Babies with cerebral palsy are frequently slow to reach developmental milestones, such as learning to roll over, sit, crawl, smile, or walk. This is sometimes called developmental delay.

Some affected babies have abnormal muscle tone. Decreased muscle tone is called hypotonia; the baby may seem flaccid and relaxed, even floppy. Increased muscle tone is called hypertonia, and the baby may seem stiff or rigid. In some cases, the baby has an early period of hypotonia that progresses to hypertonia after the first two to three months of life.

Affected babies may also have unusual posture or favour one side of their body. Parents who are concerned about their baby’s development for any reason should contact their doctor, who can help distinguish normal variation in development from a developmental disorder.

Doctors diagnose cerebral palsy by testing a child’s motor skills and looking carefully at the child’s medical history. In addition to checking for slow development, abnormal muscle tone, and unusual posture – a doctor also tests the child’s reflexes and looks for early development of hand preference. Reflexes are movements that the body makes automatically in response to a specific cue. For example, if a new-born baby is held on its back and tilted so the legs are above its head, the baby will automatically extend its arms in a gesture, called the Moro reflex, that looks like an embrace. Babies normally lose this reflex after they reach 6 months, but those with cerebral palsy may retain it for abnormally long periods. This is just one of several reflexes that a doctor can check.

Doctors can also look for hand preference – a tendency to use either the right or left hand more often. When the doctor holds an object in front and to the side of the child, a child with hand preference will use the favoured hand to reach for the object, even when it is held closer to the opposite hand. During the first year, babies do not usually show hand preference. But babies with spastic hemiplegia, in particular, may develop a preference much earlier, since the hand on the unaffected side of their body is stronger and more useful.

The next step in diagnosing cerebral palsy is to rule out other disorders that can cause movement problems. Most important, doctors must determine that the child’s condition is not getting worse.

Although its symptoms may change over time, cerebral palsy is not progressive. If a child is continuously losing motor skills, the problem is more likely to be genetic diseases, muscle diseases, disorders of metabolism, or tumours in the nervous system. The child’s medical history, special diagnostic tests, and, in some cases, repeated check-ups can help confirm that other disorders are not at fault. The doctor may also order specialised scans of the brain, including CT (computerised tomography), MRI (magnetic resonance imaging), EEG (electro encephalogram), or Ultrasound, to learn more about the possible cause of cerebral palsy.

Finally, doctors may want to look for other conditions that are linked to cerebral palsy, including epilepsy, mental impairment, and vision or hearing problems.

Cerebral palsy cannot be cured, but treatment can often improve a child’s capabilities. There is no standard therapy that works for all patients. Instead, the doctor must work with a team of health care professionals, first to identify a child’s unique needs and impairments, and then to create an individual treatment plan that addresses these.

Some approaches that can be included in this plan are:

• drugs to control fits and muscle spasms
• special braces to compensate for muscle imbalance
• surgery
• mechanical aids to help overcome impairments
• counselling for emotional and psychological needs
• physical, occupational, speech, and behavioural therapy.

In general, the earlier treatment begins, the better chance a child has of overcoming developmental disabilities or learning new ways to accomplish difficult tasks.

The members of the treatment team for a child with cerebral palsy should be knowledgeable professionals with a wide range of specialities. A typical treatment team might include:

Doctor (such as a paediatrician, a paediatric neurologist, or a paediatric psychiatrist) – the doctor, often the leader of the treatment team, works to synthesise the professional advice of all team members into a comprehensive treatment plan, implements treatments, and follows the patient’s progress over a number of years.

Orthopaedist – a surgeon who specialises in treating the bones, muscles, tendons, and other parts of the body’s skeletal system. An orthopaedist might be called on to predict, diagnose, or treat muscle problems associated with cerebral palsy.

Physical therapist – designs and implements special exercise programmes to improve movement and strength.

Occupational therapist –  helping patients learn skills for day-to-day living, school, and work.

Speech and language therapist –  specialising in diagnosing and treating communication problems.

Social worker – helping patients and their families locate community assistance and education programmes.

Psychologist – helping patients and families cope with the stresses and demands of cerebral palsy. In some cases, psychologists may also oversee therapy to modify unhelpful or destructive behaviours or habits.

Educator – an especially important role when mental impairment or learning disabilities present a challenge to education.

The children who have cerebral palsy and their family or caregivers are also key members of the treatment team, and they should be closely involved in all steps of planning, making decisions, and applying treatments.

Studies have shown that family support and personal determination are two of the most important predictors of which children with cerebral palsy will achieve long-term goals. Too often, however, doctors and parents may focus primarily on an individual symptom – especially the inability to walk. While mastering specific skills is an important focus of treatment on a day-to-day basis, the ultimate goal is to help individuals grow to adulthood and have maximum independence in society