By Dr Ananya Mandal, MD
Cerebral palsy diagnosis and screening is based on suspicion especially if there have been a risk of injury to the baby’s brain before, during or after birth. Diagnosis is made with the help of a paediatrician or a specialist in pediatric neurology.
Diagnosis and detection of cerebral palsy
The steps in diagnosis and detection of cerebral palsy include:
Detailed history of development of the child. This also includes a history of high or low blood pressure, head injury while in the womb or maternal infections while pregnant. History regarding multiple births, low birth weight and prematurity is also obtained.
Detailed history of events during and within the first six months after birth is important. During birth any complications like placental rupture, uterine rupture or umbilical complications that could lead to asphyxia or oxygen deprivation are recorded. Right after birth a history of severe neonatal jaundice and kernicterus is obtained. Any history of meningitis or encephalitis within six months after birth is significant.
The child is examined in detail. This includes the child’s reflexes, posture, motor skills and muscle tone. Intellectual development appropriate for age, memory, cognitive skills and speech, hearing and vision are also tested. An educational psychologist assess the child's intellectual development.
Tests may be suggested to rule out brain tumors and muscular dystrophy. Muscular dystrophy is a genetic condition affecting the development of the muscles and may be confused with cerebral palsy.
Blood tests are advised. Brain imaging tests include a cranial ultrasound. This uses sound waves to build up a picture of the child’s brain tissues. This may help detect abnormalities. More accurate tests include an MRI scan of the brain and a CT scan of the brain. An MRI uses radio and magnetic waves to study the brain in more detail. CT scan uses series of X-rays to look at brain structures.
Confirmed diagnosis is usually made by the time the child is two or three years old. The exact type and its severity is determined by the time the child is four or five years old.
Screening for cerebral palsy
For screening for cerebral palsy in a high risk child three basic steps are adopted. These include:
Developmental Monitoring – this is called surveillance and basically tracks the child’s growth and development over time. The child is monitored at each of the well-child office visits. Although this is done for all children, those who have risk factors for cerebral palsy may benefit most by this monitoring.
Developmental Screening – A short test is given to see if the child has specific developmental delays, such as motor or movement delays. This could be in the form of tests or questionnaires to the parents or caregivers or tests given to the child to assess movement and development. The American Academy of Pediatrics recommends that all children be screened for developmental delays during regular well-child office visits. These visits should be at 9, 18 and 24 or 30 months.
Developmental and Medical Evaluations – this is a more specific monitoring that evaluates a child suspected to have cerebral palsy. It helps detect the type and severity of the cerebral palsy. The tests evaluate movement or motor delays, motor skills, muscle tone, reflexes, and posture. This can be performed by developmental pediatricians or neurodevelopment paediatricians, pediatric neurologists or pediatric rehabilitation doctors.
Reviewed by April Cashin-Garbutt, Ba Hons (Cantab)
Last Updated: Dec 11, 2012