Objective: To study hand impairments and their relationship with manual ability in children with cerebral palsy. Design: Cross-sectional survey. Patients: A total of 101 children with cerebral palsy (mean age 10 years, age range 6-15 years) were assessed. Methods: Three motor and 3 sensory impairments were measured on both hands. Motor impairments included grip strength (Jamar dynamometer), gross manual dexterity (Box and Block Test) and fine finger dexterity (Purdue Pegboard Test). Sensory impairments included tactile pressure detection (Semmes-Weinstein aesthesiometer), stereognosis (Manual Form Perception Test) and proprioception (passive mobilization of the metacarpophalangeal joints). Manual ability was measured with the ABILHAND-Kids questionnaire. The relationship between hand impairments and manual ability was studied through correlation coefficients and a multiple linear forward stepwise regression analysis. Results: Motor impairments were markedly more prevalent than sensory ones. Gross manual dexterity on the dominant hand and grip strength on the non-dominant hand were the best independent predictors of the children's manual ability, predicting 58% of its variance. Conclusion: Hand impairments and manual ability are not related in a predictable straightforward relationship. It is important that, besides hand impairments, manual ability is also measured and treated, as it is not simply the integration of hand functions in daily activities.