Early detection of cerebral palsy in community settings: current state and a pathway forward.

Abstract

We explore how and why early detection of cerebral palsy (CP) should occur in community settings across low and middle income countries (LMICs) and high income countries (HICs). Early diagnosis is best clinical practice and can happen in the first year of life using evidence-based tools such as the General Movements Assessment (GMA) and the Hammersmith Infant Neurological Examination (HINE). In HICs, primary care surveillance guided by published motor "red flags" can identify children who need prompt referral, yet uptake remains uneven. In LMICs, clinicians demonstrate high diagnostic accuracy when tools are available, but the main barrier is health system reach rather than clinical capability. Across settings, caregiver studies show that delayed diagnosis reduces empowerment, increases mental health burden, and erodes trust in services. The central implementation task is to build reliable pathways that connect families from home to timely diagnosis, aligning community surveillance with referral networks, provider training, and policy support. Strengthening these pathways is essential to improve participation, reduce comorbidity burden, and enhance wellbeing for children with CP and their families.