Diagnosis of and Tests for Cerebral Palsy

Diagnosing cerebral palsy takes time. There is no test that confirms or rules out cerebral palsy.

In severe cases, the child may be diagnosed soon after birth, but for the majority, diagnosis can be made in the first two years.

For those with milder symptoms, a diagnosis may not be rendered until the brain is fully developed at three to five years of age. For example, the average age of diagnosis for a child with spastic diplegia, a very common form of cerebral palsy, is 18 months.

This can be a difficult time for parents who suspect something might be different about their child. Often, parents are first to notice their child has missed one of the age-appropriate developmental milestones.

If a growth factor is delayed, parents may hope their child is just a slow starter who will “catch up.” While this may be the case, parents should inform the child’s doctor of concerns, nonetheless.

Confirming cerebral palsy can involve many steps. The first is monitoring for key indicators such as:

  • When does the child reach development milestones and growth chart standards for height and weight?
  • How do the child’s reflexes react?
  • Does it seem as if the child is able to focus on and hear his or her caregivers?
  • Does posture and movement seem abnormal?

Doctors will test reflexes, muscle tone, posture, coordination and other factors, all of which can develop over months or even years. Primary care physicians may want to consult specialists, or order tests such as MRIs, cranial ultrasounds, or CT scans to obtain an image of the brain. Even once a diagnosis of cerebral palsy is made, parents may wish to seek a second opinion to rule out misdiagnosis.

Why Diagnosis is Important?

A diagnosis is important for many reasons:

  • To understand the child’s health status
  • To begin early intervention and treatment
  • To remove doubt and fear of not knowing
  • To find and secure benefits to offset the cost of raising a child with cerebral palsy

A variety of benefit programs are available to children with disability or impairment. To qualify for these programs, the child must have a formal diagnosis. Without a diagnosis, parents can fall into a limbo pattern.

DIAGNOSING CEREBRAL PALSY The Diagnosis Care Team

The process for diagnosing cerebral palsy usually begins with observations made by the child’s primary care physician, usually a pediatrician, and the child’s parents. There are some exceptions.

If a baby is born prematurely, or at a low birth weight, he or she is monitored closely in the neonatal intensive care unit of the hospital from time of birth. In extreme cases of child abuse, or shaken baby syndrome a pediatric neurologist called to the hospital’s emergency or NICU unit will diagnosis the child’s condition. In the majority of cases the child will attend regular well-baby visits where the pediatrician first uncovers signs of cerebral palsy during examination. In some cases, it is the parents who notice symptoms they relay to the child’s doctor during these visits.

Developmental delay, abnormal growth charts, impaired muscle tone, and abnormal reflexes are early indications of cerebral palsy. Because there is no test that definitely confirms or rules out cerebral palsy, other conditions must be excluded from the list of possible causes, and cerebral palsy must be fully considered. Other disorders and conditions can appear as cerebral palsy, and cerebral palsy is often accompanied by associated conditions that complicate the process of diagnosis.

The medical examination process can involve multiple doctors, tests, and appointments. During this time doctors will rule out other similar conditions such as:

  • degenerative nervous disorders
  • genetic diseases
  • muscle diseases
  • metabolism disorders
  • nervous system tumors
  • coagulation disorders
  • other injuries or disorders which delay early development, some of which can be “outgrown”

Common tests that involve neurologists or neuroradiologists, include neuroimaging, such as cranial ultrasound, computed tomography scan (CT Scan), and magnetic resonance imaging scans (MRIs). These tests allow neurologists to actually “see” the brain. Various disorders, injuries, and conditions yield different results. These can be used to rule out cerebral palsy.

Infants who test positive for a developmental disorder may be referred to specialists for further evaluations.

A child may be sent to an orthopedic surgeon to ascertain delay in motor development, record persistence of primitive reflexes, examined for dislocated hips, and assessed for abnormal posture.

Specialists are brought in to test hearing, vision, and perception, as well as cognitive, behavioral, and physical development.

A genetic specialist may be consulted for hereditary components.

The pediatrician will document all surveillance, screening, evaluation, and referral activities in the child’s health record.

The lengthy and detailed process can help rule out or confirm cerebral palsy. A formal diagnosis is usually made once the brain is fully developed between 2 to 5 years of age.

  • Pediatrician
  • Developmental Behavioral Pediatrician
  • Geneticist
  • Neurologist
  • Neuroradiologist
  • Ophtalmologists
  • Orthopedic Surgeon
  • Otologists
  • Neonatologists
  • Pediatric Geneticists

After the child has been diagnosed with cerebral palsy, the doctors will ascertain the extent, location and severity of the condition as well as any associative conditions or co-mitigating factors. Cerebral palsy cannot be cured, however it can be managed. The focus of treatment will be on the management of the child’s health status. This often requires a team of specialists. For more information on the management of cerebral palsy:

Care Team and Care Plan for Management of Cerebral Palsy

DIAGNOSING CEREBRAL PALSY 12-Step Diagnostic Process

The diagnosis process begins by monitoring the child’s development and watching for possible signs of impairment. If a baby is born prematurely, or at a low birth weight, he or she is monitored closely at time of birth in the hospital’s neonatal intensive care unit. If the infant attends regularly scheduled well-baby visits, the pediatritian may be first to notice signs of cerebral palsy. In some cases, it is parents who notice symptoms they relay to the child’s doctor.

