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Recent studies have provided methods to detect infants and young children with cerebral palsy (CP) early. For infants who are high-risk, such as those born very premature, there are international guidelines to detect CP early using a range of sophisticated assessment tools (magnetic resonance imaging, General Movements Assessment using videos, standardized neurodevelopmental assessments). These tools are being used in Neonatal Follow-up programs that follow high-risk newborns systematically over the first years of life.

 

Many children with CP are not born early and did not have a high-risk delivery. A different strategy is needed for these children so that we can diagnose CP early. We developed a toolkit to help community physicians detect CP in infants as part of their well-baby care visits.

Early Detection Tools: Prompts for Referral

Clinical features

If “YES” to any ONE of these ATYPICAL SIGNS (if premature, use corrected age), refer to a developmental pediatrician or a child neurologist for diagnostic assessment.

Typical development
Atypical development
Clinical feature
Typical development
Child reaches for rattle with either hand
Atypical development
Clinical feature

The child consistently demonstrates a hand preference before 12 months of age

Typical development
Child's hands are not fisted
Atypical development
Clinical feature

The child consistently keeps 1 or 2 hands fisted (closed/clenched) after the age of 4 months

Typical development
Child is able to lift head along with body
Atypical development
Clinical feature

The child demonstrates a persistent head lag beyond 4 months of age

Typical development
Child reaches for ball equally with both sides of body
Atypical development
Child reaches for ball only with one side of body
Clinical feature

The child demonstrates consistent asymmetry of posture and movements after the age of 4 months

Typical development
Child is sitting up and holding their head and body up without support
Atypical development
Clinical feature

The child is not able to sit without support beyond 9 months of age

Typical development
Atypical development
Child's legs are too stiff for them to interact with
Clinical feature

The child demonstrates stiffness or tightness in the legs between 6–12 months of age (e.g. unable to bring
their toes to mouth when having their diaper/nappy changed)

Warning signs

If “YES” to EITHER of these signs, monitor and plan for a follow-up visit with your patient rather than immediately refer for diagnostic assessment

The child demonstrates a persistent Moro reflex beyond 6 months of age
Child is walking on their toes

The child demonstrates consistent toe-walking or asymmetric-walking beyond 12 months of age

Referral recommendations

When referring to a medical specialist for diagnostic assessment, also refer to:

  • All children should be referred to a motor intervention specialist (e.g. pediatric occupational therapist and/or pediatric physical therapist)

  • If the child manifests a delay in communication, they should be referred to a speech-language pathologist

  • If the child manifests hearing concerns, a referral should be made to an audiologist

  • If the child manifests vision difficulties (e.g. not fixating, following, and/or tracking), a referral should be made to an optometrist or an ophthalmologist, and to a functional vision specialist (e.g. occupational therapist with expertise in pediatric vision; early childhood vision consultants)

  • If the child manifests feeding difficulties (e.g. poor sucking, swallowing, choking, not gaining weight), a referral should be made to a feeding specialist (e.g. occupational therapist or speech-language pathologist or nutritionist)

Reference PDFs

Overview of the toolkit

Helpful links

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