Cerebral Palsy — What Are the Early Signs?

Cerebral palsy (CP) is the name of a group of movement disorders diagnosed during infancy or early childhood. Cerebral palsy is the result of brain damage that happens at or around birth.

Symptoms vary widely depending on the part of the brain that is damaged and how quickly CP is diagnosed. Early CP diagnosis leads to early interventions, impacting the child’s physical, cognitive, and emotional development.

What is cerebral palsy?

Cerebral palsy (CP) is a category of movement disorders diagnosed in infancy or early childhood. Brain damage that occurs at some point during pregnancy, childbirth, or the first few weeks after birth is the most common cause of CP. Occasionally, an infection or head injury in the first year of life can also lead to a diagnosis.

Children with CP often have tense muscles and spastic, uncoordinated movement patterns. In some cases, children have overly relaxed, loose muscles that also lead to movement disorders.

Approximately 1 in 345 children is diagnosed with CP. Boys are more likely to be diagnosed than girls, and research data also show higher rates in black versus white children.

Signs and symptoms of CP vary depending on the part of the brain that is damaged and how early in life a child receives appropriate interventions. Brain injury does not change throughout a child's life, but no one can definitively predict the challenges a child with cerebral palsy will face or how independent they will ultimately be. Some adults with CP are almost entirely independent, while others require round-the-clock care.

How soon can a baby be diagnosed?

Cerebral palsy can be detected within the first six months, but is more often fully diagnosed between 12–24 months. In rare cases, children with very mild forms of CP may not be diagnosed until they are 4–5 years old.

Your pediatrician may suspect CP or other developmental disorders if your baby is not meeting typical developmental milestones at any well-child visit, especially if your baby has risk factors.

Babies are referred to pediatric neurologists for further evaluation if primary care providers have concerns about CP. Neurologic testing includes questionnaires and in-depth exams. Brain imaging is the best way to diagnose CP early in life, sometimes even before a baby starts missing milestones. The most common test is the magnetic resonance imaging (MRI) scan, which provides information about brain structure and can detect damaged areas.

Risk factors for cerebral palsy?

Brain damage that occurs around birth accounts for approximately 92% of cerebral palsy cases. Major risk factors include:

• Some maternal infections;
• Maternal drug and substance use;
• Use of infertility treatments;
• Multiple gestation pregnancy — twins, triplets, etc.;
• Prolonged labor deliveries requiring tools, e.g., forceps, vacuum, c-section;
• Premature birth and/or low-birth-weight;
• Decreased oxygen levels before or during labor;
• Breathing difficulties after birth;
• Untreated jaundice.

Brain damage during the first year or so of life accounts for the other 8% of cases. The two most common causes during this period are infections such as meningitis or head injuries.

When to be concerned that my baby might have cerebral palsy?

If your baby's birth was complicated, you and your baby's healthcare provider should pay close attention to your baby's overall development. Missed or delayed milestones may be signs of CP or other developmental disabilities. Delayed milestones that cause concern for CP vary by age, but include:

• Inability to hold their head up;
• Constantly stiff or floppy;
• Stiff, outstretched legs when you pick them up;
• Back arches away from you when held;
• Doesn't roll over;
• Has trouble or doesn't bring hands to mouth;
• Prefers one hand over the other;
• Crawling movement is lopsided;
• Doesn't stand, even with support, by 12 months.

When to see a doctor?

Parents should prioritize going to well-child visits with their child's healthcare provider. The frequent visits during the first year help pediatricians identify physical and developmental concerns. In addition, well-child visits provide a great opportunity to discuss any concerns or questions you may have. Of course, if you have concerns between appointments, call your provider's office and request an appointment.

If your healthcare provider sees any cause for concern, they will refer your baby to specialists for further evaluation. Babies with significant risk factors often receive these referrals or evaluations — even before their newborn hospital discharge.

Tips for parents

• Go to all scheduled well-child appointments.
• Document your baby's development, one option is the CDC milestone tracker.
• Don’t ignore your concerns. Talk to your child's healthcare provider, and seek a second opinion, if needed.
• Request a free developmental assessment. Contact your state's Early Intervention Program. Each state provides free assessments to help determine if your baby is eligible for publicly-funded treatments and interventions.
• Ask about resources. Local, state, and federal resources are available for children diagnosed with CP. Ask your healthcare provider, insurance company, local early intervention support system, or available resources.

Cerebral palsy is a lifelong condition that can affect every aspect of your family’s life. The brain injury that causes this movement disorder will not change over time. However, your baby will grow and develop on their own timeline. Early identification and interventions are the keys to maximizing your child’s development potential.

If you have concerns about your baby’s development or movements, talk to your healthcare provider without delay.