Cerebral Palsy Diagnosis

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Getting a cerebral palsy diagnosis is not as simple as a single test. Doctors diagnose cerebral palsy by observing symptoms and monitoring growth and development. They also use brain imaging scans and multiple tests.

How Is Cerebral Palsy Diagnosed?

Diagnosing cerebral palsy is often complicated. There is no single test that can confirm a diagnosis of cerebral palsy. Doctors use a combination of observations, screenings, CT scans, and tests over the first months to years of life to make a diagnosis.[1]

Testing can include a physical examination, growth measurements, developmental screening and monitoring, brain imaging, and ruling out other conditions.

In some instances, cerebral palsy symptoms are severe enough that a physician will make the diagnosis shortly after birth.

Early diagnosis is best when it is possible. The sooner intervention and treatment begin, the more they can impact the child’s ongoing quality of life.

Are There Early Signs of Cerebral Palsy I Can See in My Child?

If you have any concerns about your child’s behaviors, developmental path, or symptoms, talk to your pediatrician right away. Doctors screen and test babies, but they also rely on parents’ observations.

Look out for some of the earliest signs of cerebral palsy in babies to get the earliest diagnosis possible: 

• Your child is missing developmental milestones, like holding up their head, rolling, or sitting.
• Their arms, legs, or neck feel unusually floppy or abnormally stiff and tense.
• The legs or arms are stiff and cross over each other.
• Your child favors one side of the body over the other.
• They push away from you when picked up.

What Is the Average Age of Diagnosis for Cerebral Palsy?

As testing and screenings get better, the age of diagnosis gets earlier. Currently, most children don’t receive a diagnosis of cerebral palsy until they are between 12 and 24 months old.

Observations and Screenings for All Babies

Some of the screenings that help diagnose cerebral palsy are used for all newborns. Others are reserved for children showing symptoms or developmental delays. These are some of the common screenings most babies undergo soon after birth: 

• All infants receive an APGAR score (activity, pulse, grimace, appearance, and respiration) within the first five minutes of life. If there are problems with breathing, circulation, or neurologic function, the APGAR score will be low, indicating that further evaluation should be considered.
• All states in the U.S. routinely give newborns a blood test to screen for diseases such as sickle cell anemia, PKU (phenylketonuria), hypothyroidism, and galactosemia.
• Other types of screening may include hearing tests and tests of cardiac and respiratory function.

Although these screenings will not diagnose cerebral palsy, they help determine the need for additional tests for the condition. They can also uncover associated conditions that often co-occur with cerebral palsy.

Developmental Observations

Doctors perform developmental screenings at well-baby visits to determine if the child is growing and developing appropriately. They observe and evaluate to check for developmental delays, which could indicate cerebral palsy.

Development screenings include a review of milestones. These are the development of age-appropriate skills such as using the hands, sitting up, and making sounds in response to language. Pediatricians typically do these screenings at 9, 18, and 24 or 30 months.

As a child gets older, it is easier to observe developmental delays. If a pediatrician suspects cerebral palsy at any of the milestone screenings, they will refer the parents to specialists and run additional tests to rule out or diagnose cerebral palsy. 

These developmental screenings are critical so your child’s physician can refer, diagnose, and begin interventions as soon as possible. Early interventions have the biggest impact on a child’s outcome.

Early intervention services are available in most states to assist both children and families:

• Speech therapy
• Physical therapy
• Occupational therapy
• Assistive technology and devices
• Nutritional counseling
• Family training and support

Imaging Scans to Diagnose Cerebral Palsy

Specific testing is more conclusive than observation of developmental milestones. Imaging tests and scans help physicians diagnose cerebral palsy and rule out other conditions.

The most common tests ordered when considering a diagnosis of cerebral palsy include:

Cranial Ultrasounds

A cranial ultrasound captures images of the brain using soundwaves. Cranial ultrasound is a preferable method in the first month of life, as it is the least invasive of the neuroimaging techniques.

Cranial ultrasound uses reflected sound waves to create pictures of the brain and the inner chambers. A radiologist performs the study by moving a transducer across the top of the baby’s head over the soft spot (fontanelle). The scan produces images of the brain and its inner fluid chambers on a monitor.

Although cranial ultrasound is not used to diagnose cerebral palsy directly, the study aids the diagnosis of other medical conditions. It gives a picture of neurological status and diagnoses conditions that might cause cerebral palsy, including a brain hemorrhage and fluid on the brain.

CAT Scan

A CAT scan or CT scan, short for computerized tomography, is a test involving a special X-ray machine that can be used to take pictures of the baby’s brain, skull, and vessels in the brain.

The infant is placed into the scanner, which will then take the images. The process generally lasts around 10 to 15 minutes, or sometimes longer, depending on whether sedation is needed and how many images are being taken.

MRI

MRI (magnetic resonance imaging) is a type of neuroimaging that uses magnetic fields to take pictures of the infant’s brain and spine. MRI scans will look at the structures in more detail and generate more definitive results than ultrasound or CT.[2]

The MRI scanner is a machine that uses a strong magnet. Like a CT scan, the baby’s head is placed into the scanner in order to take images of the brain.

It’s safe and painless, but an MRI takes more time, and the infant has to be completely still during the scan. This is usually a difficult task for babies. Sedation is generally required to help babies remain calm and still during this more lengthy scan.

For more detailed information on imaging tests and cerebral palsy, refer to our article, Cerebral Palsy Imaging Tests.

Other Tests

Numerous other tests and evaluations that aid in the diagnosis of cerebral palsy, or associated conditions include:

• Blood tests to check for genetic and metabolic abnormalities[3]
• Speech and language testing
• Hearing testing
• Vision testing
• Oral motor tests, including feeding and swallowing evaluations
• Neurological evaluations, including neuromuscular testing[4]
• Tests of cognitive functioning
• Gait testing, which evaluates any problems with walking
• Physical and occupational therapy evaluations[5]

What Happens After Diagnosis?

Once your child is diagnosed with cerebral palsy, medical professionals and specialists will begin considering the best treatment options. They will also test for and diagnose any associated conditions.

Generally, comprehensive treatment plans come from a group of medical professionals who work together to ensure your child gets the best combination of therapies.

This group, which are often referred to as a patient care team, usually consists of these and other medical professionals:[6]

• General or developmental pediatrician
• Nurse case manager
• Neurologist
• Counselor
• Dietitian
• Physical therapist
• Occupational therapist
• Speech and language therapist
• Orthopedic specialist
• Others, depending on your child’s needs.

The Importance of Early Screenings and Diagnosis

Keep in mind that getting proper routine screenings for your child is crucial. Not only will it help you understand your child’s health needs, but it assists in obtaining a diagnosis, early intervention, and treatment.

Early screening and diagnosis can also help you secure benefits and compensation more quickly, which can significantly help with the medical costs for a child with cerebral palsy.[7]

Remember, however, that a cerebral palsy diagnosis can take months to years. There may be a period of time during which your child is diagnosed with developmental delay. A more specific diagnosis may come later.

There are many elements that contribute to the diagnosis, so it usually takes time and repeated evaluations to rule out or confirm the condition. This is very often the case with neurodevelopmental disorders, in general.

Aside from severe cases of cerebral palsy, which are typically diagnosed at birth, most diagnoses happen somewhere around two years of age.[8]

If you suspect your child’s condition resulted from a medical mistake, talk to a birth injury lawyer. An experienced lawyer can help you recover damages that will help pay for your child’s treatments and care.