Infant Development & Types of Cerebral Palsy

KidPower is providing this developmental page for informational purposes only. The below can be warning signs that your baby is not developing as they should be. All babies develop at their own pace, however, so the below examples are approximations. If you have any concerns about your infant's development please address those to your pediatrician who can refer you to a pediatric neurologist. They use adjusted age for premature infants so keep this in mind. However, even if your baby is premature, they need to be hitting milestones regularly, though they may be slightly behind the typical timeline. Most of the information on this page describes cerebral palsy, however the information can be used for other disabilities as well.

Risks for the child later being diagnosed with cerebral palsy, a brain injury that causes delays in motor, speech, and other areas, include the following:
Prematurity
meconium aspiration
fetal distress
lack of oxygen before, during or after birth
maternal anemia, seizures, diabetes, high blood pressure, bleeding early in pregnancy(not spotting but actually bleeding)
Loss of twin, triplet, etc. during the pregnancy

The above are just some of the reasons a child should be closely monitored for delays in gross and fine motor, speech as well as other areas including seizure activity. Children with none of these warning factors can also later be diagnosed with cerebral palsy if there was an event that caused brain damage during pregnancy or birth that went undetected.

Hemiplegic Cerebral Palsy affects one side of the body, such as right hand/arm and foot/leg or left hand/arm and foot/leg. It can also affect the child's visual fields and cause a problem called visual field cuts. If the brain damage that causes the cp is located on the left side of the brain it can also possibly affect language development. Hemplegics brain damage is usually located in the temporal and parietal lobes of the brain but can be located in the frontal or occipital lobes as well if the damage is mainly to one side or the other.
For hemiplegia concerns, look for one hand that is always fisted while actively using the other. One leg, same side of body as hand that is fisted, is unusually stiff while other seems to actively move.

Diplegic Cerebral Palsy affects both legs(gross motor) and at times can also affect one or both hands(fine motor). If the hands are affected they will not be as affected as the legs. Diplegics can also have vision and eye involvement. Diplegic cp is caused by damage to the frontal lobe of the brain.
For diplegia concerns look for unusually stiff legs that are hard to move but can usually move arms and hands actively. Some diplegics also fist their hands and can be hypotonic(floppy) or hypertonic(stiff/spastic) in their trunk. Diplegia is the most common type of cp among premature infants.

Quadriplegic Cerebral Palsy affects all four limbs equally or almost equally including the trunk and can cause problems with head control. If involvment is not quite equal then the legs will be more affected. Can also affect language/oral motor development, and vision or the eyes as well.
For quadriplegia look for both hands fisted most of the time and both legs unusually stiff and hard to move, for example, hard to get apart when trying to change a diaper.
If the baby is hypotonic instead of spastic or stiff as described above then it would be more of the baby looking as if they have no strength in their limbs. Instead of being unusually stiff they would then be unusually floppy.

There are three other types of cerebral palsy that are not as common. Monoplegia affects only one limb, double hemiplegia is like quadriplegia but the arms are more affected then the legs and triplegia where both legs and one arm are affected fairly equally. One other classification can be made, hemiplegic, diplegic where both legs are affected with one arm affected and the side where the arm is also affected has the most involvment.

Spastic Cerebral Palsy is caused by damage to the motor cortex of the brain.

Dystonic Cerebral Palsy, which affects the movement of the body, presents as slow, rhythmic twisting movements of the trunk, or an arm or leg. Can also include abnormal postures. This is caused by damage to the cerebellum or basal ganglia.

Athetoid Cerebral Palsy also affects the movement of the body. It presents itself as slow writhing movements usually in the wrists, fingers and face. Tone usually fluctuates. Also caused by damage to the cerebellum or basal ganglia.

Ataxic Cerebral Palsy affects balance and coordination. The muscle tone is usually hypotonic(floppy) but there can be some hypertonia(spasticity). Ataxia is caused from damage to the cerebellum.

Mixed Cerebral Palsy is caused by damage to the motor cortex and the cerebellum or basal ganglia. Mixed usually presents with spastic muscles and involuntary movements. Muscle tone can be too high in some muscles and too low in others.

Typical Development by 3 months:
Is holding head up when lying on stomach, smiles when sees familiar faces or is talked to, can visually track objects that move, is actively moving arms and legs. If a baby rolls over before 3 months, from stomach to back, this is usually because they are unusually stiff. They will usually hold their head up well when pushing up with arms and this can force them over when combined with holding their legs stiff.

Atypical Development by 3 months:
Is having and has had trouble with their sucking reflex, not able to hold head up while lying on stomach, legs and/or arms are unusually stiff or unusually floppy, keeps one or both hands fisted most of the time and is hard to get their hands open.

Typical Development by 6 months:
Rolls from back to stomach and stomach to back, sits with support, will turn toward sounds, will pass toys from hand to hand using each hand about equally, will put toys in mouth, cooing.

Atypical Development by 6 months:
Rolls by extending back and legs "toned rolling", cannot sit even with support--will either round back forward or will push backward, eyes are noticeably crossed, legs scissor or cross and are hard to get apart, only using one hand--not switching toys back and forth--other hand is constantly fisted, not making any cooing sounds, only turns head to one side unless forced to turn it to the other.

Typical Development by 9 months:
Sitting unsupported, saying one to two words such as Mama, Dada or the name of a favorite toy, crawling, getting in and out of a sitting position, knows their name and will respond to it, drinking from a tippy/sippy cup with some assistance.

Atypical Development by 9 months:
Not sitting or has just started sitting unsupported, rounds back forward while sitting, arches back, has a hard time with fine motor control in hands--hard to pick up and manipulate objects, army crawls--pulls self with just one side of the body, will not support weight on legs, gags excessively on thin liquids, has trouble with head and/or trunk control, toes are continually pointed.

Typical Development by 12 months:
Pulling to a stand and walking around furniture. Some children are beginning to take a few independent steps, saying more words, has pincer grasp--picks things up with thumb and first finger.

Atypical Development by 12 months:
Cannot pull to a stand or has a lot of trouble trying, continually walks on toes, still has an immature grasp in one or both hands--no pincer grasp--will grasp objects with all fingers and palm or cannot grasp objects.

Typical Development by 15 months:
Stands without support, most are also walking without support, can feed self, using 4 or 5 words.

Atypical Development by 15 months
Not standing independently, continually stands or walks on toes and cannot bring them down easily if at all, cannot sit unless is W sitting, sits to one side.

Children are all born with certain involuntary reflexes that disappear usually within the first year of life. By 3 to 4 months of age they should be starting to loose some of these newborn reflexes. Watch for a prolonged babinski reflex--this is when you tickle the bottom of their feet--they should stop fanning out their toes and start curling them under when you stroke the foot from heel to toe by a year old. Prolonged startle reflex--the babies arms and legs come together, the legs then shoot out and the hips flex. This reflex disappears by 4-5 months of age. Asymmetric tonic neck reflex--When the child's head is turned to one side the leg and arm on the side the baby is facing extend and the arm and leg on the opposite side bend(flex). This reflex should disappear by 5-6 months of age. If you notice any of these reflexes persisting longer then listed above consult your pediatrician.
If your child is not rolling over and sitting with support by 9-10 months you should get a referral to a pediatric neurologist, this includes premature infants.
At one year if your child is only rolling over and is not close to sitting or supporting the weight of their heads or their body weight when put in a standing position you need to be referred to a pediatric neurologist, this includes premature infants.
If your child is not walking by 18 months you should bring this to the attention of your pediatrician.

For links to information about cerebral palsy and more, go to our Special Needs Links page.

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