Diagnosing Cerebral Palsy in Children

Cerebral palsy is a group of nonprogressive neurological disorders caused by an injury to the area of the brain that controls muscle movement and posture. This may occur while a baby is in the womb, during birth, or in the first two years of life.

Doctors at the Center for Children, part of Hassenfeld Children’s Hospital at NYU Langone, diagnose cerebral palsy during early childhood, often before a child is three years old.

Causes and Risk Factors for Cerebral Palsy

Most of the time, brain damage that leads to cerebral palsy occurs before or during birth. Doctors can’t always identify the exact cause, and parents can’t anticipate or prevent the condition.

Sometimes, cerebral palsy is the result of an interruption in the flow of oxygen to the baby’s brain. Babies born after a difficult labor—especially if there is a birth complication that reduces oxygen flow to the baby—have a higher risk of developing the condition.

The risk of being born with cerebral palsy is higher in babies who have a very low birth weight and in those born before 32 weeks of pregnancy.

Fever or infections during pregnancy, such as chicken pox or rubella, can cause the mother’s body to produce inflammation-causing proteins, called cytokines. These cytokines can enter the baby’s bloodstream and harm the developing brain before birth.

Less commonly, cerebral palsy may occur during infancy as a result of an injury to the child’s brain due to an accident or because of an infection of the brain, such as meningitis. This is called acquired cerebral palsy.

To diagnose the condition, doctors look for patterns of signs and symptoms that emerge as a baby grows. Our team of cerebral palsy experts—including neonatologists, neurologists, orthopedic surgeons, geneticists, physiatrists, and physical and occupational therapists—work together to evaluate your child’s muscle function and overall development. If the results of a physical assessment indicate cerebral palsy, doctors may recommend additional testing.

Signs and Symptoms of Cerebral Palsy

Physical and cognitive signs and symptoms that indicate cerebral palsy vary widely, depending on which parts of the brain are affected, how severe the injury is, and the age of the baby or child when symptoms first appear. These signs and symptoms may emerge at any time during the first few years of a child’s life, and may include the following:

• a baby’s inability to lift his or her own head by the appropriate age of development
• poor muscle tone in a baby’s limbs, resulting in heavy or floppy arms and legs
• stiffness in a baby’s joints or muscles, or uncontrolled movement in a baby’s arms or legs
• difficulty coordinating body movements, including grasping and clapping
• a delay in meeting milestones, such as rolling over, crawling, and walking
• difficulty swallowing or uncontrolled drooling
• muscle spasticity, which causes muscles to contract, or tighten, making bending or straightening joints in the hips, knees, ankles, shoulders, elbows, and wrists difficult
• poor balance
• involuntary movements or tremors
• difficulty with fine motor tasks, such as writing or using scissors
• difficulty controlling muscles related to speech

Cerebral palsy affects every child differently. Some children can move with the assistance of a walker or brace, and others may not be able to stand or walk. Social and developmental aspects of the condition also vary widely.

The condition may affect one side of the body, which is called hemiplegia. When it affects the upper or lower body, the condition is called diplegia. Quadriplegia is when cerebral palsy affects the upper and lower body on both sides. This is the most severe form of the condition.

If cerebral palsy is severe, some signs and symptoms may be evident at birth. In many children, however, symptoms appear over time, as the child develops.

Mild cerebral palsy may not be noticed until a child begins walking and has symptoms that may include stiffness or tightness in joints, a limp, uncontrolled movement, or difficulty controlling muscles in the hands and feet. Physical symptoms may be accompanied by speech delays, hearing or vision problems, or cognitive and intellectual disabilities.

As children grow during the first year of life, spasticity and imbalance in developing muscles may cause changes in the alignment of bones and joints throughout the body. For instance, if muscles surrounding the hips become too tight, this tension may pull the hip bone from its socket, called hip displacement. A similar imbalance of muscles in the back may result in scoliosis, in which the spine develops unusual curves.

Orthopedic conditions such as these may limit movement or make sitting or walking difficult or uncomfortable. Our experts closely monitor children with cerebral palsy as they grow. If doctors notice that changes in bone alignment start to become evident, they can begin treatment early to prevent the condition from becoming a more serious problem.

