Different types of cerebral palsy are often diagnosed at different times. Severe cerebral palsy can be diagnosed as early as one month of age. Spastic cerebral palsy may not be diagnosed until the baby is six months of age, and dyskinetic cerebral palsy is typically not apparent until the child is roughly 18 months of age. Ataxic cerebral palsy may take even longer to diagnose. Because the clinical signs of cerebral palsy evolve as a person’s nervous system matures, a diagnosis may require several trips to the doctor for serial examinations. This is particularly true of preterm babies.
Signs vs. Symptoms
Often when discussing medical diagnoses, the layperson might think about “symptoms” more than “signs.” The difference between the two is subtle: symptoms are internal feelings, and signs are observable to other people. Here, we discuss early signs of cerebral palsy because infants and very young children may be unable to communicate or express their symptoms.
Parental Observations and Cerebral Palsy
Often, parents are the first to notice signs of cerebral palsy in a baby. In fact, 70 to 80 percent of all disabilities in children are initially noticed by parents. Nonetheless, physicians must do regular and proper examinations of all babies and young children. In addition, if there is any suspicion that a baby’s brain suffered an oxygen-depriving insult, which can be caused by cord, placenta or uterine problems, as well as brain bleeds, an MRI should be performed soon after birth to assess any potential brain damage. MRI scans must be performed at regular intervals thereafter so physicians can monitor the brain injury as it evolves.
Signs of Cerebral Palsy
Cerebral palsy is caused by damage to the motor control centers of the developing brain that usually occur during or near the time of childbirth. Impairments caused by cerebral palsy range in severity, usually in correlation with the extent and location of the brain injury. The most common early signs of cerebral palsy are developmental delays. Cause for concern may include delays in reaching key growth milestones, such as rolling over, crawling, sitting, and walking. When diagnosing cerebral palsy, medical professionals will look for signs such as abnormal muscle tone, unusual posture, persistent infant reflexes (such as looking for a nipple), and early development of a hand preference.
Cerebral palsy primarily affects muscle tone, gross and fine motor functions, balance, control, posture and reflexes. Early signs of cerebral palsy related to these areas include abnormality with muscles in the mouth and face. Parents may be able to detect problems swallowing and feeding and holding facial expressions.
Signs of Cerebral Palsy by Age
Signs of Cerebral Palsy in Infants Younger Than Six Months
- When the baby is picked up while lying on his or her back, the head lags. However, increased tone in the neck muscles may make head control seem more normal than it actually is.
- The baby feels very stiff or very floppy
- The baby has shaky or twitchy arms and legs.
- When the baby is picked up, the legs get stiff and cross or scissor.
- The baby is irritable, has difficulty feeding (sucking, swallowing or chewing) and sleeping, or vomits frequently
- The baby is difficult to handle and cuddle
- The baby has poor visual attention
- The baby is overly docile (the body doesn’t appropriately tense or stiffen).
Signs of Cerebral Palsy in Babies Older Than Six Months
- The baby doesn’t roll over in either direction.
- Poor head control.
- The baby reaches out with one hand only while keeping the other one in a fist.
- Holding the hands in fists continuously.
- Inability to bring the hands together.
- Inability to push up with the hands while lying on the stomach.
- Difficulty bringing the hands to the mouth.
- Frequent vomiting
- The baby is difficult to handle and cuddle
- Poor visual attention
- Extreme docility (the body doesn’t appropriately tense)
- Abnormal muscle tone (stiffness or floppiness)
Signs of Cerebral Palsy in Babies Older Than Ten Months
- Lopsided crawling reflex (the baby pushes off with one hand and leg while dragging the opposite hand and leg)
- Inability to sit independently without supports
- Inability to stand without support
General Clinical Signs of Cerebral Palsy in Babies and Young Children
In addition to the above signs, the following signs may potentially be cause for concern at any age during a baby or toddler’s growth and development, and may be a sign of cerebral palsy:
- Baby favors one hand over the other before it is developmentally appropriate
- Abnormal motor development and coordination
- Difficulty forming sounds and/or words
- Retention of the primitive reflexes (such as rooting) well past the age in which they should stop
- Joint and bone deformities and contractures (permanently fixed, tight muscles and joints)
- 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 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
- Delayed postural reactions: Postural reactions are motor skills that develop during the first year of life and form the basis of functional motor skills. These reactions automatically maintain the body in an upright position through changes in muscle tone and in response to the position of the body and its parts. The three types of postural reactions are:
- Righting reactions, which maintain the head in alignment with the body, and maintain upper body alignment with the lower body.
- Equilibrium reactions, which are reactive reactions that return the body to a vertical position after displacement.
- Protective reactions, which are reactive and protect the body from falling if the body has been displaced beyond the point whereby postural correction can bring the body back to a vertical position.
Research Update: Signs 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.
Why is It Important to Identify 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 he or she can begin treatment and therapy regimens. Early diagnosis, treatment, and therapy for cerebral palsy helps minimize a child’s handicaps. Beginning therapeutic and rehabilitative programs and measures early can help the child reach his or her cognitive, physical, social, and emotional potential with greater ease. Additionally, early diagnosis and treatment can help the entire family adjust to a life with cerebral palsy.
Furthermore, diagnosing cerebral palsy early for children whose injuries were caused by medical malpractice is particularly important because these children may be entitled to compensation from a personal injury or medical malpractice case. Funds from a successful medical malpractice case help children with permanent injuries such as cerebral palsy afford important treatment, therapy, and lifestyle adjustment resources. If a family waits too long to detect cerebral palsy, adjust to the condition, and pursue legal help, their child’s statute of limitations may expire. Detecting early signs of cerebral palsy, diagnosing the condition, and pursuing legal action if need be is critical for a better life for children with cerebral palsy from medical malpractice.
Video: Michigan Cerebral Palsy Lawyers Discuss Birth Injuries
View our video library to see Michigan cerebral palsy lawyers Jesse Reiter & Rebecca Walsh discuss causes of and treatments for cerebral palsy and other birth injuries.
Miller, G. Diagnosis and classification of cerebral palsy. In: UpToDate, Hoppin, AG (Ed), UpToDate, Waltham, MA, 2013.