To learn more of what to expect during the process of diagnosis, MyChild has identified The 12-Step Process of Diagnosing Cerebral Palsy. The steps include:

MyChild™ has developed two checklists which may be of assistance when awaiting diagnosis. The MyChild™ Risk Factor Checklist records exposure to possible risk factors which can be discussed with the the obstetrician-gynecologist during pregnancy, and the child’s primary care physician while awaiting diagnosis. The MyChild™ Diagnosis Checklist helps parents record specific findings as the diagnosis is being made.

DIAGNOSING CEREBRAL PALSY Screens, Tests and Evaluations

Planning a family can be an exciting time, but it is also a time to begin providing for the safety of the child. Before conception, it is extremely valuable to establish reproductive health by consulting with a doctor.

Expectant parents should be made aware of possible pregnancy risk factors that can increase the likelihood of a child developing cerebral palsy or other conditions. Although exposure to a risk factor does not guarantee a child will be harmed during development, it does indicate a need for concern and evaluation. The best way to lessen the threat is to be aware of risk factors and know what actions can be taken if exposure occurs. Risk factors are a significant concern before conception, during conception, during pregnancy, and during birth. Smoking, infections, exposure to toxins, prescription drugs, age, and blood type incompatibility can all impact development of a child in the womb.

Though there are no tests to definitively diagnose cerebral palsy, information on helpful screens, tests and evaluations include:

Screens, Tests and Evaluations for Cerebral Palsy:

DIAGNOSING CEREBRAL PALSY The Importance of Early Diagnosis

Many people involved with the research and treatment of cerebral palsy believe the earlier a diagnosis is made, the better the child will fare. Early diagnosis allows the child to begin treatment before impairments have “set in.”

An infant’s brain, muscles, reflexes, and motor control continue to develop long after birth. For children with cerebral palsy, their brain injury prevents normal development. Eventually, muscles, coordination, and posture may become impaired. Beginning treatment early in infancy can yield some of the largest gains.

Because the young brain is developing (in a way, learning how to be a brain) treatment may help the child’s brain to adjust to the injury. The younger the brain, the more adaptable it may be, perhaps increasing
the chance that the brain can “rewire” itself to mitigate the extent of the injury.

Motor control and reflexes are also still developing in babies. Spasticity becomes more apparent as the child grows. During infancy, the child may show no or little spasticity. As a result, the limbs are easier to move, possibly increasing the effectiveness of physical therapy both on the muscles and the brain.

Early diagnosis also enables parents to find benefits and funding for their children. A diagnosis increases the chances of qualifying for Early Intervention programs and receiving state and government aid.

DIAGNOSING CEREBRAL PALSY Reasons for Delayed Diagnosis

Delayed diagnosis may be necessary. The predominant reason is that cerebral palsy is difficult to diagnose and doctors worry about the impact on parents. Learning one’s child has cerebral palsy can be devastating, and some doctors fear parents may hear the news and withdraw from the child before having an opportunity to bond. Strong parental bonds are important for a child’s development.

Doctors do not want to deliver premature diagnoses and prefer to first rule out other conditions to avoid misdiagnosis. When they may suspect cerebral palsy, doctors might keep the suspicions to themselves and talk to the parents about the symptoms. They may mention their suspicions, or just subtly prepare the parents for an eventual diagnosis.

Again, the main reason to delay diagnosis is uncertainty of diagnosing cerebral palsy. There are so many possibilities, one of which is that the child’s brain may compensate for the injury. Additionally, many other conditions may appear as cerebral palsy. A danger of early diagnosis is misdiagnosis.

DIAGNOSING CEREBRAL PALSY Avoiding Misdiagnosis

Misdiagnosing any condition can be harmful to a child and can lead to inappropriate treatment such as unnecessary surgeries, medications, and expense.

Misdiagnosis can mean the condition was wrongly identified, altogether. Or, it can mean the condition was correctly identified, but the subtype was classified in error. Misdiagnosis could also entail wrongly identifying the underlying condition, the cause of the condition, the extent or severity of the condition, or complications of the condition. For instance, the diagnosis of cerebral palsy may be correct, but the severity, extent or co-mitigating factors may have been improperly diagnosed. Not all specialists agree on the classification of the condition as provided and defined by another specialist.

Commonly diagnosed conditions are misdiagnosed less, while difficult-to-diagnose conditions are more commonly mistaken. Misdiagnosis can be the result of a doctor’s error, misread test results, incorrect laboratory readings, or overlooked alternatives. It is recommended that parents avoid misdiagnosis by obtaining a second opinion, consulting with specialists, having medical tests thoroughly explained, and becoming educated on the child’s diagnosed condition.

If a child who has cerebral palsy is not diagnosed properly, the untreated impairment can result in more severe spasticity, abnormal posture, contractures and deformities. Other conditions can be mistaken for cerebral palsy.