15-60% of CP patients have a seizure disorder, and it is essential to ensure anti-seizure medications are adequate and absent seizure recognized.

A true confirmation of CP can only be done at 3-5 years of age when the brain is fully developed.

Speech, vision & language assessment and intervention by appropriate team members

If there is late sitting (after eight months)

Delay in walking- after 18 months

Asymmetric hand function (hand preference in less than a year old infant)

This is an important dilemma for pediatricians when they are deciding for a referral for CP surgery. In the Indian context majority of our patients will need a multidisciplinary approach for taking care.

Many parents out of anxiety, ignorance, and hope fail to plan for the rationing of resources for their CP kids. CP is common in the middle income to lower socioeconomic strata doctors, need to act as counselors regarding judicious resource utilization. The rule of thumb, which has to be followed, is always to see if a child can be made independent. The biggest misconception which families have is equating “Ambulation” with “Independent.” Pediatricians need to counsel families saying that language, communication, vocational training is more important than gait. Many families spend almost 1/3-1/4th of their total income on physical therapy, which is the least rewarding of all the interventions. Many parents and typically mothers can be taught to perform stretching exercises saving on the money that is spent on spasticity management and reallocate the resource for other needful utilization.

This is an essential question with long term implications. Hardly there is any need for orthopedic surgery in the less than 6-year-olds except when the hip is at risk. Most Orthopedic surgical interventions are around the 7-9 year age group so that there is adequate compensation for gait abnormalities.