Cerebral palsy: early recognition and classification

A parent says, “She only uses her left hand,” or “His legs feel stiff when I change the nappy.” Your job is not to wait politely until the second birthday. Your job is to decide whether this child has a high probability of cerebral palsy, what pattern of motor disorder you are seeing, how the child functions day to day, and what must start now. ^{[1] [16]}

This page owns early recognition and classification. Ongoing hip surveillance, advanced tone management, feeding programmes and lifelong multidisciplinary care live on the companion page for CP surveillance and management. Cross-link developmental surveillance and dedicated GMA/HINE teaching rather than hiding full specialty manuals here. ^{[1] [17]}

Overview & Definition

Cerebral palsy is not one disease. It is a group of permanent disorders of the development of movement and posture. The cause is a non-progressive disturbance that happened in the developing fetal or infant brain. The motor disorder is often accompanied by epilepsy, sensation problems, perception issues, communication difficulty, behaviour challenges and secondary musculoskeletal problems. That is the modern consensus language from the Bax proposal and the Rosenbaum report. ^{[2] [3]}

Say the definition aloud in a viva without fluff: permanent motor disorder; early brain disturbance; lesion itself not progressive; associated impairments common. Then add the practical point: the clinical picture can still evolve in the first years as the nervous system matures, even though the original injury is not an ongoing degenerative disease. ^{[3] [19]}

Smithers-Sheedy and colleagues asked what still “counts” as CP in the twenty-first century. Registers and clinicians must keep clear inclusion rules. Progressive disorders, pure neuromuscular disease without early central injury, and transient motor signs that resolve do not belong under the CP label. When the story is wrong for a static early brain injury, stop and rethink. ^[19]

References20ShowHide

1. [1]Novak I Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA pediatrics, 2017.PMID 28715518
2. [2]Bax M Proposed definition and classification of cerebral palsy, April 2005. Developmental medicine and child neurology, 2005.PMID 16108461
3. [3]Rosenbaum P A report: the definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology. Supplement, 2007.PMID 17370477
4. [4]Palisano R Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental medicine and child neurology, 1997.PMID 9183258
5. [5]Palisano RJ Content validity of the expanded and revised Gross Motor Function Classification System. Developmental medicine and child neurology, 2008.PMID 18834387
6. [6]Eliasson AC The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Developmental medicine and child neurology, 2006.PMID 16780622
7. [7]Hidecker MJ Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Developmental medicine and child neurology, 2011.PMID 21707596
8. [8]Sellers D Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Developmental medicine and child neurology, 2014.PMID 24344767
9. [9]Surveillance of Cerebral Palsy in Europe Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Developmental medicine and child neurology, 2000.PMID 11132255
10. [10]Romeo DM Hammersmith Infant Neurological Examination in infants born at term: Predicting outcomes other than cerebral palsy. Developmental medicine and child neurology, 2022.PMID 35201619
11. [11]Fehlings D The Hammersmith Infant Neurological Exam Scoring Aid supports early detection for infants with high probability of cerebral palsy. Developmental medicine and child neurology, 2024.PMID 38818710
12. [12]Sutter EN Evidence-Based Infant Assessment for Cerebral Palsy: Diagnosis Timelines and Intervention Access in a Newborn Follow-up Setting. Journal of child neurology, 2024.PMID 39262331
13. [13]Morgan C Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Developmental medicine and child neurology, 2016.PMID 27027732
14. [14]Morgan C Enriched environments and motor outcomes in cerebral palsy: systematic review and meta-analysis. Pediatrics, 2013.PMID 23958771
15. [15]Te Velde A Age of Diagnosis, Fidelity and Acceptability of an Early Diagnosis Clinic for Cerebral Palsy: A Single Site Implementation Study. Brain sciences, 2021.PMID 34439692
16. [16]te Velde A Early Diagnosis and Classification of Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis. Journal of clinical medicine, 2019.PMID 31623303
17. [17]Rosenbaum P Classification in childhood disability: focusing on function in the 21st century. Journal of child neurology, 2014.PMID 24810083
18. [18]Himmelmann K MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations. Developmental medicine and child neurology, 2017.PMID 27325153
19. [19]Smithers-Sheedy H What constitutes cerebral palsy in the twenty-first century? Developmental medicine and child neurology, 2014.PMID 24111874
20. [20]Einspieler C Are abnormal fidgety movements an early marker for complex minor neurological dysfunction at puberty? Early human development, 2007.PMID 17129688