Hydrocephalus

This fluid is known as cerebro-spinal fluid and it normally flows from the brain, down the spinal cord and into the bloodstream. If any of the pathways are blocked, the fluid accumulates in the brain, causing it to swell. In babies and infants this causes the head to enlarge, but in older children the bones of the skull are fused and the head size cannot increase, which creates increasing pressure. Usually, a child with hydrocephalus has a shunt surgically inserted and this will drain the fluid and reduce the pressure from day to day.

Hydrocephalus can be present at birth or it can develop following a premature birth. Most children with spina bifida suffer from hydrocephalus. Hydrocephalus can also develop following meningitis, a stroke, a brain haemorrhage or a brain tumour.

Children with hydrocephalus can have fits, but these are not usually directly a result of the hydrocephalus, but rather of the condition which caused the pathways to become blocked. A child with hydrocephalus is likely to have learning difficulties or physical effects. This will vary from child to child and may be very slight.

Key characteristics

A child with hydrocephalus may:

• have learning difficulties of various kinds
• have poor concentration, reasoning and short-term memory
• have co-ordination problems, especially eye-hand coordination and a degree of clumsiness
• have problems with motivation and organisational skills
• demonstrate sequencing difficulties
• have visual problems
• become seriously distressed by everyday noises
• suffer impaired vision (and possibly have their eyes fixed in a downward position, as a result of the cerebro-spinal fluid causing pressure on the nerves which control eye movement)
• develop breathing, speaking or swallowing difficulties
• have an early puberty.

Although a shunt usually works without any problems and is intended to last for a lifetime, it may possibly develop a blockage or an infection, or the tube may require surgically lengthening as the child grows. It is important to notice any sudden changes and to notify the parents straight away, or call the doctor or an ambulance if you feel particularly concerned. Signs
of a blocked or infected shunt are:

• general fatigue
• visual problems
• behavioural changes
• sudden or gradual decline in attainment levels
• vomiting
• headaches
• dizziness
• sensitivity to light
• drowsiness
• fits.

Support strategies

You may need to:

• develop the child’s concentration skills
• break instructions down into short sentences for everyday tasks
• teach simple sequencing activities
• develop strategies for improving short-term memory
• support the child in working on their coordination skills (especially eye to hand)
• develop strategies to help the child improve organisational skills
• adapt materials for a child who may have visual problems
• build confidence and self-esteem through encouragement and praise
• seek specialist advice for anything which causes concern.

Support agencies

The Association for Spina Bifida and Hydrocephalus (ASBAH)