What are the key clinical features to consider when diagnosing cerebral palsy in a child?

Key clinical features to consider when diagnosing cerebral palsy (CP) in a child include:

• Abnormal motor features such as unusual fidgety movements, asymmetry or paucity of movement, and abnormalities of tone including hypotonia (floppiness), spasticity (stiffness), or dystonia (fluctuating tone).
• Delayed motor development milestones, including late head control, rolling, crawling, not sitting by 8 months (corrected for gestational age), and not walking by 18 months (corrected for gestational age).
• Early asymmetry of hand function or early hand preference before 1 year (corrected for gestational age).
• Persistent toe walking.
• Feeding difficulties, which may manifest as coughing, choking, gagging, altered breathing pattern, or change in colour while eating or drinking.

Children with these features, especially if they have known risk factors for CP, should be referred urgently to a child development service for multidisciplinary assessment to facilitate early diagnosis and intervention.

It is also important to consider and exclude red flags for other neurological disorders, such as absence of known risk factors, family history of progressive neurological disorders, loss of attained cognitive or developmental abilities, unexpected focal neurological signs, or MRI findings inconsistent with CP.

While awaiting referral, any associated features such as chest infections, constipation, gastro-oesophageal reflux, or pain should be managed appropriately.

Providing information to parents or carers about CP may be considered depending on the level of clinical suspicion.

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