GPAtlas🧭 When to suspect
Cerebral palsy (CP) is the commonest motor disability of childhood, affecting around 2 to 2.5 per 1,000 live births. It is a non-progressive disorder of movement and posture caused by a static injury to the developing brain – the underlying lesion does not worsen, but the clinical picture evolves as the child grows, which is why signs are rarely obvious at birth and the diagnosis emerges over the first two years.
Suspect CP in any child with delayed motor milestones, abnormal tone (spasticity, hypotonia or fluctuating dystonia), or abnormal/asymmetrical movements. Risk rises sharply with prematurity (the lower the gestation, the higher the risk), low birth weight, neonatal encephalopathy, neonatal sepsis, chorioamnionitis, and postnatal meningitis. Two principles anchor primary care: diagnosis is clinical (imaging looks for a cause, it does not confirm CP), and milestones must be corrected for gestational age until 2 years.
The functional impact is graded by the Gross Motor Function Classification System (GMFCS), levels I to V (I = walks without limitation; V = transported in a manual wheelchair), and the motor pattern is described by subtype and topography:
| Subtype | How it presents |
|---|---|
| Spastic (commonest) | Velocity-dependent increased tone, brisk reflexes, clonus. Described as hemiplegic (one side), diplegic (legs > arms) or quadriplegic (four limbs, often with greatest comorbidity). |
| Dyskinetic | Fluctuating tone with involuntary movements (dystonia, choreoathetosis); linked to basal ganglia injury and kernicterus, with higher rates of hearing impairment and epilepsy. |
| Ataxic | Hypotonia, incoordination, intention tremor and a broad-based unsteady gait. |
| Mixed | Features of more than one subtype (commonly spastic and dyskinetic). |
Infants with major risk factors should be on an enhanced developmental follow-up programme to 2 years (corrected). Refer all children with delayed motor milestones, persistent toe-walking, or any suspicion of CP urgently to the child development service for multidisciplinary assessment.
Source: NICE NG62
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