Pediatric Neuro Overview
A major danger sign in several of these problems is rising intracranial pressure; another priority is protecting the airway during a seizure.
A child's brain and spinal cord grow rapidly, and many neurologic problems are congenital (present at birth). Two ideas tie the topic together: recognizing increased intracranial pressure (ICP) early, and protecting the airway during and after a seizure. Because the signs of rising pressure look different in a baby than in an older child, you have to know both.
Across hydrocephalus, head injury, and meningitis, the shared danger is rising pressure inside the skull. Learn the age-specific signs cold: an infant shows a bulging fontanel and a high-pitched cry; an older child shows a morning headache, vomiting, and a falling level of consciousness. (Febrile seizures and meningitis are covered in the Pediatric Emergencies guide.)
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Increased ICP & Hydrocephalus
Too much pressure — or too much fluid — inside the skull.
The skull is a closed box, so anything extra — swelling, bleeding, or extra cerebrospinal fluid (CSF) — raises the pressure inside and squeezes the brain. Hydrocephalus is a buildup of CSF that enlarges the ventricles and raises ICP; it is often treated with a ventriculoperitoneal (VP) shunt that drains CSF from the brain into the abdomen.
Signs of Increased ICP by Age
- Infant: bulging or tense fontanel, increasing head circumference, separated sutures, high-pitched cry, irritability, poor feeding, "setting-sun" eyes
- Older child: headache worse in the morning, vomiting, double vision, irritability, and a decreasing level of consciousness
Early signs are subtle (irritability, bulging fontanel, morning headache, vomiting). The late, ominous signs are Cushing's triad: a rising blood pressure with a widening pulse pressure, bradycardia (slow heart rate), and irregular respirations. These mean the brain is being compressed — report them immediately.
Immediately after placement, follow the surgeon's positioning orders — commonly the child is kept flat and positioned off the operative side to prevent overly rapid CSF drainage. Watch for shunt infection (fever plus ICP signs) and malfunction (the ICP signs come back). Measure head circumference in infants, and remember a growing child will need shunt revisions over time.
Spina Bifida & Neural Tube Defects
The spine doesn't close all the way before birth.
Neural tube defects happen when the spine fails to close during early pregnancy. They range from mild to severe:
- Spina bifida occulta — the mildest; often just a dimple or tuft of hair over the spine, usually no symptoms.
- Meningocele — a sac pushes out containing the meninges and CSF (no nerves), so there is usually little or no nerve damage.
- Myelomeningocele — the most severe; the sac contains the meninges and the spinal cord, causing motor and sensory loss below the defect and a neurogenic bladder and bowel. Often occurs with hydrocephalus.
Keep the newborn prone (on the abdomen) and cover the exposed sac with a sterile, nonadherent dressing moistened with normal saline so it never dries out. Apply no pressure, do not place a diaper over it, and prevent infection and injury until the defect is surgically closed.
Taking folic acid before and during pregnancy prevents most neural tube defects. These children have a high rate of latex allergy from repeated surgeries and catheterizations, so their care is kept latex-free and families avoid latex products like balloons.
Seizure Disorders & Epilepsy
What to do in the moment matters more than the type.
Seizures come from abnormal electrical activity in the brain. They may be generalized (tonic-clonic, with stiffening and jerking, or brief "absence" staring spells) or focal (starting in one area). Whatever the type, the nurse's priorities during a seizure are the same: keep the child safe and protect the airway.
Ease the child to the floor and turn them on their side, protect the head, and loosen tight clothing. Never restrain the child or put anything in the mouth. Time the seizure and note what it looks like. A seizure lasting more than 5 minutes, or repeated seizures without recovery between them, is status epilepticus — an emergency treated rapidly with a benzodiazepine by the available ordered route (IV, intranasal, buccal, rectal, or IM).
Give antiseizure medication on time and never stop it abruptly — stopping suddenly can trigger status epilepticus. Teach good oral hygiene with phenytoin, which can cause gum overgrowth (gingival hyperplasia), and keep follow-up visits to monitor drug levels.
Cerebral Palsy
A movement disorder from an early, fixed brain injury.
Cerebral palsy (CP) is a disorder of movement and posture caused by an injury to the developing brain before, during, or shortly after birth. The spastic type (stiff, tight muscles) is the most common.
Signs
- Delayed milestones and abnormal muscle tone (often spasticity)
- Persistent primitive reflexes and stiff, "scissoring" legs
- Feeding difficulty and risk of aspiration
The brain injury itself does not get worse — but without care, the child's function can decline from complications like contractures and aspiration. Care is multidisciplinary (physical, occupational, and speech therapy), with antispasmodics such as baclofen, aspiration precautions, and good nutrition. The goal is to maximize ability, not cure.
Reye's Syndrome
The reason aspirin is avoided in children with a viral illness.
Reye's syndrome is a rare but serious illness that causes sudden swelling of the brain (encephalopathy) and fatty damage to the liver. It is strongly linked to giving aspirin during a viral illness such as influenza or chickenpox (varicella).
Signs
- Persistent vomiting after a viral illness
- Lethargy progressing to confusion, combativeness, seizures, and coma
- Signs of liver dysfunction
Because of the Reye's syndrome link, do not give aspirin (ASA / salicylate) to children or teens for fever or a viral illness unless it is specifically prescribed (for example, in Kawasaki disease). Use acetaminophen instead. For chickenpox, use acetaminophen for fever and avoid ibuprofen unless a provider directs otherwise. Teach families to read over-the-counter labels, since aspirin hides in some combination cold and stomach products. Care is supportive, with close monitoring of neuro status and ICP.
Nursing Care & Safety
The shared priorities across pediatric neuro problems.
- Neuro checks — level of consciousness, pupils, the age-specific ICP signs, and head circumference in infants.
- Seizure precautions — padded side rails, suction and oxygen at the bedside, and side-lying positioning.
- Positioning — elevate the head of bed for increased ICP; flat and on the unoperated side after a VP shunt; prone with a moist sterile dressing for an unrepaired myelomeningocele.
- Aspiration & injury safety — especially in cerebral palsy and after seizures.
- Family teaching — folic acid in pregnancy, a latex-free home for spina bifida, never giving aspirin, medication timing, and developmental support.
Match the hallmark to the disorder: bulging fontanel + high-pitched cry = increased ICP in an infant; sac on the back + prone, moist, latex-free care = myelomeningocele; side-lying + nothing in the mouth = seizure care; non-progressive movement disorder = cerebral palsy; aspirin + recent virus = Reye's syndrome.
? A nurse enters a room and finds a child actively seizing. The child is in bed and unknown objects are on the mattress. What is the first action?
Frequently Asked Questions
Common student questions on this topic.
What are the signs of increased intracranial pressure (ICP) in children?
How is the sac protected in myelomeningocele before surgery?
Why are children with spina bifida at high risk for latex allergy?
What should the nurse do during a child's seizure?
Why should aspirin be avoided in children?
What is cerebral palsy, and does it get worse over time?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Pediatric Neurological Disorders Cheatsheet
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