Pediatric Hydrocephalus

A baby with hydrocephalus has extra fluid in and around the brain. This fluid is called cerebrospinal fluid (CSF). Most CSF is found in fluid-filled areas (ventricles) inside the brain. Its purpose is to cushion and protect the brain and the spinal cord.

Too much CSF can increase the pressure in your baby’s head. This causes the bones in your baby’s skull to expand and separate. The baby's head may look larger than normal.

Hydrocephalus is rare. It may be caused by any of these problems:

• The fluid is blocked from flowing through your baby’s head.
• Your baby has problems absorbing the fluid.
• Your baby makes too much fluid (rare)

This condition can be congenital. This means that your baby is born with it. Hydrocephalus can also happen later in life. Causes of this condition include:

• Congenital aqueductal stenosis (narrowing of the aqueduct)
• Neural tube defects, such as spina bifida
• Premature birth
• Infections
• Tumors
• Bleeding inside your baby’s brain
• Birth injuries
• Blood vessels in your baby’s head that aren’t formed right
• Injuries

Symptoms can occur a bit differently in each child. They can include:

• A full or bulging soft spot on the top of your baby’s head (fontanel)
• Increasing head size (circumference)
• Seizures
• Bulging eyes and not being able to look up when facing forward
• Visible scalp veins
• Irritability
• High-pitched cry
• Poor feeding
• Projectile vomiting
• Sleepiness or being less alert than usual
• Developmental delays

The symptoms of hydrocephalus may seem like symptoms of other conditions. Make sure your child sees their healthcare provider for a diagnosis.

A healthcare provider may first spot this condition in your baby during an ultrasound in pregnancy. In many cases, hydrocephalus doesn't develop until the third trimester of the pregnancy. Ultrasounds done earlier in pregnancy may not show this condition.  

Your child may be diagnosed with this condition after birth. Your child’s healthcare provider will examine your child and ask you about their prenatal, birth and family history. If your baby is older, your child’s provider may ask if they care meeting milestones. Children with this condition may be likely to have developmental delays. If your child has a delay, their healthcare provider may check for underlying problems.

Your baby’s head may be larger than normal. Your child’s healthcare provider will measure their head. This measurement is called the head circumference. If your baby’s head size isn’t in the normal range or is growing faster than normal, they will have tests. These tests can confirm hydrocephalus.

Ultrasound

This test uses sound waves to create an image of the inside of the body. During pregnancy, this test can show the size of the ventricles inside of your baby’s head. It can also be used after birth while the anterior fontanelle remains open.

MRI

This test uses large magnets, radio waves and a computer. Together, these show detailed images of organs and structures inside your baby’s body.

CT scan

This test uses X-rays and computer technology to make detailed images of any part of your baby’s body. These include bones, muscles, fat and organs. CT scans are more detailed than X-rays.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

The goal of treatment is to reduce the pressure inside your baby's head. This can be done by draining the fluid. Your child may need medicine to remove the extra fluid. Some children need surgery.

In surgery, a doctor usually places a mechanical shunting device in your baby’s head. This helps to drain the fluid from your baby’s brain. The fluid is directed to another part of your baby’s body, where it can be absorbed.

The shunt usually runs behind your baby’s ear. The tubing goes under your baby’s skin to the belly (abdomen), heart, or lung. Your baby's healthcare provider will decide the drainage location. This will be based on your baby’s condition, age and other factors. The belly is generally the first choice. A VP (ventriculoperitoneal) shunt is often used to direct fluid into the abdomen, often associated with spina bifida.

Most children with spina bifida and shunted hydrocephalus will need the shunt for life. The most common problem with shunts is that they can get blocked, break or come apart. The signs of shunt problems in children with spina bifida are different for each person. The most common signs of a shunt problem are:

• Fever
• Neck stiffness, pain, tenderness
• Abdominal pain
• Headache
• Vomiting and nausea
• Seizures
• A change in intellect, school performance or personality
• Back pain at the spina closure site
• Worsening arm or leg function, increasing weakness or loss of sensation, worsening coordination or balance and/ or worsening orthopedic deformities
• Increasing scoliosis
• Worsening speech or swallowing
• Changes in bowel or bladder function 

Families and health care providers must pay close attention to a child’s symptoms, especially if they are similar to those that were present with previous shunt problems. Your health care provider should measure your child’s head at each well visit.

When brain or spinal cord function gets worse and there is no other clear cause, health care providers should check to see if there are problems with the shunt. To see if there is a problem with a shunt, health care providers will study images of the brain (usually an MRI or CT scan for children older than 1 year and a head ultrasound for children under 1 year). If there are any questions or concerns about a child’s shunt or hydrocephalus, you may call Children’s National Neurosurgery at 202-476-3020 or visit our Neurosurgery department for more information.

Sometimes surgery and shunts can cause problems. Possible complications include:

• Infection
• Bleeding
• A shunt that doesn’t work, and may drain too much or not enough fluid

After surgery, your child’s healthcare team will tell you how to care for your baby at home. They’ll also tell you symptoms that are an emergency. If your child has these symptoms, call their healthcare provider right away.

You can't prevent hydrocephalus in your child. But your baby’s healthcare provider may suggest genetic counseling if you plan to have more children. Through counseling, you can learn about the risk for this condition in future pregnancies. You may also need testing during pregnancy to check for hydrocephalus.

Hydrocephalus can affect your baby’s brain and development. Your child’s outlook depends on how severe the condition is. It also depends on other brain and health problems your baby has.  

The key to treating this condition is getting it diagnosed and treated early, and preventing infections. Your baby will need regular checkups to make sure his or her shunt is working right. Your child’s healthcare team will work closely with you as your baby grows.

The key to treating this condition is getting it diagnosed and treated early, and preventing infections. Your baby will need regular checkups to make sure his or her shunt is working right. Your child’s healthcare team will work closely with you as your baby grows.

• Persistent vomiting
• Persistent headache
• Change in behavior or mental status
• Increased sleepiness
• Fever
• Redness or tenderness along the shunt track

Call 911 if your child has:

• Seizures
• Inability to arouse
• Sundowning of the eyes (downward gaze)