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/

Electrical Stimulation Restores Mobility to Young Boy with Cerebral Palsy

August 13th, 2012
From CBS DFW 

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11 year old Matthew Hurt isn’t just walking better these days.  The North Texas boy’s running, jumping and riding have improved as well, all thanks to a device the size of an iPod.

Shortly after a premature birth, doctors diagnosed Matthew with mild cerebral palsy.  He’s developed cognitively like any other child his age, but the cerebral palsy resulted in weakness on his right side.  That led to a condition known as “foot drop” which causes a person to drag the toe of the shoe on the ground or slap the foot on the floor.

This caused Matthew to have an unnatural gait, and made it difficult for him to walk without tripping and falling.  And as a result, that made it hard to keep up with his friends.

However, doctors recently fit Matthew with a medical device.  It’s called the WalkAide.  The device is worn around the calf, just below the knee, and uses electrical stimulation to combat foot drop and restore mobility to people like Matthew.

Since wearing the WalkAide, Matthew’s gait has improved significantly. He can walk faster and farther before getting tired. He’s also able to keep up better with his friends when he’s on the golf course playing his favorite sport.

The WalkAide can also be used in patients living with traumatic brain injury, multiple sclerosis, stroke, and some spinal cord injuries.

Watch the video of Matthew here.

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Shriners help teen with Cerebral Palsy achieve dreams

August 1st, 2012

From http://www.dailyrepublic.com/

Isac Huddleston, 18, accomplished something recently that he and his family never thought possible: He walked to receive his high school diploma.

Huddleston has lived with spastic cerebral palsy his whole life. As long as he can remember, he’s walked with crutches and worn casts. Doctors told him he probably would never walk on his own, he said.

But with physical therapy, surgery and support, he handed his crutches to his friends, bound and determined to walk without them for such a monumental occasion.

“My friends told me to do my pimp walk and get my diploma,” he said, laughing.

His mother, Barbara Huddleston, cried while watching him from the stands at Rodriguez High School.

“It wasn’t the fact that he got his diploma,” she said. “It was the fact that he was walking.”

The Huddlestons said he would never have made such progress without the help and support of the local Montezuma Shriners and the Sacramento Shriners Hospital for Children.

Isac Huddleston was born prematurely, and at 3 pounds, 6 ounces, fit in the palm of his mother’s hand. As he grew up, Barbara Huddleston noticed he wasn’t developing normally.

“He didn’t sit up. . . . He’d cruise along the wall,” she said. “We really became concerned.”

His mother took him to the doctor to get diagnosed, but initially, they were left with few answers. When she finally received the news he had cerebral palsy, she was devastated.

“It was almost better not knowing,” she said.

Barbara Huddleston and her husband both had jobs and health insurance, but faced looming health care costs and struggled transporting their son to and from Sacramento for surgery.

That’s when Isac Huddleston’s grandfather, James Huddleston, directed them to the local Montezuma Shriners and the Shriners Hospital in Sacramento.

James Huddleston, a Shriner master himself, suggested they seek help through sponsors at the Montezuma Shriners.

Barbara Huddleston never thought that the group would sponsor her son because they had health insurance. To her surprise, they not only sponsored her son with free transportation to and from the hospital, but they significantly helped with the medical costs as well.

Ken Wright, ambassador and past president of the Montezuma Shriners, said that their organization is made up of dedicated volunteers. The Shriners, he said, don’t turn any child away, whether they have health insurance or not.

“Shriner loves taking care of kids,” he said. “We don’t want to see kids in wheelchairs and crutches if they can be helped.”

The enormous financial support from the Shriners was matched at the Shriner Children’s Hospital with personal and thorough treatment by its medical staff, Barbara Huddleston said.

Growing with cerebral palsy was difficult for Isac Huddleston, but he said he had some great experiences through the care he received at the Shriners hospital.

“There’s an uplifting spirit there,” Barbara Huddleston said. “They’re focused on making a good experience.”

One of Isac Huddleston’s favorite memories at the hospital was the East-West Shrine football game, where he hung out and played wheelchair sports with NFL players such as Jerry Rice.

Isac Huddleston proudly displays his Shrine Game memorabilia, including a football signed by former 49ers quarterback Ken Dorsey, in a case in his room.

His family has seen his condition improve by leaps and bounds over the years. Part of that improvement is thanks to the Shriners hospital, Barbara Huddleston said, and the other came from her son’s attitude.

“When I was younger kids asked ‘What’s wrong with you?,’ ” he said. “I said ‘There’s nothing wrong with me, I have cerebral palsy.’ ”

His mother said, “Rather than hide it, it’s been an educational experience for him.”

Isac Huddleston will head to University of Reno Nevada in the fall, where he will study environmental science. He said he would like to work with people with prosthetics and believes his experiences will allow him to help others.

As he heads to college, his mother said she is in of awe how far he’s come.

“Doctors had not expected his improvement to be as succesful as it was,” she said.

Without the support from the Montezuma Shriners, she said, she doesn’t believe it would have been possible.

“The Shriner support has come full circle,” she said. “We never know where he’ll go in life. That’s why we want to say thank you.”

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