All children reach different milestones, for physical, social and emotional, cognitive, and language development at their own pace. However, if a child is significantly behind the average for meeting milestones, it may signal that there is a developmental delay. A child whose milestones are temporarily behind, but who then catches up to peers is not said to have a delay. A developmental delay is ongoing.
Children with cerebral palsy are likely to have developmental delays because they suffered brain damage during or right after birth. Often, it’s the failure to meet milestones within a reasonable time period that leads to an evaluation and diagnosis of cerebral palsy. For parents, it is important to know what the typical milestones are, to understand reasonable time frames for when they should be achieved, and to reach out to the child’s pediatrician if milestones are consistently delayed.
For a child with cerebral palsy, which effects the muscles and movements, seeing physical delays in development is often the first sign that leads to a diagnosis. Very early milestones, up to about two months of age, include holding up the head and pushing up when lying on the stomach. By four months old, most babies will be able to lift the head up unsupported, roll over front to back unassisted, hold and shake a toy, and bring the hand to the mouth.
By six months, babies start to roll over in both directions and remain sitting up without help. They stand and bounce on the legs and begin to rock back and forth. By nine months, babies stand up with the support of something to hold on to, sit up without assistance, and crawl. By one year most children can pull themselves up to stand and then walk with support. At eighteen months old a child should be able to walk unassisted, help with undressing, use a cup, and eat from a utensil.
Not all children with cerebral palsy will have cognitive impairments. For these children the milestones may be right on time, while others, like physical milestones, are delayed. Some, on the other hand, will experience delays. Two-month old babies should react to faces and follow movements with the eyes. They also start to get bored with activities and fuss. By four months, babies will respond to affection and reach for toys. They watch people’s faces and demonstrate emotions. They recognize people they know.
By six months of age, a baby should be able to observe everything nearby, bring objects to the mouth, and express curiosity about objects they cannot reach. By nine months babies can play peek-a-boo and search for items that are hidden. They put objects in their mouths.
By one year, a child will start to explore objects in more detail, will copy people’s gestures, use objects for their intended purposes, point at objects, and follow very simple directions. At eighteen months old, a child should understand what most objects are, scribble without help, and follow verbal commands with no gestures used.
Social and Emotional Milestones
Emotional and social milestones are not always as easy to assess, but delays in these can also indicate a child has cerebral palsy or another developmental disorder. A two-month old baby should be able to smile at people and use simple self-calming techniques. By four months, babies smile more and play with people. They get upset when play stops and will copy facial expressions of emotions. Six-month-old babies begin to recognize people and respond to emotions in others.
By nine months old, a baby may start to show fear of strangers or cling to the people they know. They also begin to show a preference for favorite toys. By one year of age a child should have favorite people, show fear in certain situations, be upset when mom or dad goes away, and make moves to get attention. At eighteen months, children engage others in play by sharing toys, throw tantrums, show affection, play pretend with toys, and begin to explore alone.
Language and Communication Milestones
Language delays in a child with cerebral palsy are not uncommon. These delays could be due to cognitive delays or to the physical impairments in muscles that control speaking. Children with cerebral palsy may also have physical defects that cause problems with vision and hearing. By two months of age a baby should coo and gurgle and also turn toward sounds. At four months, babies make babbling sounds and attempt to copy adult sounds. Their cries sound different when they have different needs.
By six months old, babies respond to sounds with sounds, respond to their own name, use sounds to express emotion, and start to develop distinct consonant sounds. At nine months a baby should understand the word no and say simple things like “mama” or “baba.”
By one year, babies can respond to simple requests and make gestures like waving to greet someone. They try to copy words that adults say and change their tone as they do so. At eighteen months most children can say several different simple words.
Evaluating Developmental Delays
For many parents of children with cerebral palsy, it is the evaluation of delays that leads to a diagnosis of the condition. If you see delays in your child’s development, speak to your pediatrician and consider having specialists evaluate your child. Some children simply have early delays and then catch up later, but if the delays persist, there is likely something else going on.
Your pediatrician or recommended specialists will evaluate your child by observing him and engaging with him in simple tests and tasks. A physical exam can uncover physical developmental delays, but gauging the other types of delays usually requires more thorough observations. A full evaluation may require a developmental specialist, a neurologist, and a developmental psychologist.
Developmental delays are often characteristic of cerebral palsy, but interventions can help. Working with physical therapists, education specialists, psychologists, and others can improve your child’s development and help him catch up with other children. The earlier you can determine that there is a developmental delay and get treatments and interventions, the better the results will be.