Table 1.

AAP and AADMCP 2022 key guidelines and ethical resources.

AAP and AADMCP 2022 Key Guidelines

Early identification as the basis for securing timely and needed intervention following diagnosis of cerebral palsy among children.

For infants older than 5 months of age, specific scores on the Hammersmith Infant Neurological Examination (less than 73) in combination with abnormal findings from magnetic resonance imaging (MRI) in regions of the brain responsible for regulating motor skills have consistently demonstrated an accurate diagnosis of cerebral palsy 90% of the time for infants at 6, 9 and 12 months of age.

Among infants younger than 5 months of age, the Prechtl’s General Movements Assessment in combination with abnormal MRI findings in cerebral regions pertaining to motor skills have consistently yielded an accurate diagnosis of cerebral palsy 95% of the time for these infants.

Strongly encourage pediatricians to initiate a comprehensive diagnostic neuromotor work-up of children especially with respect to motor milestones and muscle tone, along with potential brain imaging.

Facilitate this work-up from the onset of any symptoms in line with cerebral palsy by referral to a specialist to complete this work-up sooner rather than later, which will also account for the long waiting lists in securing appointments with specialists.

Support pediatricians in connecting children with suspected or confirmed cerebral palsy with early intervention programs for the initiation of evidence-based developmental therapies that could potentially increase neuroplasticity in children during this critical time when the greatest gains are possible.

Address pain and discomfort among children with cerebral palsy from the onset and on a continuum by identifying sources of pain and a plan to alleviate them.

Treat each child’s new onset of symptoms or functional decline as the chief focus of presenting medical complications rather than initially attributing these symptoms to underlying cerebral palsy without any further investigation for sources of symptoms.

Involvement from the palliative care team in assisting these children to achieve pain and symptom management as well as minimize discomfort.

Initiation in transition of care for children with cerebral palsy during their early preteen and adolescent years (between 12 to 14 years of age) to begin preparing them for the coming transition several years later into late adolescence and early adulthood.

Comprehensive written physician sign-out as the child transitions from pediatric to adult care.

Immersing the pediatrician in community contexts by increasing communication and collaboration with the child’s resource providers, including therapists, schools, inpatient providers (e.g., complex care team), community play and support groups, and sources of financial resources, among others.

Support pediatricians in taking an active role in educating caregivers of these children on indicators and risk factors for child maltreatment, as well as connecting them with resources in cases where there is potential risk of child maltreatment.

Screening for developmental disabilities inclusive of cerebral palsy beginning for infants at the age of 9 months and continuing, as they grow into toddlers, at both 18 months and 30 months of age, irrespective of known risk factors.

Promote routine well-child visits for children with cerebral palsy with primary care that include receiving vaccinations on-schedule throughout their childhood and adolescent years.

Multidisciplinary village of providers involved to address, on a continuum, the medical, developmental, socio-emotional, academic and further needs of children with cerebral palsy.

In the care of these children, take a more biopsychosocial approach rather than a biomedical approach with their caregivers by viewing the pediatrician as a catalyst in encouraging caregivers to engage in different social, recreational and other kinds of activities and groups in the community that are in line with the child’s interests and development.

Encourage pediatricians to further provide recommendations for recreation and athletics that account for access to adaptive equipment whenever indicated.

Ethical Resources for Diagnosis Guidance

GMFCS—https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/severity-of-cerebral-palsy/gross-motor-function-classification-system/ (accessed on 26 May 2023).

MACS—https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/severity-of-cerebral-palsy/manual-ability-classification-system/ (accessed on 26 May 2023).

CFCS—https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/severity-of-cerebral-palsy/communication-function-classification-system-cfcs/ (accessed on 26 May 2023).