A cerebral palsy diagnosis may arrive early in a child’s life, within weeks of birth, but the disorder is often difficult to diagnose in newborns and infants. Months of careful observation may be required to identify characteristics of cerebral palsy and diagnose one of the sub-types of the disorder. Spastic cerebral palsy, for example may not be recognized until a child is several months old.
Each case of cerebral palsy presents unique signs, making it hard to generalize diagnoses. In addition, children advance at their own rates, so tracking developmental milestones doesn’t always point to a clear diagnosis. Case history, clinical observation, and the particular signs present in each case are all important factors leading to a CP diagnosis.
Understanding Developmental Progress
Early intervention leads to the best outcomes, so doctors, parents and specialists from various disciplines collaborate, thoroughly evaluating signs suggesting the presence of the disorder. CP is not considered a progressive condition, so the underlying causes do not become worse over time.
Signs and symptoms, on the other hand, can change over the course of a patient’s lifetime, resulting from the complex relationships between the neurological and physical impacts of cerebral palsy.
Early signs of cerebral palsy often appear as physical difficulties, but the disorder may also manifest in other developmental areas. Commonly classified into four zones, childhood developmental progress is monitored for irregularities, when cerebral palsy is suspected.
Children lagging in physical development receive special attention from pediatricians and other specialists committed to making early diagnoses. In many cases, difficulties resolve as a child “catches up” with developmental milestones, but delays can be an early sign of illness.
Rolling over, sitting up, standing and walking represent achievements clinicians can compare, establishing baseline norms for childhood development. In the case of cerebral palsy and other conditions, comparing performance on these benchmark personal accomplishments furnishes insight into the presence and extent of injury. In itself, a physical developmental delay doesn’t mean a child has CP, but serves as a vital early clue.
Normal Stages of Development
Parents are most often the first ones to recognize childhood disorders. Established standards help them evaluate childhood growth and development, comparing and contrasting their own child’s progress, with that of other babies. There are some developmental guidelines for the first year of life that can help:
Ages 1-3 Months
- Smile – first to his or herself, and then as an interaction with others
- Raise head and chest while lying face down
- Open and shut palms
- Move hands to mouth
- Develop grip
- Follow objects with eye
- Grabs for dangling objects
Ages 3-6 Months
- Develop head control
- Sit up with some support
- Reach and grab for hair and other objects
- Manipulate items with hands
- Make babbling sounds
Ages 6-9 Months
- Crawl – may including scooting, traditional hands and knees crawling and pulling along in an “army crawl”
- Sit without support
- Respond to familiar sounds and words
- Babble sounds like mama and dada
- Pull-up to standing position
- Clap and play games
Ages 9-12 Months
- Grasp objects between thumb and forefinger
- Begin self-feeding
- Move around with help from furniture
- Form a few words
- Associate mama and dada with individual parents
- Point to things he or she wants
- Imitates and plays by copying parents’ acts
- Takes first steps around age one year
Ages 12-18 Months
Beyond one year, motor coordination and language skills improve, as children interact more with their surroundings.
- Walks without assistance
- Plays alone
- Develops 4-10 word vocabulary
- Demands attention
- Responds to simple requests, his/her reflection and familiar faces
- Climbs on furniture
Ages 18 Months and older
- Plays socially with others
- Forms sentences
- Expands play – throws ball, rolls wheeled toys
- Expresses anger – tantrums
- Climbs stairs
Recognizing the Obvious Signs of Cerebral Palsy
Developmental milestones furnish reference points for parents, guiding their expectations as children grow older. Childhood development timetables are based upon trends among healthy babies, so when cerebral palsy is suspected, early signs of physical, cognitive and emotional difficulties help confirm diagnosis.
In addition to delays reaching movement goals and other developmental milestones, specific signs of cerebral palsy may include the following:
Children less than six months old may show the following indications suggesting cerebral palsy.
- Child feels stiff (excessive muscle tone)
- Child feels floppy (low muscle tone)
- When held, child overextends and flexes, as if pushing away
- Neck falls backward when child is picked-up from a lying position
- Child’s legs become stiff or crossed when lifted
As development continues beyond six months, signs may manifest in other ways.
- Child does not roll over in either direction
- When reaching out, child extends only one hand, while the other remains drawn-in and fisted
- Child has difficulty bringing his or her hand together
- Hand to mouth coordination is difficult for the child
In addition to these signs, babies and young children with cerebral palsy may show poor reflexes and posture, swallowing and feeding difficulties, and noted preference toward one side of the body.
The severity and extent of brain injury correlate with CP impairment, so signs of the disorder are more pronounced and easier to interpret in some cases, than others. Further indications a child may be suffering from cerebral palsy include these signs:
- Poor visual attention – wandering visual interests
- Inappropriately docility
- Frequent vomiting
- Shaky muscles in the arms and legs
- Difficulty pushing-up head and torso when laying face-down
- Crawling delays
- Trouble standing independently without support
- Increased reflexes
- Clonus (series of quick, rhythmic involuntary reflex movements)
- Abnormal oral patterns – biting hard without release, grimace, overly sensitive mouth
Postural reactions provide further insight into childhood development, reflecting motor function advances as a child ages.
- Righting reactions keep the child’s head, torso and legs in alignment.
- Equilibrium reactions help a child stay upright after a disturbance.
- Protective reactions set-in when equilibrium is severely upset and the child may fall.
Communication problems and difficulty walking, particularly by age 18 months, as well as infrequent smiling and pointing are further hallmarks of cerebral palsy.
If Your Child is Developing Slowly
In known cases involving childbirth complications and birth injury, babies are closely monitored from birth. MRIs and other tests are used to confirm cerebral palsy diagnoses in medical settings. For parents, educators and caregivers, tracking developmental milestones at home may uncover early indications of CP and other childhood disorders.
Each child’s progress is highly individualized, so variations meeting benchmarks are common. But when overall development lags and parental intuition points to a problem; signs, symptoms and developmental concerns should be shared with the child’s pediatrician.