Clinical approach

Clearly there is need to approach this as with any other child with an intercurrent illness but specific factors to consider in the recent history:

  • VP shunt – Are there any signs of raised intracranial pressure such as headache, vomiting, new or different seizure activity, irritability or drowsiness?

  • UTI – Is there a history of fever, recent fluid intake, decreased frequency of clean intermittent catherization and any other difficulties? Any recent history of constipation?

  • Fracture – Remember that fractures below the level of the injury will be painless but could there could be abnormal limb positioning or movement.

  • Medications – particularly any started recently. 

Approach to clinical exam for a child with spina bifida