Cerebral palsy (CP) is a disorder of movement and posture that leads to activity limitations and is caused by abnormal development or damage to the developing brain during gestation, infancy, or early childhood (Rosenbaum et al., 2006; Morgan et al., 2018). Some children initially thought in early life to have CP may later lose the diagnosis (Nelson & Ellenberg, 1982; Chen et al., 2020). Understanding CP prevalence and its co-occurring conditions is crucial, as children with CP often have significant health and service needs (Cogswell et al., 2022). Previous data indicate that the prevalence of CP in children in the United States has been stable in the past decades, with the most recent estimate, from the 2016–2018 National Survey of Children’s Health (NSCH), reporting a CP prevalence of 2.9 per 1,000 children, which align with findings from other survey and surveillance data (Casseus & Cheng, Zablotsky et al., 2019; 2021; Maenner et al., 2016; Arneson et al., 2009; Kirby et al., 2011; Christensen et al., 2014). U.S. estimates are generally higher than those in Europe and do not show the downward temporal trend seen in many countries (McIntyre et al., 2022).

Previous studies have estimated the prevalence of co-occurring conditions associated with CP, such as epilepsy, intellectual disability (ID), autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD), often focusing on individual conditions or a limited set of conditions across different populations (Boulet et al., 2009; Christensen et al., 2014; National Guideline Alliance (UK), (2017); Casseus & Cheng, 2021; Chen et al., 2024). More recent estimates of CP prevalence and a broader assessment of co-occurring conditions in U.S. children are important for evaluating the public health implications of CP and guiding the development of services to support affected children.

We sought to provide updated estimates of CP prevalence among children in the United States using data from the 2016–2021 NSCH, overall and by selected demographic and perinatal characteristics. Additionally, we analyzed prevalence patterns and severity over time and examined the prevalence of co-occurring developmental, neurological, and mental health conditions among children with CP.

During 2016–2021, the overall prevalence of ever having a CP diagnosis was 3.1 per 1000 children aged 2–17 years old in the United States (95% CI: 2.7, 3.5) (Table 1). CP was more prevalent among boys (3.6 per 1000 [95% CI: 3.0, 4.4]) than among girls (2.5 [2.0, 3.0]). The prevalence of CP was slightly higher among children aged 10–13 years old (3.7 [2.9, 4.6]) compared to those aged 2–9 years (2.6 [2.1, 3.3]), but did not differ by household educational attainment. The prevalence of CP appeared slightly elevated among children who were NH Black and NH other race/ethnicity, compared to NH White, but differences did not reach statistical significance. The prevalence estimate was significantly higher in children born with very low birth weight (46.6 per 1000, [95%CI: 34.3, 62.9]), low birth weight (7.1 [5.3, 9.5]), or prematurely (12.7[10.2, 15.7]) compared to those with normal birthweight (1.9 [1.6, 2.3]) or term birth (1.8 [1.5, 2.2]).

Figure 1 shows the CP prevalence overall and by selected demographic characteristics for 2016–2018 and 2019–2021 (See Table S1 estimates). No clear changes were observed in the overall prevalence or across any subgroups between the two time periods.

During 2016–2021, 88.2% (95%CI: 82.8%, 92.0%) of children aged 2–17 years old who had ever received a diagnosis of CP were reported to currently have CP. Among children aged 6–17 years old with current CP, 56.8% (95%CI: 48.4%, 64.7%) had difficulty walking or climbing stairs and 63.7% (55.3%, 71.4%) had difficulty dressing or bathing, and no changes were seen over time. Among children aged 2–17 years with current CP in 2016–2021, 40.3% were reported as mild CP (95%CI: 33.7%, 47.2%), 36.5% as moderate (29.7%, 43.8%), and 23.3% as severe (18.0%, 29.5%). The percentage of reported severe CP significantly increased from 16.8% (95%CI: 11.7%, 23.6%) in 2016–2018 to 30.3% (95% CI: 21.7%, 40.6%) in 2019–2021 (p = 0.037) (Table 2).

During 2016–2021, children aged 3–17 years old with a current CP diagnosis had a significantly higher prevalence of one or more developmental, neurological, or mental health conditions, as compared to those without CP: 91.2% (95%CI: 87.3%, 94.0%) versus 23.7%(23.3%, 24.1%) for any condition; 84.9% (77.8%, 90.0%) versus 17.7% (17.3%, 18.1%) for another developmental disability; 50.3% (42.9%, 57.7%) versus 3.5% (3.3%, 3.8%) for a neurological condition; and 27.4% (21.0%, 34.9%) versus 8.9% (8.6%, 9.1%) for a mental health condition (Table 3). The most prevalent condition was developmental delay: 78.1% (71.1%, 83.8%), followed by learning disability: 62.4% (54.6%, 69.6%) and speech/language disorder: 57.9% (50.2%, 65.2%). The largest differences in prevalence between children with and without a current CP diagnosis were observed for epilepsy or seizure disorder (PR: 69.3, 95% CI: 55.1–87.2) and intellectual disability (PR: 42.8, 95% CI: 35.0–52.3).

