What are the earliest signs of cerebral palsy?

Cerebral palsy (CP) is typically diagnosed between 18 and 24 months of age (1), although signs 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 clinical signs 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 at high risk of developing cerebral palsy, such as those who suffered birth asphyxia or HIE, were born prematurely, had a low birth weight, are a twin/multiple, had a serious infection, or experienced another type of birth injury.


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.


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

Cerebral palsy can be caused by damage to  the motor control centers of the brain. In many cases, it develops after a baby experiences oxygen deprivation or another type of harm 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.

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 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 of cerebral palsy before medical professionals do. Nonetheless, physicians must do regular and proper examinations of all babies and young children.

Signs 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 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

Signs 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 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 clinical signs of cerebral palsy in babies and young children

At any stage in a child’s growth and development, the following signs 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 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 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.

Trusted 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 cerebral palsy attorneys have decades of joint experience with birth injury and cerebral palsy cases. To find out if you have a case, contact our firm to 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 give personal attention to each child and family we help, and are available 24/7 to speak with you.

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Related resources


Video: catching the early signs 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.