Unknown

Clinical assessment and AP pelvic x-ray at 18 months of age or at diagnosis if older.

Reassess clinically in 6 months and verify GMFCS level.

GMFCS I

18 months

18 months

Initial clinical assessment and AP pelvic x-ray at 18 months of age or at diagnosis if older.

4 Years Old

Clinical assessment and verify GMFCS level. No repeat x-ray required.

6 Years Old

Clinical assessment and verify GMFCS level. No repeat x-ray required.

If WGH IV hemiplegia is identified, perform surveillance according to WGH IV classification.

If GMFCS is unchanged, discharge from surveillance.

If GMFCS level has changed, perform surveillance according to new classification.

Verify WGH IV

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GMFCS II

18 months

18 months

Initial clinical assessment and AP pelvic x-ray at 18 months of age or at diagnosis if older.

4 Years Old

Clinical assessment and verify GMFCS level. Repeat X-ray.

6 Years Old

Clinical assessment and verify GMFCS level. No repeat x-ray required.

If WGH IV hemiplegia is identified, perform surveillance according to WGH IV classification.

8 Years Old

Clinical assessment and verify GMFCS level. No repeat x-ray required.

10 Years Old

Clinical assessment and verify GMFCS level. Repeat X-ray.

If GMFCS is unchanged, discharge from surveillance.

If GMFCS level has changed, perform surveillance according to new classification

GMFCS III

18 months

18 months

Initial clinical assessment and AP pelvic x-ray at 18 months of age or at diagnosis if older.

Age 2

Clinical assessment and verify GMFCS level. Repeat X-ray.

Age 4-7

Clinical assessment and verify GMFCS level annually. No repeat x-ray required.

If WGH IV hemiplegia is identified, perform surveillance according to WGH IV classification.

If stable, discontinue X-rays until age 10

Age 10 until skeletal maturity

Clinical assessment and x-ray annually until skeletal maturity. Discharge if stable.

If GMFCS level has changed, perform surveillance according to new classification

GMFCS IV / GMFCS V

18 months

18 months

Initial clinical assessment and AP pelvic x-ray at 18 months of age or at diagnosis if older.

Follow-up every 6 months with clinical assessment and X-ray.

Age 7 - Skeletal maturity

Follow-up annually with clinical assessment and X-ray until skeletal maturity.

If stable, discharge from surveillance.

If MP >33% on pelvic x-ray, refer to orthopedic specialist. If <33%, continue with surveillance.
Learn how to measure MP.