We observed a similar CP prevalence estimate for U.S. children during 2016–2021, 3.1 per 1,000 children aged 2–17 years, as has been seen in earlier years in the same survey, as well as from NHIS, and other survey and surveillance sources (Cogswell et al., 2022; Casseus & Cheng, 2021; Zablotsky et al., 2019; Maenner et al., 2016; Arneson et al., 2009; Kirby et al., 2011; Christensen et al., 2014). Consistent with previous data, we observed a higher prevalence of CP among boys and strong associations with lower birthweight and prematurity.

No clear changes were observed in the overall prevalence of CP in 2016–2018 (3.3 per 1,000 children), and 2019–2021 (2.8 per 1,000 children). These results are congruent with the consistent frequency of low birth weight and preterm birth, both strong risk factors for CP (Korzeniewski et al., 2018), observed in the US during this period (Osterman et al., 2023; Khan et al., 2023).

There were no significant changes in the percentages of children with current CP experiencing difficulty walking or climbing stairs, or with difficulty dressing or bathing between 2016 and 2018 and 2019–2021. This suggests that the severity of motor impairment related to these activities remained consistent over the two time periods. However, the percentage of parent-reported cases of severe current CP significantly increased from 16.8% in 2016–2018 to 30.3% in 2019–2021. Research has shown that caregivers encountered multiple challenges in adjusting their lifestyles to meet the needs of children with CP (Dlamini et al., 2023). This reported increase in severity may suggest increased mental health concerns and challenges in accessing medical care for children with CP during the COVID-19 pandemic (Lai et al., 2023), potentially exacerbating some symptoms of children with CP and influencing parents’ overall perception of their child’s condition. Further monitoring parent-reported cases of severe CP could identify whether estimates return to pre-pandemic levels or continue to rise and help understand factors contributing to the changes.

This study also provides nationally representative prevalence estimates of selected co-occurring developmental, neurological, and mental health conditions among U.S. children aged 3–17 years with a current CP diagnosis. Our findings indicate approximately nine out of ten children with CP have at least one of these selected co-occurring conditions, which is almost 4 times more prevalent than in children without CP. More than half of children with CP have developmental delay (78%), learning disability (62%), and speech/language disorder (58%), which are 9 to 15 times higher than the prevalence observed for children without CP. Relative to children without CP, the largest relative differences in prevalence were observed for intellectual disability and epilepsy or seizure disorder (43 and 69 times more prevalent in children with CP relative to children without CP, respectively). These prevalence estimates for each individual co-occurring developmental or neurological condition were in the range of or aligned with previous estimates (Boulet et al., 2009; Christensen et al., 2014; National Guideline Alliance (UK), (2017); Casseus & Cheng, 2021; Chen et al., 2024). We also observed that approximately one out of four children with CP experienced anxiety or depression, a prevalence closely aligned with the pooled prevalence of mental health symptoms (28%) using the Child Behavior Checklist reported in a meta-analysis of studies among children and adolescents with CP (Downs et al., 2018).

Moreover, mental health conditions in children with CP, especially when they also have complex co-occurring developmental and neurological conditions, may not be as readily recognized or addressed as other well-established conditions. An analysis of 2016–2020 NSCH data revealed that 75.5% of children aged 6–17 years with CP had a mental health disorder including anxiety, depression, behavioral disorders, and ADHD. Notably, only 21.5% of children with CP received mental health care (Cribb et al., 2023). The high prevalence of these co-occurring conditions in children with CP indicates that in addition to mobility assistance, many other services may be needed to optimally support children with CP. According to an analysis of 2014–2018 NHIS data, 72% of children with CP required medical services from specialists—significantly higher than children with ADHD (26%), ASD (35%), or no developmental disabilities (12%) (Cogswell et al., 2022).

This analysis is subject to limitations. The data are based on parent report and the presence of CP and co-occurring conditions was not verified in medical records, which subjects the data to recall bias. In addition, children with the condition(s) but without a diagnosis would not be captured in these data. Even after combining six or three years of data, the effective sample size was small for some subgroups, leading to less stable or unreliable estimates.

Data describing the prevalence of CP, including co-occurring conditions and groups most likely to be impacted, can be used to identify and plan for services to support people with CP and their families. This analysis provides more recent, nationally representative prevalence estimates of CP among children in the United States and estimates of co-occurring developmental, neurological, and mental health conditions among those affected by CP. Although the prevalence of CP and the severity of physical difficulties have remained constant in the United States in recent years, the high prevalence of co-occurring conditions among this population highlights the need for the multiple types of healthcare services and supports. These insights inform efforts to provide comprehensive and optimal care for children with CP and their families. Further monitoring of parent-reported cases of severe CP could aid in understanding whether estimates return to pre-pandemic levels or continue to rise, and factors associated with the changes.

Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10995-025-04177-5.