What are the earliest signs and symptoms of cerebral palsy?

Cerebral palsy (CP) is a type of motor disorder that can result from brain damage or abnormalities. In many cases, it is caused by a birth injury; that is, a complication or medical error shortly before, during, or after birth.

Cerebral palsy is typically diagnosed between 18 and 24 months of age (1), although signs and symptoms may be present much earlier. In fact, recent research indicates that babies can often be diagnosed with cerebral palsy by six months of corrected age if physicians know what clinical features and test results to look for (2). The age of diagnosis varies depending on the severity of disability (more severe cases tend to be diagnosed earlier) and subtype of cerebral palsy (spastic, athetoid/dyskinetic, or ataxic) (3, 4). Because the signs and symptoms of cerebral palsy evolve as a child’s nervous system matures, a diagnosis may require several trips to the doctor for repeat examinations.

Close monitoring is especially important for babies who experienced a birth injury such as birth asphyxia or birth trauma, because they are at higher risk of developing cerebral palsy.


Signs vs. symptoms

Following colloquial language, we use the term “symptoms” in addition to “signs” throughout this page. Technically, however, symptoms are internal feelings, while signs of a condition are observable to other people. For example, soreness is a symptom, while an infant’s inability to hold their head up could be a sign. Infants and very young children may be unable to communicate or clearly express their symptoms. Therefore, diagnosis of cerebral palsy may actually be based more on clinical signs of this condition.


Signs and symptoms of cerebral palsy
cerebral palsy; neonatal brain damage; CP; birth injury; disability; special needs

Often, parents or doctors first suspect cerebral palsy when they notice a child exhibiting developmental delays. This means that the child does not reach key milestones, such as rolling over, crawling, sitting, walking, or speaking at the same time as their peers.

When diagnosing cerebral palsy, medical professionals will look for signs and symptoms such as abnormal muscle tone, unusual posture, persistent infant reflexes, and early development of a hand preference (1). They may also perform additional testing such as computed tomography (CT) scans, magnetic resonance imaging (MRI), electroencephalograms (EEGs), and genetic tests (5). To learn more about how cerebral palsy is formally diagnosed, click here.

In many cases, parents actually notice signs and symptoms of cerebral palsy before medical professionals do. Nonetheless, physicians must do regular and proper examinations of all babies and young children.

Signs and symptoms of cerebral palsy by age

These early signs (5, 6, 7) may indicate that a child has cerebral palsy (although parents should always consult a doctor for diagnosis).

Signs and symptoms of cerebral palsy in infants younger than six months

  • When the baby is picked up while lying on their back, they cannot hold their head up.
  • While being held, the baby may also overextend their back and neck as though they are pulling away.
  • The baby feels stiff (hypertonic) or floppy (hypotonic).
  • When the baby is picked up, the legs get stiff or cross/scissor.
  • The baby has cortical thumbs (meaning that the thumbs are persistently bent towards the center of the palm).

Signs and symptoms of cerebral palsy in babies older than six months

In addition to the signs already mentioned for children under six months of age, babies over six months may exhibit the following early indications of cerebral palsy:

  • The baby doesn’t roll over in either direction.
  • The baby develops right or left “handedness” earlier than normal (e.g. they reach out with one hand only while keeping the other one in a fist).
  • The baby struggles to bring their hands together.
  • The baby struggles to lift their hands to their mouth.

Signs and symptoms of cerebral palsy in babies older than ten months

In addition to the aforementioned signs, babies older than ten months may exhibit the following:

  • Lopsided crawling (the baby pushes off with one hand and leg while dragging the opposite hand and leg).
  • Inability to crawl on all fours (the baby may instead scoot around on their buttocks or hop on their knees).
  • Inability to stand on their own, even when holding onto support.

