How Is Cerebral Palsy Diagnosed?

Out of every 1,000 births, three or four children will be born with cerebral palsy (CP), according to research.

If you’re concerned that CP may be present in your child, the next step is to have him or her tested to either diagnose what type of CP exists or to rule CP out.

If CP is present, it is important to obtain a diagnosis as soon as possible. Why?

Why Early Diagnosis is So Important with CP

The American Academy of Pediatrics (AAP) stresses that “early identification of developmental disorders is critical to the well-being of children and their families.”

Early detection is important because it enables the family to begin early treatment remedies designed to help ease the symptoms associated with CP if this diagnosis is reached, and because cerebral palsy increases a child’s risk of other medical complications.

These complications could include seizures, hearing issues, speech and language issues, trouble seeing, difficulty eating, and intellectual disability. Addressing these supplemental issues as soon as they’re detected can help the child, and family unit as a whole, live a higher quality of life.

Additionally, if the child does not have CP, but some other type of disorder that has similar appearances to this disease, it’s important to know this up front so the family can begin treatment remedies for that particular condition. Other conditions that can mimic symptoms characteristic to CP include if the child has a blood clotting disorder, or if he or she has had a prenatal or perinatal stroke.

Who Can Diagnose CP?

Fortunately for concerned parents, there are many different medical professionals who can test for and potentially diagnose (or at least pre-diagnose) CP. This provides families with a variety of avenues if there is a concern that cerebral palsy may be present.

Among these medical professionals are:

  • The child’s pediatrician or primary care doctor
  • Developmental pediatricians (specialize in childhood development)
  • Neurodevelopmental pediatricians (specialize in child development related to the nervous system)
  • Child neurologists (specialize in brain, spine, and nerve-related diseases in children)
  • Pediatric physiatrists (specialize in physical medicine and pain management for children)
  • Pediatric rehabilitation doctors (specialize in rehabilitation for children with diseases)

Testing for Cerebral Palsy

The Centers for Disease Control and Prevention (CDC) shares that there are three basic steps these medical professionals can take to better determine whether cerebral palsy may or may not be present.

Step 1. Developmental Monitoring

The first step is developmental monitoring and involves keeping track of a child’s physical and mental growth over a period of time. This is critical in the early stages because CP is typically diagnosed by the time the child is 2 years old (although, if the symptoms are mild, diagnosis may not occur until the child is 4 or 5).

This monitoring or surveillance is achieved by viewing the child during the exam, which the AAP suggests should occur at every well-child preventive care visit. It can also be done through talking with the parents about the child’s developmental history to see if they have any concerns.

Developmental monitoring is especially important for children born prematurely, or for those with a lower than average birth weight because they are at greater risk for developmental issues.

If any concerns surface as a result of this monitoring, the doctor may suggest the next step: developmental screening.

Step 2. Developmental Screening

Developmental screening is a short test conducted by medical professionals to help identify any potential delays in the child’s motor skills or movement abilities.

For instance, at two months of age, the infant should begin smiling and making gurgling sounds, according to the CDC. And at six months, the child should like to look at him or herself in a mirror, make “ah” and “oh” sounds, and respond to his or her own name.

If any of these milestones are delayed or the child experiences abnormal difficulties with these activities, they should be noticed during this screening process.

The AAP recommends that these screenings occur, at a minimum, when the child is 9, 18, and 30 months of age. If insurance doesn’t cover the 30-month visit, the AAP suggests that this final screening occurs at the 24-month mark to be within insurance reimbursement periods.

If the results of this screening suggest that delays are or could be present, the doctor may refer the child to the next step: developmental and medical evaluation.

Step 3. Developmental and Medical Evaluations

When there is a concern that a child may have CP, there are tests that can either help identify the type of CP present or even rule out the disease.

There is no specific, single test that can be used to definitively diagnose cerebral palsy. In many cases, a number of these tests are conducted at the same time, the results of which may or may not lead the doctor to a CP diagnosis.

These types of testing include:

  • Physical exam. The doctor will assess the child and pay close attention to his or her motor skills and reflexes in addition to muscle tone and posture because these are all the cornerstone characteristics of cerebral palsy. During the exam, the doctor will ask the parent(s) in-depth questions to create a clearer image of the child’s complete medical history up to that date.
  • Brain scans (neuroimaging techniques). Because CP involves damage and injury to the brain, the doctor may want to get a closer look at your child’s brain structure and function. This can be accomplished by performing a brain scan, and there are several scan options available.
  • X-ray computed tomography (CT scan). A CT scan is used to take x-ray images of the child’s brain to determine whether any areas appear damaged and, if so, the extent of the damage.
  • Magnetic resonance imaging (MRI). MRIs involve using radio waves and magnetic fields to create an image of the child’s brain. This test is capable of showing finer details than a CT, which can help doctors determine whether cerebral palsy may exist, or if there are other type of brain-related disorders present instead.
  • Cranial ultrasound. This test uses high-frequency sound waves to create images of the brain. It’s used most often for high-risk babies born prematurely, and it’s generally preferred for this demographic because it’s not as intrusive as CT scans or MRIs. Unfortunately, it’s also not as efficient at determining whether there may be issues with the white matter in the brain, which is the area most relevant to a CP diagnosis.
  • Electroencephalogram (EEG). EEGs can potentially lead a medical professional to a cerebral palsy diagnosis. The test is conducted by placing electrodes on the child’s scalp and its goal is to get a closer look at the brain’s electrical activity. It also helps identify whether or not epilepsy exists, because the test is often requested for children who have experienced seizures.
  • Genetic testing. Blood work and other laboratory tests may be requested by your doctor to determine whether there is a genetic component responsible for the child’s delays or abnormal patterns of movement. Some research studies have found genetic links between babies born prematurely and brain damage, so these types of tests can help identify whether these particular genes are present.
  • Metabolic testing. Metabolic testing may be ordered to either rule out or properly diagnose any metabolic issues contributing to the child’s developmental issues.

Post-Diagnosis Testing

In the event that your child is diagnosed with CP, your doctor may request further testing to help determine what types of impairments may exist, and their level of severity.

Some of the most commonly tested areas for a child with cerebral palsy include:

  • Hearing
  • Vision
  • Speech
  • Movement
  • Intellectual abilities

By conducting this post-diagnosis testing, families are provided a clearer picture of the severity of the child’s cerebral palsy so they have a better idea what to expect. It also enables parents to arrange for additional therapies and treatments designed to help the child live a higher quality of life.