A single risk factor is some condition or event that will increase the chances that a child will be diagnosed with cerebral palsy. Having more than one risk factor increases the chances even more, but a risk factor is never a guarantee that a child will have the condition and not having any known risk factors is also not a guarantee that a child will not have cerebral palsy.
More recent research into all the risk factors and potential causes of cerebral palsy has determined that a certain combination of risk factors, occurring in a particular order can correlate significantly with cerebral palsy. Researchers call this a causal pathway and the idea is that one risk factor may lead to another and another, ultimately resulting in cerebral palsy. Understanding these complex pathways could help researchers and doctors better figure out how to prevent cerebral palsy in children.
What is a Causal Pathway?
A causal pathway is something that researchers are just beginning to understand in terms of cerebral palsy. It is a complicated series of events that leads to a diagnosis of the condition. Diseases and conditions that don’t always have one definitive cause are often described as arising from a causal pathway. One event or condition makes another more likely and that in turn may cause another event or condition, until ultimately the child develops the condition known as cerebral palsy.
As an example, one of the biggest risk factors for cerebral palsy is premature birth. Statistically this is known to be a significant risk factor because a large percentage of children diagnosed with cerebral palsy were born prematurely. Also, there are higher rates of cerebral palsy in premature babies than in term babies. To say that premature birth causes cerebral palsy or that it was the risk factor that led to it is too simplistic. Rather, there was a sequence of events and conditions that led to a child being premature, and all together these events caused cerebral palsy.
An important concept of causal pathways is that risk factors are interconnected. Researchers are trying to figure out how one risk factor can cause conditions that magnify or lead to other risk factors. For instance, a risk factor for cerebral palsy is an abnormal presentation at the time of birth, such as breech position. If a baby is in the breech position, the doctor has to decide how to proceed safely. The breech position could lead to the doctor to choose to use forceps as opposed to performing a Cesarean section. The use of forceps to deliver the baby is another risk factor for cerebral palsy. One risk factor leads to another.
Examples of Cerebral Palsy Causal Pathways
Causal pathways that lead to cerebral palsy can be very complicated because there are so many possibilities. One risk factor could lead to a number of other risk factors and every individual and pregnancy presents new possibilities for risk factors and resulting pathways. This has made it difficult for experts to sort out the causes of cerebral palsy and how to prevent it.
An example of a causal pathway that ultimately leads to cerebral palsy might begin with a mother’s lifestyle and health choices, known risk factors for the condition. A mother may make the choice to ignore symptoms of an infection while pregnant. She finally gets treated, but only after developing a bad fever. The fever may trigger inflammation in the developing fetus and the production of proteins called cytokines. Cytokines circulating in the fetus can cause it to be less able to tolerate any deprivation of oxygen. During delivery, a minor complication, like the mother’s drop in blood pressure, could result in the baby temporarily lacking oxygen. In another baby this may not have any lasting effects, but in this particular child it may be enough to cause the damage that leads to cerebral palsy.
A Need to Understand Causal Pathways
According to researchers, the frequency of cerebral palsy has not gone down in recent years. Despite more and more research, an increased understanding of risk factors and what causes cerebral palsy, and ever-evolving medical technology, experts are failing to prevent cerebral palsy in many children. It has become clear that simply understanding individual risk factors is not enough.
Prevention of individual risk factors has failed to prevent cerebral palsy, but if there is a better understanding of the pathways that lead to it, preventative measures may be more effective. Researchers and doctors need to know how one risk factor leads to another, and how this complicated pathway comes together to create the conditions in the brain that cause cerebral palsy.
Implications for Prevention and Negligence
The growth in understanding of cerebral palsy causal pathways is important in better understanding how to prevent this common disability. But it also makes prevention more complicated and challenging. It may not be possible to prevent cerebral palsy by targeting one or two risk factors. It may require a fuller understanding of how one of these factors may lead a child down one of multiple possible pathways.
In terms of medical negligence, the reality of causal pathways may help get doctors off the hook for making mistakes that can lead to cerebral palsy. If a causal pathway began early in pregnancy by a choice that the mother made, it may be determined that preventing cerebral palsy was far out of reach for the doctor in charge of her health and safe delivery. It also puts a lot more responsibility on parents. Long before you even conceive, it is important to understand the risk factors for cerebral palsy so that you can make all the best decisions to minimize the risk for your child.
This may be good news for doctors, but it may also mean that parents who have children with cerebral palsy will find it more difficult to make a case against a doctor they believe was negligent in some way. This means that the role of good cerebral palsy lawyers becomes more important than ever before. If you find that your child has cerebral palsy and you believe that somewhere along the line your doctor made a mistake, you need this professional on your side more than ever before.