General signs and symptoms of cerebral palsy in babies and young children

At any stage in a child’s growth and development, the following signs and symptoms may be indicative of cerebral palsy (but again, a doctor should confirm diagnosis):

  • Poor coordination
  • Difficulty speaking and/or understanding language
  • Retention of the primitive reflexes (such as rooting) well past the age at which they should stop
  • Joint and bone deformities and contractures (permanently fixed, tight muscles and joints)
  • Curling the hand into a fist
  • Soft tissue problems such as decreased muscle mass
  • Increased reflexes and clonus (a series of quick, involuntary, rhythmic, muscular contractions and relaxations of the arm or leg)
  • Sensory difficulties (hearing, vision, or processing disorders)
  • Scissor-walking or toe-walking
  • Inability to control the bladder or bowels
  • Abnormal mouth and tongue patterns, such as retracting and thrusting the tongue, biting hard and not letting go, an overly sensitive mouth, and frequent grimacing
  • Postural abnormalities
  • Delayed reactions/clumsiness (e.g. the child may fall over more than is typical for their age group)

Research update: signs and symptoms of cerebral palsy emerge around six months of corrected age

Children are often not diagnosed with cerebral palsy until about one to two years of age when it becomes clear that they are missing milestones. However, research by Novak et al. (2017), published in JAMA Pediatrics, suggests that it is possible to diagnose cerebral palsy before six months corrected age. Corrected age takes into account an infant’s due date; if they were born early, the number of months they were premature is subtracted from their age. For example, if an infant is seven months old but was born two months prematurely, the corrected age would be five months.

Novak et al. did a literature review of published papers on cerebral palsy, and concluded that the following tools are especially useful in early diagnosis and risk assessment:

  • Neonatal MRI
  • Prechtl Qualitative Assessment of General Movements
  • Hammersmith Infant Neurological Examination
  • Developmental Assessment of Young Children

In certain cases, making an absolute diagnosis at such a young age may not be feasible. However, the authors stress that the ability to identify infants in a high-risk category is extremely beneficial because they may be given certain forms of early intervention that can optimize cognitive and motor abilities and prevent secondary complications from developing.

The importance of identifying cerebral palsy early

It is crucial to diagnose cerebral palsy as soon as possible. The earlier a child is diagnosed with cerebral palsy, the earlier they can begin treatment and therapy regimens. Early diagnosis, treatment, and therapy for cerebral palsy help minimize the child’s symptoms and maximize their physical, cognitive, social, and emotional potential.

Furthermore, diagnosing cerebral palsy early for children whose condition was caused by medical malpractice is particularly important because these children may be entitled to compensation from a birth injury case. Funds from a successful birth injury/malpractice lawsuit help children with cerebral palsy afford important treatment, therapy, and lifestyle adjustment resources. If a cerebral palsy diagnosis is delayed, the child’s statute of limitations may expire. A statute of limitations is a finite period of time (as determined by state law) during which parents have to pursue a lawsuit. Detecting early signs and symptoms of cerebral palsy, getting a diagnosis, and pursuing legal action if need be can greatly improve quality of life for children with cerebral palsy from medical malpractice.

Detroit, Michigan cerebral palsy attorneys

Birth injury is a difficult area of law to pursue due to the complex nature of the medical records. Our award-winning attorneys have decades of joint experience with birth injury and cerebral palsy cases. To find out if you have a case, contact our firm and speak with one of our attorneys. We have numerous multi-million dollar verdicts and settlements that attest to our success, and you pay nothing unless we win your case. We are based near Detroit, Michigan, but handle cases throughout  the U.S.

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Video: catching the early signs and symptoms of cerebral palsy

Sources

  1. (n.d.). Retrieved January 17, 2019, from https://www.uptodate.com/contents/cerebral-palsy-clinical-features-and-classification
  2. Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., … & De Vries, L. S. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA pediatrics, 171(9), 897-907.
  3. Granild‐Jensen, J. B., Rackauskaite, G., Flachs, E. M., & Uldall, P. (2015). Predictors for early diagnosis of cerebral palsy from national registry data. Developmental Medicine & Child Neurology, 57(10), 931-935.
  4. (n.d.). Retrieved January 17, 2019, from https://www.uptodate.com/contents/cerebral-palsy-evaluation-and-diagnosis
  5. Cerebral Palsy (CP). (2018, March 09). Retrieved January 17, 2019, from https://www.cdc.gov/ncbddd/cp/diagnosis.html
  6. What are the early signs of cerebral palsy? (n.d.). Retrieved January 17, 2019, from https://www.nichd.nih.gov/health/topics/cerebral-palsy/conditioninfo/signs
  7. Sarnat, H. B., & Sarnat, M. S. (1976). Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Archives of neurology, 33(10), 696-705.