In an older child with a ventriculoperitoneal shunt, which sign would most strongly suggest shunt malfunction?

In an older child with a ventriculoperitoneal shunt, which sign would most strongly suggest shunt malfunction?

• A. Temperature greater than 100.8 degrees Fahrenheit.
• B. Headache upon awakening.
• C. Noticeable increase in activity.
• D. Bulging fontanels.

Answer: (A)

Fever in a child with a ventriculoperitoneal shunt is a red flag for shunt infection, a serious complication that can accompany or cause shunt malfunction. When infection affects the shunt system, CSF flow can be impeded and intracranial pressure can rise, so fever strongly points to a problem with the shunt that requires urgent evaluation and treatment. While headache on awakening can reflect increased intracranial pressure from shunt failure, it’s less specific, and an older child with a shunt wouldn’t typically present with a noticeably bulging fontanelle (that finding is more common in infants with open skull sutures). An increase in activity would be unusual for shunt malfunction and doesn’t align with the expected decreased activity or lethargy seen with rising intracranial pressure.

Fever in a child with a ventriculoperitoneal shunt is a red flag for shunt infection, a serious complication that can accompany or cause shunt malfunction. When infection affects the shunt system, CSF flow can be impeded and intracranial pressure can rise, so fever strongly points to a problem with the shunt that requires urgent evaluation and treatment. While headache on awakening can reflect increased intracranial pressure from shunt failure, it’s less specific, and an older child with a shunt wouldn’t typically present with a noticeably bulging fontanelle (that finding is more common in infants with open skull sutures). An increase in activity would be unusual for shunt malfunction and doesn’t align with the expected decreased activity or lethargy seen with rising intracranial pressure.