Which of the following is NOT a warning sign of cerebral palsy at 12 months?

• A. Toe walking while held, but unable to stand
• B. Athetoid movement
• C. Absent or weak primitive reflex responses
• D. Hypotonia

Answer: (C)

At 12 months, warning signs for cerebral palsy are centered on motor control problems and the persistence of reflexes that should have integrated by now. Toe walking while held and unable to stand points to weakness and poor motor coordination that limits standing and weight-bearing, which is concerning for early motor impairment. Athetoid movement represents involuntary writhing or choreiform movements, a dyskinetic pattern that is characteristic of some forms of CP and reflects abnormal movement control. Hypotonia, or low muscle tone, is also a common early finding in infants who later are diagnosed with CP, contributing to delayed motor milestones and atypical movement patterns.

Absent or weak primitive reflex responses, however, are not typical warning signs of cerebral palsy. Primitive reflexes like the Moro or rooting reflex should become integrated by around 6 months; CP more often involves persistence or abnormal persistence of reflexes rather than a loss of them. So, while the other signs reflect emerging or established motor dysfunction associated with CP, absence or weakness of primitive reflexes does not fit the pattern seen in CP at this age.