Diagnosing Cerebral Palsy

Facing the possibility that a child may have a birth injury is reason enough for parents to feel overwhelmed or concerned. The road to a formal Cerebral Palsy diagnosis for their child is not always an easy one. Because there is not a general test to confirm or rule out all forms of CP, the process to find much-needed answers about a child’s condition can sometimes be long, frustrating, and at times confusing to navigate. Roughly 43% of children displaying severe symptoms indicating a birth injury receive a diagnosis within the first few months of life. Further, 70% of all children diagnosed with a birth injury receive one by the time of their first birthday. Sadly, that means in roughly 30% of cases the diagnosis can be delayed until 3-5 years of age.

Diagnosing Cerebral Palsy takes time. Unfortunately, when it comes to the early stages of a child’s life, parents understandably lack the ability to detect how their child is limited. Being able to recognize the limits in movement and speech tied to a Cerebral Palsy diagnosis can require years of training. Not every case of CP is the same and that means far too many cases of Cerebral Palsy are missed. Because of this, the age at which a child can receive an accurate diagnosis varies and is dependent upon several different factors. Factors related to a Cerebral Palsy diagnosis include, but are not limited to:

• Severity: a child exhibiting more severe symptoms will be diagnosed at an earlier age because his or her challenges are more evident
• Type: some types of CP are easier to observe and diagnose than others, making it more apparent for a pediatrician or specialist to recognize the problems and diagnose the condition
• Parental involvement: doctors often unfairly rely on parents to monitor and describe the developments and behaviors they observe in their child

While parents are the first to suspect or raise the alarm that their child’s growth and development may be outside of the expected curve, doctors are still necessary for a diagnosis. It is important for new parents to remember that while some children progress faster than others, that does not mean that missed milestones should be ignored. There are certain developmental milestones that are reasonably expected to be achieved as they grow. Some examples of identifiable missed milestones that can help a doctor in diagnosing Cerebral Palsy are when a child might not accomplish the following:

• By two months begin to smile, coo, and push up while lying on stomach
• By six months roll over in both directions and sit up without the use of other objects for support
• By one year self-feed, form a few words, and take his or her first unassisted steps

If parents notice their child has not reached any of these milestones, it is critical that these observations be reported to the child’s pediatrician early to hopefully improve the diagnostic process. The American Academy of Pediatrics advises for screening tests to be administered at 9, 18, and 30 months of age.  However, if parents become concerned with problems surrounding their child’s development, they are encouraged to be proactive in requesting early and/or further screening. During a child’s early stages of life, pediatricians will watch for delays in key areas of motor function. Examples of these efforts include a child holding up his or her head, visual alertness, sitting, crawling, picking up small objects, and more. Doctors will supplement a Cerebral Palsy assessment by evaluating areas such as posture, reflexes, and muscle tone. All of this is aimed at reviewing as many potential factors as possible when considering diagnosing Cerebral Palsy in a child.  

The Gross Motor Function Classification System (GMFCS) is a systematic structure often used to diagnose the severity of a child’s motor impairment. This helps doctors diagnose Cerebral Palsy by level of severity, illustrating how a child is affected by their CP and what that indicates in terms of improving their gross motor skills in the future through therapy and treatment. The 5 Levels of Severity in Cerebral Palsy are as follows:

• Level I: The child is considered to be capable of being fully independent, can perform most physical activities and faces only slight problems in balance or coordination
• Level II: The child may experience trouble balancing on uneven surfaces, can require use of railings when climbing stairs, but can walk independently in most circumstances while facing limits in ability when it comes to running and jumping
• Level III: Children diagnosed with this level of CP will most often rely upon devices such as crutches or a wheelchair, but may be able to climb stairs using railing
• Level IV: A child at this level will most often face significant challenges when it comes to the ability to walk, often requiring a wheelchair for mobility
• Level V: Significant restrictions in voluntary control; medical professionals diagnosing at this level would not expect these individuals to walk or stand independently and require significant assistance

In order to perform a complete assessment, doctors may conduct other evaluations and utilize additional diagnostic tools, such as hearing and vision tests, monitor speech progression, and intellectual development assessments to help achieve an accurate diagnosis. Because Cerebral Palsy is caused by a brain injury at or around birth, imaging tests to view the brain and asses the area that suffered damage can help evaluate the child’s condition. Some common tests utilized during the CP diagnosis process include:

• Magnetic Resonance Imaging (MRI): a three-dimensional imaging of the brain that detects neurological abnormalities that are tied to issues with motor function
• Computerized Tomography (CT): an X-ray scan from multiple angles that analyze cross-sections of the brain to document any bleeding, skull fractures, and other irregular conditions
• Cranial Ultrasound: an examination of brain tissue for damage, specifically white matter
• Electroencephalogram (EEG): a tool that measures electrical activity in the brain to detect abnormalities in brain function  

It is critical to fully analyze a child’s condition to properly in order to diagnose the specific type of Cerebral Palsy that a child may have. Such a review is critical in providing the correct form of treatment and limiting how CP affects the child to help create the best possible future for a child who has suffered a birth injury. This process also includes recognizing the spectrum of conditions that may be tied to, but not directly caused by, the same brain injury associated with Cerebral Palsy.

A few examples of these conditions are:

• Speech impairment
• Intellectual disabilities
• Visual impairment
• Hearing loss
• Sensory problems
• ADHD and Autism

These extended conditions also present a challenge when properly diagnosing CP. Doctors must consider that Cerebral Palsy shares various clinical signs with many other disorders, that can cause children to develop differently or have underlying challenges not associated with CP that can impact motor development and coordination. It is important to rule out all other possible causes of a child’s symptoms before making a formal diagnosis, which can impact the all-important Cerebral Palsy diagnosis that can open doors for future treatment, therapy, and more.

A doctor’s diagnosis protocol can involve a variety of factors centered around understanding your child’s abilities as a whole and not just a limited set of challenges or concerns. While a diagnosis may be delayed as this extremely important process takes place, a parent should devote their energy to giving their child the best care possible, within medical guidance, while ensuring they are fully comfortable with the medical care being provided. Ultimately, the goal of all individuals associated with a child’s care, whether they are suspected to have Cerebral Palsy or not, is the betterment of that child in all forms possible. A Cerebral Palsy diagnosis, while unfortunate, has the ability to open doors to a wide range of assistance and answers, not limited to:

• Understanding the child’s current health status and how to limit future challenges
• Beginning early intervention and treatment to overcome challenges, where possible, caused by CP
• Removing doubt and fear of not knowing the root cause of a child’s birth injury
• Being able to secure benefits to offset the cost of therapies and treatments
• Charting a path for future care with healthcare providers and determining what possible changes are needed
• Pursuing adaptive equipment to offset challenges related to a child’s special needs
• Exploring options available for IEPs and more

Every parent wants to give their child the most they can to help them achieve their full potential. For more information on how we can help your family once a child has received Cerebral Palsy diagnosis, or connect you with various resources helping explain this complex condition, contact us today by filling out our online form or by calling (800) 692-4453.