Life

Children with hypotonic cerebral palsy often require additional support in daily activities. Weak muscle control can make standing, walking, and even holding objects more difficult. Tasks that require sustained effort, like sitting upright for long periods, may be exhausting. Some children may also experience breathing difficulties due to reduced muscle tone in the chest.

Despite these challenges, many children with hypotonic cerebral palsy can make significant progress with the right treatment and support. Early intervention is key to helping them develop strength, coordination, and independence.

Treatment Options for Low Muscle Tone in Children

1. Physical and Occupational Therapy

Therapy plays a crucial role in managing hypotonic cerebral palsy.

• Physical therapy focuses on building strength, balance, and coordination through targeted exercises.
• Occupational therapy helps children develop fine motor skills needed for daily activities like dressing, eating, and writing.

2. Bracing and Orthotic Support

Children with weak muscle tone often benefit from orthotic devices such as ankle-foot orthoses (AFOs) to provide stability and improve posture. These supports help prevent joint misalignment and make walking easier.

3. Speech and Feeding Therapy

If low muscle tone affects the face, mouth, or throat muscles, speech therapy can help improve swallowing, speech clarity, and oral motor function. Specialized exercises and feeding techniques may also be introduced to ensure safe and effective eating.

4. Strengthening Exercises

Engaging in activities that encourage movement, such as swimming or adapted sports, can help build muscle endurance and improve coordination. Therapy programs are often designed to make exercise fun and engaging for children.

5. Surgical Interventions

For children with severe joint instability or posture-related issues, surgical intervention may be necessary. Dr. David Siambanes is a board-certified orthopedic surgeon and fellowship trained in both pediatric orthopedics and spinal deformities. He specializes in procedures that enhance mobility and sitting tolerance, helping children maintain better posture and reduce pain. As the director of the Motion Analysis Center, he uses advanced gait analysis technology to assess movement challenges and determine the best treatment options.

The Importance of Early Intervention

Early diagnosis and treatment of hypotonic cerebral palsy can significantly improve a child’s ability to move, engage in daily activities, and build independence. With the right combination of therapy, bracing, and medical interventions, many children can achieve greater mobility and quality of life.

Dr. Siambanes is dedicated to providing specialized care for children with hypotonic cerebral palsy. Whether through therapy, orthotic support, or surgical solutions, his goal is to help every child reach their full potential.

How Dr. Siambanes Can Help

Hypotonic cerebral palsy presents unique challenges, but with the right support, children can make remarkable progress. Through expert medical care, therapy, and adaptive strategies, families can help their children build strength and confidence in their abilities.

If you have concerns about your child’s muscle tone or mobility, click here to request a consultation with Dr. Siambanes. Together, we can create a personalized plan to support your child’s development and well-being.