Gross Motor Function Classification System (GMFCS)

As any parent can attest, there are no hard-and-fast rules when it comes to how children grow. The same is true for children with cerebral palsy. This birth-related disorder is as unique as every child diagnosed with it.

Generally speaking, cerebral palsy affects the body’s muscles and motor control. And depending on how, when and where a child’s brain is affected, cerebral palsy will manifest in different symptoms for every child. Symptoms may even change as the child grows from one year to the next since injury to the growing brain of a child results in a broad range of neurological and physical symptoms. This is precisely what makes cerebral palsy such a broad term and can make diagnosis difficult to classify.

Fortunately, in the past 20 years a classification system called Gross Motor Function Classification System (GMFCS) for cerebral palsy was developed. This system not only gives parents a big-picture understanding of their child’s symptoms, but can also help predict how those symptoms will develop over their child’s life.

Read on to learn more about GMFCS and how different cerebral palsy severity levels are classified.

Understanding the GMFCS

In 1997, a group of pediatric doctors and scientific researchers created the GMFCS. Their aim was to foster greater consistency in how cerebral palsy is understood and described. This system allows doctors to classify cerebral palsy symptoms according to their severity. For parents, it offers a more holistic understanding of both their child’s current needs and the level of self-sufficiency they are likely to achieve as they grow.Cerebral Palsy

The GMFCS is a scale based on the gross motor function of patients with cerebral palsy. Gross motor function is a term that designates bigger, more general movements that use the body’s larger muscles—think arms, legs and torso instead of fingers, wrists or tongue. Depending on the age at which a child undergoes a GMFCS assessment, the test may focus on head control, rolling, sitting up, walking or navigating motion.

While the assessments focus on these broader movements, the GMFCS is very helpful in predicting other aspects of cerebral palsy as well, such as fine motor skills and factors such as paralysis or spasmodic tendencies. While the system does not test for a child’s learning or thinking abilities, it does offer insights that can help to predict how those abilities will develop over a child’s life. The overall focus of the GMFCS is always on the level of self-sufficiency a child is able to exercise in their movements.

GMFCS Classification Levels

The GMFCS classifies cerebral palsy into five levels of severity. Higher numbers on the GMFCS scale indicate a more severe case of cerebral palsy.

The tests are conducted during specific age ranges that get broader as a child grows older. Each classification level in the GMFCS is assessed based on observation of how the child can move and perform tasks on their own.

The different levels in the GMFCS are determined by how much assistance a child needs for specific motions according to their age range. The quality of a child’s movement, such as walking slowly or with a limp, is not a main focus of determining a child’s level on the GMFCS scale, rather the test emphasizes on functional ability.

This list offers a brief understanding of how the GMFCS interprets the movements of a child at various age ranges to classify their cerebral palsy severity level.

Up to Two Years Old

Level 1: Sitting, pulling themselves up, using both hands to play with an object, crawling

Level 2: Can sit up with help to balance, slow crawling or scooting forward on belly

Level 3: Can sit up with heavy back support, can roll or creep on their belly

Level 4: Can roll from back to stomach, cannot sit up unless held

Level 5: Needs support to hold up head and trunk, need assistance to roll over, little voluntary control of movements

Ages Two to Four

Level 1: Sits on floor with no assistance, may begin to stand or walk without assistance

Level 2: Sits on floor with assistance, especially if hands are occupied with an object; can walk with assistive devices or by holding onto furniture

Level 3: Sits on floor with rotated hips and knees, tends to crawl on their hands and knees without moving legs

Level 4: Can sit up when using their hands and arms for support, moves through hands and knees, inching forward on stomach or rolling

Level 5: Little to no ability to move without heavy assistance

Ages Four to Six

Level 1: Sits in/gets up from chair without assistance; can walk freely and begin to run/jump

Level 2: Sits in chair without assistance, but needs help to move from chair to standing/moving on floor; walks unassisted for short distances without support; climbs stairs while holding onto rails

Level 3: Sits in chair with trunk support; moves from chair to floor while holding onto something; walks with mobility device

Level 4: Sits in a chair with trunk support; walks short distances with support; difficulty turning and keeping their balance

Level 5: Needs adaptive equipment to hold them while sitting in chair; needs transportation for daily activities; no independent mobility

Ages Six to Twelve

Level 1: Walks, runs, jumps, climbs stairs independently; may struggle with balance/coordination

Level 2: Can walk indoors and outdoors with little to no assistance, needs help walking on inclined surfaces or unfamiliar areas; minimal ability to run/jump

Level 3: Can walk short distances/level surfaces with help of mobility device; may climb stairs with the use of handrails

Level 4: Relies on wheelchairs and walk-assisting devices for voluntary mobility

Level 5:  May achieve voluntary mobility with electronic wheelchair


Using the GMFCS to classify cerebral palsy severity has helped physicians in different specialties cooperate more efficiently in determining the best plan for a child’s care. By providing a common basis of understanding across healthcare disciplines, the system also improves the medical community’s ability to collect and analyze data about cerebral palsy.

Perhaps most importantly, the GMFCS helps doctors communicate to parents in a consistent, understandable way about what to expect as their child grows older.

Signs to Look For

The first few years of any child’s life offer telltale signs of who they are and what they are capable of. In cases of children with cerebral palsy, there are specific signs from one age range to the next that indicate the severity of their condition and give clues as to what the next few years may bring. The GMFCS makes it easier for doctors and parents to recognize and understand those symptoms.

This list offers a brief understanding of how the GMFCS interprets the movements of a child at various age ranges to classify their cerebral palsy severity level.

No matter how your child’s diagnosis of cerebral palsy may be classified, you need to know that they are receiving care from knowledgeable doctors on whom you can rely on through each stage of your child’s life.

We understand that as a parent of a child with cerebral palsy, nothing is more important to you than getting the best possible healthcare to help your child grow and thrive. If your child has been diagnosed with cerebral palsy because of a birth injury, you may be entitled to financial damages from the hospital or doctor responsible. This compensation can make all the difference when it comes to getting your child the care they need.

If you would like to discuss your situation with an experienced attorney, contact the team at The Oshman Firm. Our law firm has a proven track record of successful cerebral palsy claims, and we are available to help you understand your options at no cost or obligation to you.