American Medical Association Family Medical Guide - American Medical Association [178]
Hydrocephalus
At birth, the bones of the skull are slightly separated (top left), and you can feel a soft spot called the fontanelle on the top of the child’s head. The bones grow together by age 2. In a child with hydrocephalus, the buildup of cerebrospinal fluid in the cavities of the brain causes the brain to swell and spread the skull bones farther apart (bottom right), enlarging the child’s head.
Treating hydrocephalus
To relieve pressure on the brain from the accumulation of fluid in hydrocephalus, a surgeon may insert a permanent tube (called a shunt) into the child’s head to drain the fluid from the brain into the child’s abdomen or into a vein in the neck. The tube usually remains in place for life.
After the surgery, the baby’s head will gradually return to a normal size. During the first year, he or she will need to have frequent checkups. When children with hydrocephalus have this surgery early in life, their chances of normal mental and physical development are good.
In some cases, as the child grows, the tube becomes blocked, causing pressure to build up in the brain. If this occurs, the child will be irritable, vomit frequently, or develop a headache and fever. If you notice these symptoms in your child, take him or her to the doctor or to a hospital emergency department immediately. If the tube in your child’s brain is blocked, he or she will be hospitalized and the blockage will be removed or the tube replaced.
Other Congenital Disorders
Some birth defects are inherited. Others can result from an abnormality that occurs during fetal development. In most cases, the earlier a child is treated, the more successful the outcome, especially for disorders that can affect a child’s development. For example, congenital dislocation of the hip can interfere with a child’s learning to walk, and cleft lip and cleft palate can affect a child’s ability to speak and can make eating difficult. Once these disorders are treated, a child can lead a full, healthy life.
Congenital Dislocation of the Hip
Some children are born with a dislocated hip or a hip that becomes dislocated shortly after birth. In a dislocated hip, the head of a thighbone (femur) lies outside of its socket in the pelvis. The socket is shallow and poorly formed. One or both hips may be affected. The cause of congenital hip dislocation (also called developmental dysplasia of the hip) is not known, but about 1 in 60 children is born with a possible hip dislocation. The disorder tends to run in families, and it occurs more frequently in girls than in boys. Babies who were in the breech position (with buttocks or feet down rather than head down) inside the uterus are at increased risk of having a dislocated hip.
Symptoms and Diagnosis
The symptoms of a congenital dislocation of the hip are not obvious. As part of the routine examination of a newborn or infant, the doctor manipulates the child’s hip joints and, if one is dislocated, he or she will hear a click. If only one hip is dislocated, the skin folds in the buttocks and legs may be asymmetrical, and the leg on the dislocated side may appear shorter. A more reliable test uses ultrasound imaging (see page 111) to view the hip joints, enabling the doctor to see any underlying defect in the hip socket. Doctors recommend ultrasound at 4 to 6 weeks of age for infants who have risk factors for dislocation of the hip, such as family history, breech birth position, or other abnormalities of the muscles, bones, or joints.
Hip dislocation
In a normal hip joint (left), the ball at the top of the thighbone fits neatly into the socket in the pelvis. In a dislocated hip joint (right), the ball at the top of the thighbone lies outside the socket.
Treatment
If a hip disorder is detected early in life, an orthopedist (a doctor who specializes in disorders of the bones and joints) will