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/

The Triumphs and Challenges of My Teenage Years

By Crystal McClure
Writing for the CP Family Network
In my last blog, I wrote about what it was like growing up with cerebral palsy. That story primarily concentrated on my elementary school years. As any adult knows, the middle school and high school years can often be the toughest, especially for children with disabilities. I decided I wanted to share my experiences and the lessons I’ve learned in order to encourage others to persevere through the hurdles they face as a teenager.

Middle School

The transition from elementary to middle school was not as difficult as I had expected it to be. I was going to a brand new school just like everyone else. I reconnected with a few people from my pre-school days at Spring Creek who also have disabilities and use wheelchairs, walkers etc. It was a comfort knowing I “wasn’t the only one.” I became really good friends with Alex Kanavos in the sixth grade. He also has Cerebral Palsy and uses a wheelchair. We still talk to this day.

Near the end of my sixth grade year, I went back to Shriners Hospital in Kentucky, where I had 2 weeks of physical and occupational therapy. I learned how to dress myself, transfer to and from bed, and also how to go to the restroom on my own with someone just there to spot me. This was a big accomplishment in my life and still remains so. It was freeing knowing that I did not have to ask for help to get dressed and that I could do things on my own like any other 12 year old.

However, bathroom breaks proved to be one of my troubling times in middle school. It seemed as though I always had to go at the wrong time. The aides were eating lunch and would ask that I return at a later time, or my teacher didn’t like the time I chose because it was near the end of class. I was allowed to leave class 5 minutes before the bell rang for class change. Sometimes, this still wasn’t enough time to go to the bathroom and get to class in time to get settled. Why? I was not able to use the bathrooms in our wings (each grade had their own hallway). I had to go to the Multi-Handicap room, which was in the middle of the school, to use the restroom. Going into class late was not only an embarrassment for me, but also a disruption to the class as a whole.
Overall, my middle school experience was great with the exception of the bathroom issues. I am grateful that I was able to take those two weeks at Shriners to become more independent. Not only did I learn to do a lot on my own, but it helped shape me into a strong-willed person and gave me high confidence and self-esteem.

High School

High school, on the other hand, proved to be a bit more challenging. I still attended school with many of the same people from both elementary and middle school, but my freshman year we also combined with a school from Chattanooga. I still had the same friends and made many acquaintances along the way. I didn’t have the bathroom issues like I did in middle school, thank goodness.
My main issue in high school was other people. I was bullied. Nothing severe but nonetheless, it is still what I consider bullying. I was trying to go through the cafeteria one day to get to the lunch line and there were students in my way. I said, “Excuse me” three times and no one moved. I then proceeded and blew the horn on my power chair to let students know I needed through. When I did this, a girl got in my face and said some profane words along with telling me I did not have the right to use my horn. There were a couple other instances my Freshman and Sophomore years, but they were addressed by teachers and staff.
One of the most sobering moments of my high school years was not being able to attend my Junior Prom. It was set on a local riverboat which was not handicap accessible. My mother and several teachers I had grown to know well made sure that my Senior Prom was accessible for me. I had my own kind of Cinderella story that night, as in I was home when the clock chimed 12!
My Senior year in itself was probably the one I enjoyed most, but not without some flaws. During the last half of my Senior year I had enough credits to be able to only attend school for half the day. I had no way home in the middle of the day so I chose to attend half-day vocational school. I chose to be in the Graphic Design class there, which ended up being somewhat of a nightmare. I was not able to use the machines to learn anything. Because of this, the teacher just sat me in front of a computer and asked that I write a book about myself. I did this for a while, then quickly realized it wasn’t what I went there for and in essence I was being discriminated against. I addressed this issue with the staff of the school and  they placed me in Cosmetology where I finished the rest of the year.
Graduation day, May 17, 2002, was one of my proudest moments. I am the first person in my family on my Father’s side to receive a high school diploma.

Lessons Learned

Even though there were some rough patches during those seven years, given the opportunity I wouldn’t change them. I learned how to become my own person, and how to persevere and push on through tough times. For this, I am forever grateful.

About the Author

Crystal McClure lives in Tennessee. She owns her own home and holds an Associates Degree in Office Administration. She is pictured with her boyfriend, Mike.

Join Our Family

Sign up for our free enewsletter for more blogs, articles, and news about CP kids and their families.

Visit our website for more helpful Cerebral Palsy Resources!