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 medical 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 medical 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.
Medical 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.
- Developmental Behavioral Pediatrician
- Orthopedic Surgeon
- 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 medical specialists. For more information on the management of cerebral palsy:
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The Cerebral Palsy Diagnosis Guide
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:
- Step 1: Parental Observation
- Step 2: Clinical Observations
- Step 3: Motor Skill Development Analysis
- Step 4: Medical History Review
- Step 5: Documenting Associative Conditions, Co-Mitigating Factors, and Ruling-Out Other Conditions
- Step 6: Obtaining Test Results
- Step 7: Diagnosis
- Step 8: Obtaining Second Opinions
- Step 9: Determining Cause
- Step 10: Care Team Assembly
- Step 11: Care Plan Creation
- Step 12: Embracing a Life with Cerebral Palsy
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.
DIAGNOSING CEREBRAL PALSY SCREENS, TESTS AND EVALUATIONS
Though there are no tests to definitively diagnose cerebral palsy, newborn screens, tests and evaluations are used to identify areas of concern and rule-out other conditions. Information on screens, tests and evaluations which may be used during the process of diagnosis include: