Symptoms and Signs of Cerebral Palsy If present in Infants and Toddlers

Source: Dzinkowkski, Rene C. and others. Cerebral Palsy a Comprehensive Review.  Nurse Practitioner. Feb. 1996. 45-59

Early Infancy (0-3 Months)

  • Excessive lethargy or irritability
  • High pitched cry
  • Poor head control
  • Weak suck/tongue thrust/tonic bite
  • Oral hypersensitivity
  • Decreased interest in surroundings
  • Stiff or floppy posture
  • Abnormal or prolonged reflexes (see information on abnormal reflexes)
    • Moro’s reflex
    • Asymmetric tonic neck reflex
    • Placing reflex
    • Landau reflex

Later Infancy

Inability to perform motor skills as indicated:
  • Control hand grasp by 3 months
  • Rolling over by 5 months
  • Independent sitting by 7 months
Abnormal Developmental Patterns:
  • Hand preference by 12 months
  • Excessive arching of back
  • Log rolling
  • Abnormal or prolonged parachute response
Abnormal Developmental Patterns after 1 year of age:
  • “W sitting” – knees flexed, legs extremely rotated
  • “Bottom shuffling” Scoots along the floor
  • Walking on tip toe or hopping

REFLEX REVIEW

Moor’s Reflex

A reaction to a startle stimulus (loud noise, sudden touch, etc.) in which arms elevate and then clasp to midline.  Normally present till 4-5 months of age.  Absence, asymmetry, or delay of this reflex may indicate motor deficits.  Persistence of this reflex past age 4-5 months is also an indicator.

Tonic Neck Reflex

Involves extension of the arm and leg on the side to which the head is passively turned and flexion of the limbs on the oppisiot side.  An asymmetric reflex is abnormal and indicates damage to the motor pathways if present constantly after the age of 6 weeks.

Parachute Response/Reflex

When held around the waist in a horizontal prone position and then lowering the infant slowly, head first to the surface.  By age 6 to 8 months the infant should respond by extending the arms and hands to break the “fall”.  If this response is asymmetrical it indicates an unilateral motor abnormality.

Placing Reflex

When the dorsal (back) side of the hand or foot is placed on the edge of a surface, such as a table, the infant will lift the extremity and place it on the flat surface.   This reflex as well as sucking, rooting, and grasping are present at birth and reflect the function of the spinal cord, brain stem , and possibly the basal ganglia (damage to the basal ganglia results in athetoid cerebral palsy—see types of CP).

Landau Reflex

When the infant is held in a horizontal prone position, the infant will lift head and extend the neck and trunk.  When the neck is passively flexed, the entire body will flex.  This reflex is present by 6 months and hypotonicity (low tone)  indicates motor system deficits.

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