Spotting the Signs of Cerebral Palsy in the First Months: How Watching a Baby Move Can Open the Door to Early Help
Two studies from Bangladesh (Karim et al., 2025) and India (Balachander et al., 2026) on finding babies at risk early
Two recent studies suggest that doctors may be able to tell by about three months of age which babies who had a difficult start are at high risk of cerebral palsy, even where brain scans are not available. One study tested which assessments work best, and the other showed that a busy hospital clinic in India could add a short video of a baby's movements to routine check-ups and bring babies with unusual movements to a therapy team sooner [1][2].
Why this question matters to families
Cerebral palsy, often shortened to CP, is a group of conditions that affect movement and posture. It is caused by a problem in the developing brain that does not get worse over time, and it is the most common physical disability in childhood [1]. The Indian researchers cite estimates of about 2 children in every 1,000 in wealthier countries and about 3 to 4 in every 1,000 in low- and middle-income countries [2]. A baby's brain is changing very quickly in the first months of life, and doctors believe therapy is most helpful when it starts early, while the brain is at its most adaptable [2]. The difficulty is that many babies who leave the neonatal intensive care unit (NICU) look well, and parents may reasonably feel that check-ups are not needed. Researchers in India noted that this belief is one reason families stop attending follow-up clinics [2].
How doctors used to find out, and how that has changed
For a long time, families often learned that something was different only when a child was slow to sit, crawl or walk. In many places this is still how it happens: in low- and middle-income countries, a parent's worry about missed milestones is often the first sign anyone acts on [1]. In Bangladesh, the typical age at which children were diagnosed fell from five and a half years to three years between 2015 and 2019, after a national register began finding children in their communities [3]. That is progress, but three years is long to wait.
The science of earlier detection began with a simple observation. In the 1990s, researchers showed that the way a young baby moves on their own, without being touched or stimulated, can reveal whether the brain has been injured [4]. Healthy babies have smooth, varied movements, and at around three months they show tiny, continuous "fidgety" movements of the arms, legs and neck. When those fidgety movements are missing, the chance of cerebral palsy is higher [5]. Doctors also use a structured physical check of a baby's reflexes, muscle tone and posture, called the Hammersmith Infant Neurological Examination, and sometimes brain scans [6]. In 2017, experts combined these methods into guidance that makes a reliable diagnosis possible from about three months of age [7], and further guidance describes the therapy programmes that can begin afterwards [8][9].
Still, guidance on paper is not the same as help in the clinic. A single hospital follow-up clinic, for example, is reported to have cut the average age of diagnosis from 18 months to 13 months by changing how its assessments were organised [10], and teams in Australia have worked on similar changes [11][12]. Many hospitals in lower-income countries, however, do not have brain scanners, and families may travel far for appointments. These two new studies were designed with that reality in mind.
The first study: which checks work best in a Bangladeshi intensive care unit
Researchers followed 227 newborns admitted to the NICU of Mymensingh Medical College Hospital in Bangladesh, a large public hospital, between November 2019 and March 2020 [1]. The babies were included because they were born early, had signs of an injured brain, had a serious infection, or had very severe jaundice. Most were actually born at full term, and many had seizures. The team checked them repeatedly until the age of two, using video assessments of movement, physical examinations, developmental scoring tools, and, when COVID-19 made visits unsafe, phone interviews with parents.
Sadly, about one in four of the babies (27%) died before their second birthday, and 13% could not be followed. Of the surviving children who were examined in person at age two, 36 (29%) were diagnosed with cerebral palsy [1]. Looking back, the team found that a movement video taken in the NICU did not miss any child who later had cerebral palsy, but it also flagged many children who did not; about one in three of these early videos could not be used at all because the baby was asleep, upset or barely moving. It therefore works as an alert rather than an answer. At three months, combining the video of fidgety movements with the Hammersmith examination identified children correctly in the small group who could be seen in person: it caught 91 out of every 100 children who went on to have cerebral palsy, and it did not wrongly label any child who did not [1]. Because only 40 babies were assessed this way, these figures could change in a larger group. No baby in the study had a brain scan as part of routine care, so these results show that careful watching and examining can do a great deal without one.
The researchers also found that questionnaires completed by parents over the phone worked better the older the child was, which means they can help when families cannot travel, though they are less reliable than seeing the baby in person [1]. Because the group at three months was small, the researchers describe these findings as encouraging rather than final.
The second study: building a "movement corner" in a busy Indian clinic
In Bangalore, a team at St. John's Medical College and Hospital asked a different question: could a hospital routinely video-record babies' movements during check-ups, and would that help babies get therapy sooner [2]? They set aside a quiet room, mounted a camera over a mattress, and recorded 3 to 5 minutes of each baby's movements at about term age and again at 9 to 20 weeks of age. Two specially trained reviewers watched each video, and parents were told the result. If fidgety movements were missing or unusual, the family was called in to discuss the result with a doctor and was referred to a team of therapists and specialists.
