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Cerebral Palsy: Developmental Milestones 24 to 36 Months

Cerebral Palsy: Developmental Milestones 24 to 36 Months

By Teresa Kelly

(Editor’s note: this is the third in a series of articles focused on developmental delays as they may show up in a child with cerebral palsy)

Most, but not all, children with cerebral palsy (CP) are diagnosed by 18 months of age. Children can grow on very different timetables based on a variety of factors, including illness or injury, and environmental conditions.

Children who are diagnosed with CP as toddlers may have experienced mild brain trauma that went unrecognized until the usual age for walking – between 10 and 14 months – came and went and parents went looking for answers.

Some parents don’t want to admit that their children are developmentally delayed, preferring to think of them as “late bloomers,” and so ignore the signs of that something may not be “quite right” about their child. Or parents don’t want to “bother” the pediatrician about their fears and concerns, hoping things will get better as the child gets older. In these cases, it often takes concerned relatives or childcare workers to step in and help.

Sometimes, too, a pediatrician just keeps saying “don’t worry” or “wait a while longer.” In these cases, it’s up to the parents (perhaps aided by relatives or caregivers), to change doctors. “Let’s wait and see” is not an adequate response to a parent’s ongoing concern about developmental issues.


Childhood Brain Injury

Some children develop cerebral palsy as the result of an injury after birth that cut off oxygen to the brain, known as brain asphyxia. The main causes of this are:

  • Choking on foreign objects such as toys and pieces of food (including peanuts, popcorn, or hot dogs)
  • Poisoning
  • Near drowning

A doctor should be consulted any time a child stops breathing for any reason. A child can suffer an episode of asphyxia and seem fine until a few months later, then start showing signs of cerebral palsy, such as trouble walking. Parents should then be on the alert for any later changes in motor control (walking, talking, or picking up small objects) because these may indicate a brain injury.

A child can also suffer brain injury as the result of a blow to the head, such as being in a car accident. Another cause is shaken baby syndrome, where a caregiver, in trying to quiet a crying child, perhaps, shakes them too hard, sending the soft brain pounding against the inside of the hard skull.

Severe infections, especially meningitis or encephalitis, can also lead to brain damage in this age group. Meningitis is inflammation of the meninges (the covering of the brain and the spinal cord), usually caused by a bacterial infection. Encephalitis is brain inflammation that may be caused by bacterial or viral infections. Either of these infections can cause disabilities ranging from hearing loss to CP to severe retardation.

Some children grow up in environments that are not stimulating enough for growing brains; this could result from extreme poverty or the mental illness of a caregiver. When a child isn’t regularly talked with, held, played with, or visually stimulated, small brains may not develop. Anyone who sees a child who may be in this type of environment should contact local children’s protective services officials.


Developmental Warning Signals

By the end of year 2 (24 months) and the beginning of age of 3, most children are walking alone, standing on tiptoe, and climbing on and off furniture unassisted. According to the Centers for Disease Control and Prevention, warning signs that children in this age range may not be progressing like they should include:

Around 24 Months old:

  • By 15 months, does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon)
  • Cannot walk by 18 months
  • Fails to develop a mature heel-toe walking pattern after several months of walking, or walks only on his toes
  • Does not speak at least 15 words
  • Does not use two-word sentences by age 2
  • Does not follow simple instructions by age 2
  • Cannot push a wheeled toy by age 2
  • Does not imitate actions or words by the end of this period
  • Experiences a dramatic loss of skills he or she once had

By 36 Months Old:

  • Shows frequent falling and difficulty with stairs
  • Persistent drooling or very unclear speech
  • Cannot build a tower of more than four blocks
  • Difficulty manipulating small objects
  • Cannot copy a circle by age 3
  • Cannot communicate in short phrases
  • No involvement in “pretend” play
  • Does not understand simple instructions
  • Little interest in other children
  • Extreme difficulty separating from mother or primary caregiver
  • Poor eye contact
  • Limited interest in toys
  • Experiences a dramatic loss of skills he or she once had


Early Intervention is Critical

Children with cerebral palsy can be helped immensely by early treatment. Physical therapy can help strengthen leg and core body muscles; and speech therapy can help strengthen jaw, mouth and tongue muscles necessary to clear speech and allow for healthy eating. Vision and hearing problems can be corrected or improved with the use of adaptive equipment. The earlier your child starts getting help, the better the opportunity for developing the skills needed to lead the fullest life possible.

For help with finding early intervention resources in your state, call the National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285.  Or visit the NICHCY website. Once you find your state on this webpage, look for the heading “Programs for Infants and Toddlers with Disabilities: Ages Birth through 3.”


Further Reading

Cerebral Palsy: Developmental Milestones Birth to 12 Months

Cerebral Palsy: Developmental Milestones 12 to 24 Months

Cerebral Palsy Developmental Milestones Three to Four Years

Cerebral Palsy: Developmental Milestones Four to Five Years

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