treatment

Care Team for Diagnosis

For decades, physicians have been overly cautious in diagnosing cerebral palsy and other motor delays. Now, there is a push to diagnosis early.


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:

  • Pediatrician
  • Developmental Behavioral Pediatrician
  • Geneticist
  • Neurologist
  • Neuroradiologist
  • Ophtalmologists
  • Orthopedic Surgeon
  • Otologists
  • Neonatologists
  • 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 Unexpected Journey

/the-journey/await-diagnosis/

Awaiting Diagnosis

A parent may be concerned about developmental delays or a doctor may observe a sign outside of growth norms. There is no definitive test for cerebral palsy, causing doctors to diagnose over time. For parents that suspect a child may have cerebral palsy, the long wait between that initial suspicion and an official diagnosis can be an emotional one. But, what is often a time of anxiety evolves into an empowering experience that leads to acceptance and unconditional love.
More »

Cerebral Palsy Diagnosis

doctor checking infant's reflexes

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.

Cerebral Palsy Diagnosis

baby sleeping peacefully

Reasons for Delayed Diagnosis

For all the benefits of early diagnosis, delayed diagnosis does occur – predominantly because the disorder is difficult to diagnose and doctors worry about the impact on parents. Receiving a diagnosis of cerebral palsy can be devastating, and doctors fear parents may withdraw and further hamper the child’s development.

Doctors do not want to deliver premature diagnoses. Where 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.

Of course, the main reason to delay diagnosis is the difficulty of clearly identifying the disorder. Many possibilities exit, including the brain’s potential to compensate for the injury. Additionally, a number of other conditions may appear as cerebral palsy. Misdiagnosis is a danger of early diagnosis.

Cerebral Palsy Diagnosis

baby in NICU getting a backrub

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.

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