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Developmental Delay

A parent is likely to notice when a child doesn’t roll over when he or she should, or when an infant is not enjoying a first step. When this occurs, it could mean the child is slow to develop, or it could be a sign of developmental delay. Developmental delay is an indicator that a child may have cerebral palsy.

In the event a child has developmental delays, a number of interventions will help a young person develop their skill set, and their confidence, into adulthood.

What is developmental delay?

Doctors look for visible signs of brain injury when they evaluate children for cerebral palsy. Development delay, which occurs when an infant does not reach a milestone at the expected time, is often the first sign in most children. Doctors will also look for anatomic signs, such as evidence of excessively stiff or loose limbs. Radiological signs of cerebral palsy are visible in the brain through neuroimaging techniques like MRIs, CT scans, and cranial ultrasound.

Certain milestones are reached at predictable times. Reaching these milestones later than expected does not necessarily indicate cause for concern; many infants develop at their own pace. However, delay does suggest the possibility of a problem, especially when combined with other risk factors and anatomic or radiological signs.

Examples of milestones important for motor development include:

  • Reaching for toys at three to four months
  • Rolling onto back at around four months
  • Sitting without assistance at six to seven months
  • Smiling at around six weeks
  • Walking at 10 to 14 months

If developmental delay is suspected the ensuing evaluation is broken into two parts:

  • Developmental evaluation is performed by a specialist, such as a developmental psychologist, developmental pediatrician, or pediatric neurologist. It is a very thorough exam used to determine whether the child is lagging behind. Tests may be performed at this stage to rule out conditions, or to diagnose.
  • Developmental screening is used to detect whether possible impairment of the child’s development exists. Doctors ask parents questions and interact with the child to gauge capabilities, reflexes and responses. If delay is detected, the process moves onto the second part.

Failure to thrive is a condition diagnosed when the child does not meet age and weight appropriate standards. Failure to thrive often describes children who fall below the third to fifth percentile in weight, or a child who experiences an extreme decrease in his or her growth rate. The child could have a digestive or dietary concern, or an orthopedic condition which makes it difficult to swallow or consume foods properly.

Anatomical signs

Cerebral palsy often affects limbs. Signs, although not always present early in an infant’s life, may appear as the child develops. Doctors look for impairment of a child’s limbs, usually in the form of hypertonia or hypotonia. Other signs include impaired torso support and control, difficulty in balancing, and infant reflexes that either do not develop, or persist after they should have disappeared.

Radiological signs

Cerebral palsy is caused by an injury to the brain. The injury or malformation is detected through modern neuroimaging techniques. Cranial ultrasounds can be used on extremely young infants but are not as reliable as CT scans and MRIs (although the latter requires infants to lie still, which can be problematic.) As many as 83% of children with cerebral palsy will present with a detectable injury to the brain. Radiological exams can be an important step in diagnosing cerebral palsy.

mom with pregnant belly lying on the ground

Developmental milestones

Developmental milestones are the points in time when a child learns to accomplish a specific task. A significant delay in reaching developmental milestones is often the first indicator a child may have cerebral palsy.

Although children grow and develop at their own pace, these milestones are established to mark the average age moments most children learn the specific task. Reaching these milestones late is a sign that a child may have cerebral palsy or another development disability, especially if other signs are present. These should be discussed with a child’s doctor.

Source: Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, as of February 16, 2012. Adapted from Source: CARING FOR YOUR BABY AND YOUNG CHILD: BIRTH TO AGE 5 by Steven Shelov, Robert E. Hannermann, © 1991, 1993, 1998, 2004 by the American Academy of Pediatrics. Used permission of Bantam Books, a division of Random House, Inc.

  • gallery_6

    The journey: Awaiting diagnosis of cerebral palsy – you are not alone

    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.
    The Cerebral Palsy Journey: Awaiting Diagnosis »

  • baby with big eyes gazing playfully

    Cerebral palsy risk factors

    Cerebral palsy risk factors are events, substances or circumstances that increase the risk of developing cerebral palsy. A risk factor does not ensure a child will develop cerebral palsy; it means chances are higher than if that risk factor was not present. The absence of risk factors does not ensure that a child will not develop cerebral palsy.

    Cerebral Palsy Risk Factors »

  • an adorable baby looking up at the doctor in a humorous inquisitive manner

    Signs and symptoms of cerebral palsy

    Reaching the expected developmental benchmarks of infancy and childhood – sitting, rolling over, crawling, standing and walking – are a matter of great joy for parents, but what if a child’s developmental timetable seems delayed? There are many telltale signs that a child may have cerebral palsy, but those factors can be indicative of many conditions.
    Signs and Symptoms »

  • doctor holding infant during exam

    Diagnosis and Tests for Cerebral Palsy

    Parents are often disheartened to learn that there is no singular test that will accurately diagnose a child with cerebral palsy. Once a round of medical evaluations are initiated in order to form a diagnosis, parents prepare for a long and sometimes frustrating process that will, in time, provide answers about a child’s condition.
    Diagnosis and Tests for Cerebral Palsy »


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AAP urges doctors for early diagnosis

doctor checking infant's reflexes

American Academy of Pediatrics issues clinical report urging early diagnosis of cerebral palsy

For decades, physicians have been overly cautious in diagnosing cerebral palsy and other motor delays. But recently, the American Academy of Pediatrics stressed the importance of early diagnosis in a clinical report.
AAP Clinical Report »

Clarifying Terminology

doctor examining baby's feet

Signs vs. symptoms

Signs can be clinically substantiated; symptoms are subjective to an individual's personal experience. Signs are indicators of disease, disability or impairment detected through evaluation or testing administered by a medical professional.

Symptoms, however, are feelings experienced, perceived or expressed by the child as a result of a condition.

When diagnosing cerebral palsy, parents and doctors are typically looking at signs, especially in infants and toddlers, who do not have the capability yet to explain symptoms they are experiencing.


Signs are detected through medical evaluation, clinical tests, and practitioner observance. Although a parent may see signs of cerebral palsy when the child shows motor development delay, a doctor must rule out other conditions and formally diagnose the impairment.

The physician will also determine the extent, location and severity level of impairment, along with associative conditions or co-mitigating factors. Signs may vary by individual, depending on the brain injury or malformation and severity level. Examples of signs of cerebral palsy include:
  • Not blinking at loud noises by one month
  • Not sitting by seven months
  • Not turning head toward sounds by four months
  • Not verbalizing words by 12 months
  • Seizures
  • Walking with an abnormal gait


Symptoms are the effects of impairment an individual experiences. The child perceives and notices the symptoms, which are not necessarily visible to others. At such a young age, a child is limited in his or her ability to express symptoms and often relies on the careful observation of parents.

Symptoms, relayed to the medical practitioner, assists in the diagnosis process. Some symptoms of cerebral palsy include:
  • Choking
  • Difficulty grasping objects
  • Difficulty swallowing
  • Fatigue
  • Inability to focus on objects
  • Inability to hear
  • Pain


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