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.
The child’s pediatrician is likely to refer the child to one or more of the following medical specialists to obtain a formal cerebral palsy diagnosis. The care team for diagnosis may include:
- Developmental Behavioral Pediatrician
- Orthopedic Surgeon
- Pediatric Geneticists
Since there is no definitive test that can diagnose cerebral palsy, doctor’s may utilize one, or a combination, of the following to aid the diagnosis process:
- Assessing reproductive health factors
- Reviewing paternal health records
- Reviewing pregnancy, labor and delivery records
- Reviewing newborn screens conducted at birth
- Considering APGAR score
- Reviewing baby birth, medical, developmental and growth records
- Performing a physical examination of baby
- Performing additional screens (hearing, fatty acids, amino acids and hemoglobinopathies)
- Conducting neuroimaging tests to determine if brain damage exists
- Performing electroencephalography (EEG) or electromyography (EMG) to analyze nervous system function
- Conducting lab tests (blood work, urinalysis or genetic testing)
- Conducting evaluations (mobility, gait, speech, hearing, vision, feeding and digestion, cognitive and rehabilitation needs)
The doctors may 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 delay 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.
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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 to Diagnosing Cerebral Palsy:
- 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
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: