Cerebral Palsy: Developmental Milestones Birth to 12 Months

By Lee Vander LoopCP Family Network Editor
Many children with cerebral palsy are diagnosed shortly after birth. Others, however, may go months or even years with no diagnosis. Without a diagnosis, valuable early therapies and treatments are delayed.
How is a parent struggling with the question “is my child developing normally?” supposed to tell? If you are concerned, you should not hesitate to talk to your doctor. Trust your hunches. According to research, parental concerns detect 70% – 80% of all disabilities in children. So if your gut is telling you something is not right, chances are, it’s not.
Meanwhile, there are guidelines known as “developmental milestones” to help parents determine whether or not their child is keeping up with his or her peers. These milestones are a set of functional skills or age-specific tasks that most children can do at a certain age range. For children who have suffered a brain injury at birth, however, these guidelines often don’t apply. Depending on the severity and location of the brain injury, some children experiencing developmental delays may be able to achieve milestones only through a variety of therapy and interventions. Others with severe brain injuries may never achieve some developmental milestones.

Signs of Cerebral Palsy in Infants Up to 12 Months

The signs of cerebral palsy vary greatly because there are many different types and levels of disability, but an early indication is a delay in controlling movement of the head or arms and legs. This list of cerebral palsy symptoms, divided by age range, is not comprehensive but serves as a good starting point to determine if your child may have developmental delays. If you see any of these signs, call your child’s doctor or nurse.

• 2 months and older:
  • Have difficulty controlling his head when picked up
  • Have stiff or shaky arms or legs
  • Have stiff legs that cross or “scissor” when picked up
  • Have oral motor difficulties and problems sucking and feeding
• 6 months and older:
  • Continue to exhibit poor head control when picked up
  • May reach with only one hand while keeping the other in a fist
  • Have problems eating and drinking
  • May not roll over without assistance
  • May not be able to push up with their hands when laying on their stomach
• 10 months and older:
  • Crawl by pushing off with one hand and leg while dragging the opposite hand and leg
  • Not be able to sit by himself or herself
• 12 months and older:
  • Not yet crawl or attempt to pull themselves up
  • Not be able to stand with support

Basic Developmental Skills

Cerebral palsy is caused by a problem in the brain that affects a child’s ability to control his or her muscles. Problems in different parts of the brain cause problems in different parts of the body. There are many possible causes of problems, such as genetic conditions, problems with the blood supply to the brain before birth, infections, bleeding in the brain, lack of oxygen, severe jaundice, and head injury. A child who lacks basic motor skills will have difficulty reaching subsequent milestones without help.
The Interdisciplinary Council on Developmental and Learning Disorders Outlines the six basic developmental skills which lay the foundation for all learning and development. Although all children develop at their own rate, growth can be defined in the following areas:

• Gross Motor – Gross motor enables your baby to achieve major milestones such as head control, sitting, crawling, maybe even starting to walk. Children exhibiting a delay in gross motor skills need to be evaluated as early as possible so they can start getting physical therapy to help them strengthen their muscles.
• Fine Motor – These skills allow a child to hold a spoon, or pick up a piece of cereal between thumb and finger. Children exhibiting delays in these skills will have difficulty holding a spoon, manipulating small objects or grasping items between their thumb and fingers.
• Sensory – Sensory skills include seeing, hearing, tasting, touching and smelling.
  A child with a brain injury may have trouble processing information from these senses, a condition known as Sensory Processing Disorder. Normally diagnosed by developmental pediatricians, pediatric neurologists and child psychologists, children experiencing difficulties with sensory processing may exhibit either a “hyper” (over) or “hypo” (under) sensitivity to stimulation of the senses.
An infant with hypersensitivity may:

• Dislike being touched or dressed
• Seem intolerant of normal lighting in a room
• Startle easily at small sounds
An infant with hyposensitivity, may:

• Seem restless and seek stimulation
• Not startle or respond to loud noises
• Language – A child with cerebral palsy may lack the muscle strength in the mouth and tongue to control sounds or may have trouble hearing or processing sound, all of which will delay language. An infant developing normally from birth to 5 months will react to loud sounds, turn her head toward a sound source, watch your face when you speak, make pleasure and displeasure sounds (laugh, giggle, cry, or fuss), and make noise when talked to. Other milestones are listed by the National Institute on Deafness and other Communication Disorders.
• Social and Emotional– Social and emotional milestones are often harder to pinpoint than signs of physical development. A child from birth to 12 months who has trouble processing sensory input or who has poor control of movement because of a brain injury may be delayed in:
  
  • Crying to express distress or to attract attention
  • Fixating on faces
  • Smiling purposefully at certain people (mom, for example)
  • Cooing or laughing to attract attention
  • Playing “peek-a-book” or other game
  • Responding to their own names
  • Developing stranger anxiety
  A full list of both social and emotional milestones is listed here.

An Important Note about Developmental Milestones

Developmental milestones are only guidelines. No two babies are alike and no two develop the same, though most reach certain milestones at similar ages. Every child develops at their own rate. If your child was born prematurely, you will need to look at the guidelines a little differently. Also, all human development depends on environmental stimulation. A child deprived of a loving, nurturing and stimulating environment will experience developmental delays.
Your baby’s physician will evaluate your child’s development at each well-baby visit. Don’t be surprised if the pediatrician tells you not to worry, to be patient, to give your child more time to develop. Often, that’s what parents hear, especially in the early stages of investigating their child’s apparent delays. And it’s often true. Children develop at different rates; the pediatrician is well aware that many children show sudden bursts in development rather than slow, steady growth.
On the other hand, your pediatrician may recommend that a developmental screening be conducted. Its purpose is to see if your child is experiencing a developmental delay. The screening is a quick, general measure of your child’s skills and development. It’s not detailed enough to make a diagnosis, but it will show whether a child should be referred for a more in-depth developmental evaluation.

Resources

You can find a wonderful interactive Milestone Checklist at the CDC, provided by the National Center on Birth Defects and Developmental Disabilities. It details specific developmental accomplishments and allows sharing of forms with other caregivers for their input. http://www.cdc.gov/ncbddd/actearly/milestones/index.html
The American Academy of Pediatrics offers a Parenting website, healthychildren.org: Ages & Stages:
http://www.healthychildren.org/English/ages-stages/baby/pages/Developmental-Milestones-1-Month.aspx
National Library of Medicine, National Institute of Health, Medline Plus, Infant and Newborn development
http://www.nlm.nih.gov/medlineplus/infantandnewborndevelopment.html
March of Dimes, Your Growing Baby
http://www.marchofdimes.com/baby/growing_indepth.html
Center for Disease Control and Prevention, CDC, Child Development
http://www.cdc.gov/ncbddd/child/

Kids and Seniors Warmly Welcome CP Families to Easter Seals

We recently gave the Easter Seals Inter-Generational Center in Silver Spring, MD, a $2,500 grant to help make improvements to their facility. The CP Family Network’s grant will be used to replace cribs in the nursery, allowing the Center’s hard-working staff to focus their money and attention on the wonderful programs they offer to children and adults with special needs.

The CP Family Network supports Easter Seals in its mission to ensure that all people with disabilities or special needs and their families have equal opportunities to live, learn, work and play in their communities. We look forward to seeing how our donation impacts the lives of the special needs children they serve. To see photos of the donation and the Silver Spring facility, watch this video and subscribe to our YouTube channel.

Here is the video!

http://youtu.be/Q2VTzhdUlH4

“Stay Put” Rule Can Prevent Disputed IEP Changes

By Anita Howell, writing for the CP Family Network

Early in our special education journey, I would have sworn IEP stood for Intensely Exhausting Process rather than Individual Education Plan. As a regulatory auditor and parent of a child with cerebral palsy, I was driven to read and research incessantly before every IEP meeting. Unfortunately, no amount of reading ever seemed to prepare me for the latest surprise.  That all changed late one night when I found a little golden nugget in the rules and regulations that enforce the Individuals with Disabilities Education ACT (IDEA).Two little words – “Stay Put” – gave me the confidence boost I needed.

The “Stay Put” rule is intended to maintain consistency when there is a dispute between parents and a school district.  If the parents disagree with proposed changes to their child’s education plan, the district must leave the last agreed upon plan in place until the parents exhaust the appeals process.

In our situation, the team often wanted to give up on our son, Ryan.  Ryan’s cerebral palsy is very involved and he needs maximum assistance with all activities.  We also had a period of time where seizures and medication made him lethargic, causing set-backs. We were routinely pushed, at times even bullied, to drop therapy services.  We felt the team’s behavior was shameful in that a child’s future potential can’t possibly be assessed, especially at the age of 3.  In the last two years (ages six and seven), Ryan has made great progress, making me even more thankful for the two little words that have protected his education.

The first meeting after my late night discovery was quite interesting; however, I did find that the school district needed to be educated on the “Stay Put” rule.  As the team began to discuss their reasons for removing services, I expressed that those items were in dispute and would need to remain unchanged while we appealed their recommendations. Initially, I was lectured on how it is a team decision and that one person couldn’t independently make decisions.

As in our situation, you may need to present proof that “Staying Put” is a legitimate legal requirement in order to be taken seriously. The rule can be found in §300.518 – Child’s status during proceedings of Title 34 of the Code of Federal Regulations.  Paragraph (a) states that while administrative or judicial proceedings are pending, the child must remain in his or her current educational placement.  Federal commentary further clarifies this to include related services.

There are a few things to remember when relying on the “Stay Put” rule:

• There is an exception to this rule – children who have been removed from their current IEP placement as a result of disciplinary actions are required to remain in the interim placement during the appeals process. The interim placement is the placement that was determined at the time of discipline.
• While in the meeting, make sure the team is aware of your specific concerns and that you will be disputing any changes.
• Let the team know you will be providing a written statement as to your concerns and that you are requesting mediation regarding the disputed items.
• Make sure your concerns are properly documented in the meeting minutes prior to signing off on the IEP documents.
• Follow-up within 2 days by adapting the sample letter below to document your concerns.
• Review the updated IEP to make sure no disputed changes were made.
• Carefully review anything you sign to make sure you are not waiving your child’s “Stay Put” rights.

Sample Letter/Memo

May 1, 20XX

To: IEP Team for John Smith

Re:  April 30, 20XX IEP Meeting for John Smith

As a follow-up to our April 30, 20XX IEP meeting, I would like to formally state that the following changes are disputed:

1)      Removal of occupational therapy.

2)      Reduction of speech therapy.

3)      Change from direct physical therapy services to consultative physical therapy services.

If the school district plans to require the above changes, we would like to request a mediated meeting.  Accordingly, as required by §300.518 Child’s status during proceedings of Title 34 of the Code of Federal Regulations, we are requesting that none of the disputed changes be made until we have completed the appeals process.

Sincerely,

Mary Smith

Now you have the tools needed to prevent surprise changes to your child’s IEP.  Print out these steps, focus on things you want added to your child’s IEP, take time to enjoy your family, and get some rest the night before your next IEP meeting.

More cerebral palsy information and other valuable resources for parents, families, caregivers and others are available from Cerebral Palsy Family Network.

Writer’s Profile

Anita Howell has been married to Wes since 1988. They have an 18- year-old daughter, Emily, currently attending college, and an 8-year-old son, Ryan. She writes, “Though I have never been a medical, research, or legal professional, Ryan’s stroke at birth has thrown me into the deep end of the pool for all of it. It was quite overwhelming in the early years; however, God has made Philippians 4:13 very real throughout my journey.” She shares the successes and encouragement she has found along the way with other parents on her blog posts atwww.specialfaithforspecialneeds.com.