Cerebral palsy (CP) is sometimes diagnosed late due to a combination of factors related to the nature of the condition, variability in symptoms, limitations in early detection methods, and systemic healthcare challenges. Understanding why diagnosis can be delayed requires exploring the complexity of CP’s presentation, the timing and methods of medical evaluation, and the broader context of healthcare access and awareness.
**1. Variability and Subtlety of Early Symptoms**
Cerebral palsy is a group of disorders affecting movement, muscle tone, or posture caused by abnormal brain development or damage to the developing brain, often before, during, or shortly after birth[2][4]. The symptoms of CP can vary widely in type and severity, ranging from mild motor delays to severe physical disabilities. Early signs may be subtle or nonspecific, such as slight delays in reaching motor milestones, mild muscle stiffness, or unusual reflexes, which can be mistaken for normal developmental variation or other conditions.
For example, some children with cerebral visual impairment (a form of CP affecting vision) were diagnosed on average at 4.6 years old, indicating that early visual symptoms were overlooked or misattributed[1]. This delay in recognizing visual impairment reflects a broader challenge: early CP symptoms may not be obvious or may overlap with other developmental issues, making early diagnosis difficult.
**2. Limitations of Early Diagnostic Tools and Assessments**
Diagnosing CP in infancy or very early childhood is challenging because the brain injury or abnormal development that causes CP may not produce immediately clear or consistent signs. Standard neurological exams and developmental screenings may not detect subtle motor abnormalities until the child grows and motor demands increase.
Recent efforts to standardize early detection in high-risk infants, such as those born prematurely, have improved early diagnosis rates, but many children are still diagnosed later. For instance, a study showed that among premature infants, only a portion were diagnosed with CP within the first year, with others diagnosed later as symptoms became more apparent[6]. This reflects the difficulty in predicting long-term motor outcomes from early neurological assessments alone.
**3. Influence of Risk Factors and Medical History**
Certain risk factors increase the likelihood of CP, including premature birth, low birth weight, infections during pregnancy, birth complications causing oxygen deprivation (hypoxia), and brain hemorrhages[2][4][5]. However, not all children with these risk factors develop CP, and some children without obvious risk factors may still have CP due to genetic mutations or subtle brain injuries[2].
The presence of other medical conditions can also complicate diagnosis. For example, children with CP often have co-occurring conditions such as epilepsy, hearing impairment, or cognitive challenges, which may mask or complicate the recognition of CP symptoms[3][7]. In some cases, hearing or visual impairments related to CP may be diagnosed first, delaying the recognition of the underlying motor disorder.
**4. Socioeconomic and Healthcare Access Factors**
Access to specialized healthcare, early intervention services, and rehabilitation can influence the timing of diagnosis. Studies indicate that children from low-income families or regions with limited healthcare resources may experience delayed diagnosis and treatment, even when services are theoretically available[3]. Factors such as limited awareness among caregivers and primary care providers, lack of routine developmental screening, and delays in referral to specialists contribute to late diagnosis.
Even when rehabilitation services like physical therapy are accessible, families may face challenges in recognizing early signs or obtaining timely evaluations, which can postpone diagnosis and intervention[3].
