Stay informed with the latest updates on coronavirus (COVID-19). Find out more >>

Cerebral palsy - pain and irritability

  • See also

    Chest infection
    Increased Seizure


    Pay particular heed to concerns of parents or carers about behavioural change. Possible causes include

    • Otitis media
    • Pharyngitis
    • Dental disease
    • Gastro-oesophageal reflux
    • Urine infection
    • Constipation
    • Renal stones (increased risk if on Topiramate)
    • Subluxating and dislocated hips
    • Fractures (including pathological)
    • Increased seizures
    • Medications
    • Gynaecological
    • Sleep deprivation (associated with pain and spasm) 
    • Spasticity (spasms may cause pain, but are often secondary to pain)
    • Increased intra-cranial pressure (many children have VP shunt)
    • Consider non-accidental injury (under reported in this group)
    • Changes in home environment, school or family


    The pattern and time course of distress may point to one or more of the above causes. The majority of clues come from a carefully taken history.

    • Examine ENT, abdomen, hips, limbs in particular
    • Check FWT urine for blood (?stones), white cells (infection?)

    Investigations that are sometimes useful

    • Hip X-ray
    • Gastroscopy
    • Abdominal ultrasound or renal CT
    • Bone Scan
    • CT brain

    Consider seeking review by paediatric dentist


    • Provide adequate analgesia
    • Treat identifiable causes
    • If there is no obvious cause after assessment
      • Consider trial of anti-acid medication (eg ranitidine) 
      • Consider trial of laxatives
    • Admission may be required for further investigation, or because of degree of distress
    • Social work assessment may be useful to evaluate stresses at home and / or to organise support services
  • Reference List

    1. Benvenuto et al. A Pragmatic Approach to Assessment of Chronic and Recurrent Pain in Children with Severe Neurological Impairment. Children (Basel) 2022 Jan;9(1): 45. Retrieved from (viewed 07 Sept 2022).
    2. NICE guideline [NG62]. Cerebral Palsy in under 25s: assessment and management. Retrieved from (viewed 07 Sept 2022).