1.When should we suspect congenital spina bifida in children? After the birth of a child, some parents will conduct a full body examination of the infant with anxiety, lest they find some abnormalities, especially spina bifida deformity, which is the most common in infants and young children. So, what are the conditions to suspect that your child may have a spina bifida deformity? First, there are skin abnormalities. The most common is asymmetry of the intergluteal cleft. In normal people, there is a “Y” shaped cleft between the buttocks and the torso, called the gluteal cleft. If the two upper branches of the “Y” are found to be asymmetrical, especially if they are accompanied by inconsistencies in the height of the two buttocks, this should be brought to the attention of the parents. It is also common to find purple-red flakes of capillary hemangiomas in the middle of the child’s lower back that rise above the skin surface, which is also a sign of spina bifida. In some children, subcutaneous lipomas can be found in the middle of the lower back near the upper buttocks, because the presence of lipomas does not allow the normal lumbar curvature to be visualized or the normal dorsal segmental spines of the spine to be palpated. There are clumps of hairs in the middle of the back, pits under the hairs, or hyperpigmentation, small holes can be found on the skin, with normal skin growing into its periphery, sometimes white secretion is discharged from the holes, or frequent inflammation, pustules, or even skin defects. All of these conditions may be accompanied by congenital occult spina bifida. Once these abnormalities are found, parents should pay attention to them and seek medical treatment in time and prepare for some necessary examinations. 2.Can ultrasound and MRI confirm the diagnosis of spina bifida? This is one of the most important questions for parents. First of all, let’s talk about the role of ultrasound in the diagnosis of spina bifida. Ultrasound is a valuable diagnostic tool for infants younger than 6 months of age because lipomas, cerebrospinal fluid, and the spinal cord have different echogenic properties, and because immature bones are not sufficiently calcified in infancy, ultrasound can easily pass through the spine to explore the interior of the vertebral canal and can reveal spinal cord embolism. Although ultrasound is safe, simple and relatively inexpensive, it cannot provide all the information. MRI (Magnetic Resonance Imaging) can confirm the diagnosis of spina bifida in the vast majority of cases and is the most valuable means of diagnosing spina bifida. 3.What parts of the body should be examined by MRI? Generally speaking, MRI examination should preferably include the whole brain and spinal cord because congenital spina bifida can also be accompanied by craniocerebral and cervico-occipital malformations, and even hydrocephalus, spinal cord cavernous disease, and subcerebellar tonsillar hernia, etc. Therefore, the MRI examination has to be comprehensive and detailed in order to ensure that valuable information will not be missed. 4. Besides ultrasound and MRI, what other tests are needed? Plain radiographs of the spine can detect abnormal development of the tailbone, abnormal segmentation, bone structure deformities, missing vertebral plates, hemivertebrae and longitudinal fractures of the spinal cord and bone spurs in the spinal canal.CT and CT three-dimensional reconstruction are mainly used to understand the defects of bone structure. Urodynamics tests the urinary function of the bladder to understand the nerve damage, and posterior tibial, fibular and pubic somatosensory evoked potentials can make an accurate judgment of the nerve damage accompanying spina bifida. 5. What are the effects of the various tests on the child’s body and development? Parents are very concerned about the impact of each test on their child. This can be summarized as follows: ultrasound and MRI have no effect on the child; CT and X-ray have been clearly concluded to have an effect on younger children, but should be accepted if necessary. 6.What prenatal means can detect fetal spina bifida? This is the most important question for every pregnant woman. Well, as of now there are three main prenatal means to screen for spina bifida in the fetus. One is ultrasound, which is the main means of prenatal diagnosis. High-resolution fetal ultrasound has a sensitivity of nearly 100% for prenatal screening for cerebrospinal bulging, and can also detect spinal cord defects, as well as accompanying spina bifida, hydrocephalus, and so on. Second, maternal plasma alpha-fetoprotein testing can detect open spina bifida. Third, MRI of the fetus is now available in some medical units, and where available, MRI of the mother and child can be performed directly without ultrasound, leading to early diagnosis of spina bifida. Nevertheless, there are still some hidden spina bifida that are difficult to be detected. 7. What if the child is too young to cooperate with the examination? The use of chloral hydrate, a sedative commonly used in children, either by enema or orally, is safe, effective and reliable.