Cerebral Palsy Diagnosis

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A cerebral palsy diagnosis includes brain imaging scans, like MRIs and CT scans, symptom observation, and monitoring of growth and development. Getting a cerebral palsy diagnosis is not as simple as a single test. Diagnosing mild cerebral palsy is particularly challenging.

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.

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

If you have concerns about your child’s behaviors, developmental path, or symptoms, talk to your pediatrician immediately. 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.

Can Mild Cerebral Palsy Be Diagnosed?

A child might not be diagnosed right away when symptoms of cerebral palsy are mild. The symptoms can go undetected for years. Most children are diagnosed as toddlers, but some people never get diagnosed until they are adolescents or adults.

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 standard 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. They can also uncover associated conditions that often co-occur with cerebral palsy.

Developmental Observations to Diagnose Cerebral Palsy

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 milestone screenings, they will refer the parents to specialists and run additional tests to rule out or diagnose cerebral palsy. 

Early Interventions for Cerebral Palsy

These developmental screenings are critical so your child’s physician can immediately refer, diagnose, and begin interventions. Early interventions have the most significant 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 sound waves. Cranial ultrasound is preferable 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 in 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 takes the images. The process generally lasts 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 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 to take images of the brain.

It’s safe and painless, but an MRI takes longer, and the infant must 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.

What Other Tests Are Used to Diagnose Cerebral Palsy?

Numerous other tests and evaluations that aid in the diagnosis of cerebral palsy or associated conditions include:[1][3]

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

Diagnosing Cerebral Palsy By Type and Severity

If your doctor diagnoses your child with cerebral palsy, they will also diagnose a type and severity based on a motor function scale. These details are essential for planning treatment.

Types of cerebral palsy are diagnosed based on symptoms and the area of the body affected. For example, spastic cerebral palsy, the most common type, causes muscle stiffness.

It can also be categorized as diplegia, hemiplegia, or quadriplegia to describe symptoms in the legs, on just one side of the body, or all over the body.

Doctors use the Gross Motor Function Classification System (GMFCS) to diagnose the severity of cerebral palsy. By observing a child’s movements and functioning, they assign a GMFCS of I through V, with V being the most severe and most impaired.

Why Is Cerebral Palsy Difficult to Diagnose?

Cerebral palsy can be a difficult diagnosis to make. Some children go undiagnosed for months or years, especially those with mild symptoms.

Some of the symptoms of cerebral palsy are easily confused with normal developmental variations. Other signs or symptoms don’t become evident until a child is older.

Parents should know what normal development looks like and the signs of birth injuries or cerebral palsy. Talk to your doctor if you have any concerns.

What Happens After a Diagnosis of Cerebral Palsy?

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 is often referred to as a patient care team, usually consists of these and other medical professionals:

• 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 will also assist 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.

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.

Many elements 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.[4]

What to Do if Your Child Is Diagnosed with Cerebral Palsy

The first thing to do is to get a thorough evaluation. You can then assemble a team of experts and begin any needed treatments and therapies.

If you suspect your child’s condition resulted from a medical mistake, talk to a cerebral palsy lawyer. An experienced lawyer can help you seek compensation through a lawsuit or settlement. This compensation can help pay for your child’s treatments and care.