Testing in Newborns

Although cerebral palsy is not diagnosed right away, our neonatal specialists can often identify signs of neurological damage in a newborn baby based on the results of tests performed immediately after a baby is born. Our neonatal specialists immediately address any medical needs a newborn has with early intervention. 

Additional diagnostic tests may be used to support a diagnosis of cerebral palsy or to rule out other conditions that may cause similar symptoms.

There is no single test that confirms a diagnosis of cerebral palsy. Our doctors evaluate a child’s signs and symptoms in the context of his or her family and medical history, as well as the results of diagnostic tests, to determine whether cerebral palsy is the cause.

Physical Exam

Doctors perform a quick but thorough physical and neurological exam immediately after the baby is born. They assess vital signs, including heart rate, gag reflex, eye reflex, and the baby’s ability to suck and swallow.

Doctors also use a physical exam to look for other signs of neurological problems, such as a reduced heart rate, increased or decreased muscle tone, poor muscle reflexes, and difficulty breathing or crying.

Apgar Test

Doctors use the Apgar test to assess a baby’s skin appearance, heart rate, reflexes, muscle tone, and breathing. This test is performed 1 minute after birth, 5 minutes after birth, and 10 minutes after birth. Each category is assigned a number score between 0 and 2—for example, a baby with a normal heart rate receives a score of 2—and the numbers are added for a maximum combined score of 10.

Babies with neurological disorders often have low Apgar scores. Having a score of three or less at five minutes after birth may suggest oxygen deprivation in the brain, one possible cause of cerebral palsy.

Testing in Infants, Toddlers, and Children

Many babies don’t show signs of cerebral palsy right away. If an infant or toddler begins to lag behind on physical milestones or exhibits poor control over muscle movement, doctors may recommend evaluation by a specialist.

Pediatric orthopedists, neurologists, physiatrists, and other specialists may play a role in diagnosis. Most children with cerebral palsy are diagnosed by the time they are three.

Physical Exam

Frequently, doctors can diagnose cerebral palsy in an infant, toddler, or child based on details about the baby’s birth—for example, if the birth was difficult or if the baby was born prematurely—combined with a physical exam. Pediatric specialists carefully examine your infant, toddler, or child for low muscle tone and evidence of spasticity in the hips, knees, ankles, shoulders, elbows, and wrists.

CT Scans

CT scans use X-rays to take a series of pictures of the brain. A computer combines these pictures, creating highly detailed two- and three-dimensional images that may reveal damage to the areas of the brain associated with balance and movement.

MRI Scans

MRI scans use magnetic fields, radio waves, and computer imaging technology to create detailed pictures of the brain’s tissues. MRI scans may reveal visible signs of brain damage. 

X-rays and EOS Imaging

X-rays have been commonly used to provide images of structures inside of the body. EOS imaging, a newer technique, is a type of X-ray used to obtain three-dimensional pictures of the entire body. As a child grows, doctors may use these imaging tests to monitor the development of bones.

If an X-ray or EOS image reveals an unusual alignment of bones, such as those in the feet, hips, or spine, your child’s doctor can explain the treatment options available—and which type of treatment is most appropriate for your child’s needs.

EOS imaging uses significantly less radiation than a standard X-ray. This procedure requires that the child stand upright. It takes 30 seconds to complete. Hassenfeld Children’s Hospital is one of the first medical centers in New York City and the country to use this technology.

Genetic Testing

Sometimes, the signs and symptoms of cerebral palsy are very similar to those of a genetic neuromuscular disorder such as muscular dystrophy. To ensure an accurate diagnosis, our geneticists and pediatric neurologists can provide a thorough genetic evaluation using advanced techniques that may identify a condition and help guide treatment.

Our specialists also offer counseling and can help families understand the testing process. They provide educational materials about neuromuscular disorders and can describe how they can be inherited. They also offer emotional support to children and parents throughout testing and diagnosis.

If genetic testing supports a diagnosis other than cerebral palsy, our doctors refer your child to the appropriate specialist for additional testing and treatment.