Spina Bifida

Symptoms

There are no symptoms that indicate a pregnant woman has a fetus with spina bifida.

The appearance and symptoms of a child who is born with spina bifida depend on how severe the condition is.

• If the spina bifida is mild (spina bifida occulta), there may be no physical indication of the condition. In some cases a birthmark, dimple, or hairy patch may form over the defect (occult spinal dysraphism, or OSD). There are rarely any other signs.
• In severe cases (spina bifida manifesta), there usually is a fluid-filled swelling on the baby's spine. In the most severe cases (myelomeningocele), tissues and nerves from the spinal cord are exposed on the child's back.

Children with spina bifida manifesta often have parts of the brain and upper spinal cord that are not formed normally. It is also common for these children to have fluid on the brain (hydrocephalus). Related problems can cause:³

• Difficulty swallowing, which can lead to choking.
• Hoarseness.
• Breath-holding and problems breathing during sleep.
• Below-average intelligence.
• Seizure disorders, which occurs in 15% of children with severe spina bifida.
• Strabismus (sometimes called crossed-eyes, walleye, or squint), a vision problem in which the eyes do not both look in the same direction at the same time. Strabismus occurs in 20% of children with severe spina bifida.

If hydrocephalus is not treated, it can cause severe retardation or death.

The severe form of spina bifida manifesta (myelomeningocele) almost always affects the function of the limbs and organs in the lower part of the body. The child's ability to walk depends on what part of the spine is affected and how severe the spina bifida is. The lower (lumbar) spine is affected in most cases. The higher on the spine the defect occurs, the more severe and widespread are the problems. See a picture of the spine.

• If the defect is in the lower spine, the child usually is able to walk but may require ankle-foot braces and surgery to correct foot deformities.
• If the defect is in the middle of the spine, the child will need leg braces or crutches to walk and will need a variety of corrective surgeries. A wheelchair may be needed when long periods of mobility are required (for example, when shopping). Some people may use a wheelchair at all times.
• In rare cases when the defect is higher in the spine, it can affect function in the arms and upper body.

Spinal cord damage caused by severe spina bifida may cause problems such as:

• Inability to control urine or bowel movements (incontinence).
• Constipation.
• Little or no feeling in the legs and feet.
• Inability to move or feel (paralysis) the legs and, less often, the arms.

Severe spina bifida often results in curvature of the spine—scoliosis, kyphosis (hunchback), or both.

Many children who have spina bifida develop an allergy to latex, a natural rubber product that is used to make objects such as toys and health care supplies. Medical experts do not know why children with spina bifida develop this allergy so frequently. Take extra precautions to avoid having your child with spina bifida exposed to products with latex.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: May 10, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Colin Chalk, MD, CM, FRCPC - Neurology
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