One page summary: GMFCS levels I to V, explained

In two sentences

The GMFCS, or Gross Motor Function Classification System, describes how a child with cerebral palsy moves. It has five levels. Level I is walking without limits. Level V is being moved in a wheelchair by someone else. ¹

It describes what a child usually does at home, at school and in the community. It is not a measure of intelligence, of effort, or of how hard a family is trying.

The numbers, with their sources

• Number of levels. Five, from I to V. Level I has the fewest limits and level V the most ¹
• What it measures. Self-initiated movement, especially sitting, transfers and getting around. It focuses on what a child usually does, not on their best performance in a clinic ¹
• When it is assigned. Levels are described in age bands, and the system is generally not applied with confidence before age 2 ¹
• How stable it is. A child's level is generally stable from about age 2 onward, which is what makes it useful for planning ¹
• What it does not measure. It says nothing about intelligence, speech, hand function, vision, hearing or learning. A child at level V may have typical intelligence ²
• Who it applies to. Children with cerebral palsy, which CDC tracking puts at about 1 in 345 children in the United States ³

What to do this week

1. Ask for your child's GMFCS level, in writing, with the date and who assigned it.
2. Ask what hip surveillance schedule that level puts your child on.
3. If your child is level IV or V, ask about powered mobility, including at what age it can be trialled.
4. Ask whether the current therapy goals fit the level. It is a fair question and a good therapist will welcome it.
5. Put the level in the IEP or IFSP so services are argued from a shared starting point.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the physical therapist or physiatrist

• What GMFCS level is my child, and what specifically puts them at that level rather than the one above or below?
• What does that level mean for the next three years?
• What hip surveillance schedule does this level call for?
• Are our current goals the right ones for this level?

For the seating and mobility clinic

• What mobility options fit this level, including powered options?
• At what age could we trial powered mobility?
• What will insurance or Medicaid need in order to fund this?

For the school team

• How does the level change the physical school day?
• What is the plan for distance, stairs, playground and evacuation?
• Where does the equipment live during the day, and who is responsible for it?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on GMFCS levels I to V, explained

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.