Diagnosing Spina Bifida in Children

Most of the time, spina bifida is diagnosed before a baby is born during prenatal screenings that are a standard part of prenatal care. If the condition is not identified before birth, neurosurgeons and neurologists at Hassenfeld Children’s Hospital at NYU Langone, who are experts in diagnosing newborns, work closely with specialists in urology, orthopedics, and physiatry to provide a comprehensive initial assessment of your child’s needs. If necessary, our team of experts can provide immediate care.

If a baby has spina bifida occulta, the most common and least serious type of spina bifida, there may be no sign of it in prenatal tests, and a baby may have no medical complications. Doctors may not diagnose the condition until a child grows older and has symptoms such as lower back pain or has an X-ray taken for another reason.

To diagnose spina bifida, the doctor performs a physical exam and orders imaging tests.

Physical Examination

Immediately after birth, a doctor carefully examines your baby for signs of spina bifida, such as tissue that protrudes through an opening in the spine. Some babies may not have a lesion, but they may have a dimple, dark spot, or tuft of hair on the lower back. A doctor may also evaluate a baby’s muscle tone. Some babies with spina bifida may have weakness in the hips, legs, and feet.

Doctors may also perform nerve conduction tests to determine whether the condition has affected sensation in various parts of the body. For example, a doctor may test a baby’s response to hot and cold temperatures or pinpricks.

X-rays

X-rays use electromagnetic radiation to create images of the inside of the body. They provide a clear view of the bones in a baby’s spine and can confirm the location of a spina bifida lesion. X-rays may also reveal whether bones in the feet, hips, or legs have moved out of position as a result of muscle weakness caused by nerve damage. Some children may have feet that turn inward at the ankle, a condition called clubfoot, or a spine that curves too much, which is called scoliosis.

MRI Scans

MRI scans use radio waves and magnetic fields to create two- and three-dimensional images of soft tissues inside the body. A doctor often recommends an MRI scan to assess the severity of spinal cord damage caused by spina bifida and determine whether your child has hydrocephalus—a buildup of excess fluid in the brain that often occurs with the most severe type of spina bifida.

CT Scans

A doctor may order a CT scan to obtain more detailed images of a baby’s brain, spine, and other bones and joints. This test may be helpful if a doctor sees evidence of an abnormality on an X-ray and needs more information. CT scans use a computer program to create detailed images of structures inside the body.

Urological Testing

In many children with spina bifida, the nerves affecting bladder and bowels are damaged. In order to determine if this is so, a doctor performs tests to obtain information about how well these nerves function.

A day or two after birth, a doctor performs a renal sonogram, which uses sound waves to visualize a baby’s kidneys and bladder. These images help determine if the kidneys appear normal or enlarged. This may occur as a result of a backflow of urine from the bladder to the kidneys, or because of increased pressure in the bladder, which impairs drainage of the urine into the bladder. A sonogram can also show if the bladder is not emptying efficiently.

Typically, a urine sample is tested in a laboratory to be sure there is no urinary tract infection. The doctor may also take a blood sample to test for kidney malfunction.

Urine testing is repeated every three to four months during infancy. If kidney function is abnormal, blood tests are repeated. When needed, our pediatric urologists work with pediatric nephrologists, who specialize in the treatment of kidney disease.

If a baby shows signs of constipation, or difficulty emptying the bowels, our pediatric gastroenterologists, who treat conditions affecting the digestive tract, offer specialized care to help children develop continence by the time they begin school.