Diagnosing Cerebral Palsy

Cerebral palsy (CP) is a condition that can affect cognitive functions, movement, balance and muscle control. It happens when a child’s brain is injured or doesn’t develop properly before birth or early in life. CP can cause stiff or weak muscles, trouble with coordination and problems with speech or posture. 

CP is a lifelong neurological condition but early diagnosis and treatment can improve a child’s quality of life.  At Banner Health, our experts use the latest tools to diagnose and treat movement disorders like CP.

Signs of cerebral palsy

Babies and young children with CP may show signs early on. Talk to a health care provider or Banner Health specialist if you notice symptoms. Some early signs may include:

• Stiff or floppy muscles
• Trouble holding up the head
• Not making good eye contact
• Developmental delays in rolling over, sitting up, crawling or walking, language development and feeding issues
• Using one side of the body more than the other
• Trouble swallowing or drooling more than normal
• Problems with balance and coordination
• Seizures

Learn more about the signs and symptoms of CP.

How cerebral palsy is diagnosed

CP is usually diagnosed in the first few years of life, but it can take longer for mild cases to be detected. Diagnosing CP requires a team of experts, including pediatricians, pediatric neurologists, pediatric orthopedic specialists, developmental pediatricians, physical and occupational therapists, speech-language pathologists and early intervention specialists.

There is no single test for CP. Health care specialists follow several steps to make a diagnosis. These include medical history, physical exams, medical imaging and specialist evaluations.

Medical history and physical exam

Your health care provider will start by asking about the pregnancy, the birth and the early development of your child. They will look for risk factors, like premature birth or infections during pregnancy. 

During the physical exam, the provider will check:

• Muscle tone (whether muscles are stiff or floppy)
• Reflexes
• Coordination and balance
• Cognitive development/interaction
• Ability to sit, crawl or walk

They will also ask about challenges with feeding, swallowing or speaking. 

Developmental milestones

Your health care provider will track your child’s growth and movement skills. If your child isn’t reaching expected milestones, like rolling over or sitting up, it might be a sign of CP. They will compare your child’s progress to typical development charts and may schedule follow-up appointments to check progress over time. 

Parents can help by sharing what they’ve noticed about their child’s coordination and daily movements to help the provider make an accurate diagnosis.

Brain imaging tests

Brain scans can help look for signs of damage or irregular brain development. These tests may include:

• MRI (magnetic resonance imaging) scan: This scan gives clear 3D or cross-sectional images of the brain and shows areas of damage. It is the main imaging test for diagnosing CP. This test is painless but can be loud and take time. Young children might need sedation (special medicine) or light general anesthesia to help them stay still during the scan.
• CT (computed tomography) scan: This test takes cross-sectional pictures of the brain. It is often used when an MRI is unavailable. The procedure takes less time and produces images similar to X-rays. A CT scan can’t directly confirm a CP diagnosis but can help rule out other conditions with similar symptoms. 
• Cranial ultrasound: A less detailed test is sometimes used for premature babies to check for early brain damage. This technique uses high-frequency sound waves to identify possible causes of CP, such as white matter damage. 

Additional tests

Health care specialists may suggest other tests to rule out conditions similar to CP. These include:

• EEG (Electroencephalogram): This test checks for seizures, which are common in children with cerebral palsy. If your child has unusual movements or staring spells, it can help detect abnormal brain activity.
• Genetic tests: These tests check for inherited conditions that might affect movement, such as CP or muscular dystrophy.
• Metabolic tests: These check for rare metabolic disorders that cause muscle weakness or stiffness.
• Lab tests: Blood or urine tests check for infections, metabolic disorders or other problems affecting the brain.

Levels of severity in cerebral palsy

Once CP is diagnosed, health care specialists will determine how severe it is. They use a system called the Gross Motor Function Classification System (GMFCS). This tool measures how much a child can move. It has five levels, from Level 1 (mild) to Level 5 (severe). This GMFCS helps specialists determine the best way to support each child. 

• Level 1 (mild): Children at Level 1 can walk on their own without any help. They may have some problems with balance or coordination but they can do most activities. They may walk slower or have trouble running or jumping, but they can still move around like other kids. 
• Level II (mild-moderate): Children can walk by themselves but may have trouble walking on uneven surfaces or long distances. They may get tired more easily. They may also need help with things like climbing stairs or walking on bumpy ground.
• Level III (moderate): Children have trouble walking. They may use a walker or wheelchair for longer trips. They can walk short distances but it’s harder for them to keep their balance. They may also need help with more difficult tasks, like running or climbing.
• Level IV (severe): Children have trouble walking and may need a wheelchair. They may still be able to move their arms and head, but their leg movement is very limited. They need help with most daily activities, like eating, dressing and bathing. They may be able to do some things on their own, but they need a lot of support from caregivers.
• Level V (very severe): Children can’t walk or sit on their own. They need a wheelchair for all movement. They have very limited muscle control and may have trouble with basic movements. They need help with everything, like eating, dressing and personal care. Children at this level may also have problems with speech or swallowing. 

Does cerebral palsy get worse with age?

CP isn’t progressive, meaning it does not get worse as a child gets older. Although the symptoms won’t worsen, but they can change over time. Also, if therapy or treatment is not provided consistently, then there could be worsening of stiffness and or development of contractures (shortening and hardening of muscles and tendons).  Both children and adults with CP may require lifelong care. 

If you think your child may have cerebral palsy, get a diagnosis as soon as possible. Contact us today to learn more about diagnosing CP or to schedule an appointment. Our team is here to provide expert care and support for your child.

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Explore more about treatment options and living with CP. We’re here to help your child lead a happy, healthy life.