Over the study period, 188 babies were recorded, and the clinic reached its goal of assessing at least 8 in 10 eligible babies. At the later recording, 84% of babies had normal fidgety movements, and 16 babies did not. Twelve of those 16 (three in four) began seeing the therapy team while still under six months of age, whereas before the programme none had [2]. More families also came back for the three-month visit (rising from 30% to 41%). The team described a low set-up cost, mainly a camera, storage and a therapist's salary, though their savings estimate assumes the babies flagged have cerebral palsy, which this study did not confirm [2].
What this means for your baby
If your baby spent time in the NICU, these studies suggest several things worth knowing. Follow-up visits matter even when your baby looks well, because they are when movement and development checks happen. A short video of your baby moving, taken at the right ages, is painless and safe, and it is one of the best tools researchers have for catching problems early. An unusual result does not mean your baby definitely has cerebral palsy; it means your baby deserves a closer look and possibly earlier support [1]. Families in India sometimes felt uneasy about their baby being filmed, and the team found that counselling parents, done by the baby's own newborn specialist (neonatologist), helped [2]. If you are offered a movement video and are unsure why, you can ask what it will be used for and who will see it.
Early support is not a cure, but doctors hope that therapies begun while the brain is highly adaptable will improve children's movement and development [8][9]. Ask your baby's team how you can take part at home.
A useful way to picture the timeline is as three checkpoints. Before leaving the NICU, a baby may have a first movement video, which can raise a flag but not settle the question. At about three months, a second video and a physical examination give the clearest picture. After that, if there are concerns, a team of therapists and doctors can plan support, and later questionnaires and visits track how the child is developing [1][2]. Knowing the checkpoints in advance can make the appointments feel less like tests of your baby and more like steps in a plan you are part of.
What researchers are working on next
These studies leave open questions. The Bangladeshi team would like larger groups, and a way of making phone-based tools more dependable at age two. The Indian team wants to follow flagged babies to find out how they do, test whether the programme works in smaller community clinics, and use computer software to help review the videos so that the programme does not depend on one or two trained experts [2]. Researchers also need to show that earlier referral actually improves children's lives. You can read about related work on outcomes after newborn stroke and on early help delivered by parents.
The bottom line
Watching how a baby moves, and examining them carefully at about three months, may alert doctors to a higher chance of cerebral palsy even without a brain scan, and a simple clinic set-up in India brought babies with unusual movements to a therapy team before six months of age. Neither study yet shows how those children fare later. For families, the most helpful step is to keep follow-up appointments and to ask what is being checked and why.
References
- Karim T, te Velde A, Webb A, et al. Early detection of cerebral palsy among a high-risk cohort in Bangladesh. BMJ Paediatr Open. 2025;9(1):e003921. doi:10.1136/bmjpo-2025-003921 ↩
- Balachander B, Sharma AR, Stanley AC, et al. Implementation of general movements assessment for early detection and treatment of infants at-risk of cerebral palsy – translating evidence into practice in a low resource setting. BMC Pediatr. 2026;26:381. doi:10.1186/s12887-026-06709-6 ↩
- Al Imam MH, Jahan I, Das MC, et al. Population-based surveillance of children with cerebral palsy enables early diagnosis and intervention. Dev Med Child Neurol. 2021;63(7):883-884. doi:10.1111/dmcn.14861 ↩
- Prechtl HF, Einspieler C, Cioni G, et al. An early marker for neurological deficits after perinatal brain lesions. Lancet. 1997;349(9062):1361-1363. doi:10.1016/S0140-6736(96)10182-310182-3) ↩
- Kwong AKL, Fitzgerald TL, Doyle LW, et al. Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review. Dev Med Child Neurol. 2018;60(5):480-489. doi:10.1111/dmcn.13697 ↩
- Morgan C, Romeo DM, Chorna O, et al. The pooled diagnostic accuracy of neuroimaging, general movements, and neurological examination for diagnosing cerebral palsy early in high-risk infants: a case control study. J Clin Med. 2019;8(11):1879. doi:10.3390/jcm8111879 ↩
- Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171(9):897-907. doi:10.1001/jamapediatrics.2017.1689 ↩
- Morgan C, Fetters L, Adde L, et al. Early intervention for children aged 0 to 2 years with or at high risk of cerebral palsy. JAMA Pediatr. 2021;175(8):846-858. doi:10.1001/jamapediatrics.2021.0878 ↩
- Orton J, Doyle LW, Tripathi T, et al. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev. 2024;(2):CD005495. doi:10.1002/14651858.CD005495.pub5 ↩
- Byrne R, Noritz G, Maitre NL; NCH Early Developmental Group. Implementation of early diagnosis and intervention guidelines for cerebral palsy in a high-risk infant follow-up clinic. Pediatr Neurol. 2017;76:66-71. doi:10.1016/j.pediatrneurol.2017.08.002 ↩
- King AR, Machipisa C, Finlayson F, et al. Early detection of cerebral palsy in high-risk infants: translation of evidence into practice in an Australian hospital. J Paediatr Child Health. 2021;57(2):246-250. doi:10.1111/jpc.15191 ↩
- Kwong AKL, Eeles AL, Anderson PJ, et al. The Knowledge Translation of Early Cerebral Palsy (KiTE CP) study: implementing screening among a high-risk prospective cohort of Australian infants. J Pediatr. 2024;268:113949. doi:10.1016/j.jpeds.2024.113949 ↩