pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Spinal Taps in Children

[Mother confused about headaches and wonders if her fussy daughter is having headaches from her spinal tap as an infant.]

Hello, My name is Je’Nai C. and I have a 6 1/2 month old daughter. Recently my sister Jalon was very ill and they performed a spinal tap. Soon after she started experiencing migraine headaches. She went to see a neurologist and he said that the migraines were a result of the spinal tap she received. The doctor said she could go to an Anesthesiologist and receive a epidural blood patch which will then probably, but not guaranteed, make her migraines go away.
 
My daughter was born in November she developed a fever 2 days after birth. We took her to the E.R and they performed numerous tests. One of those tests performed was a spinal tap. They had to perform the spinal tap twice because she was being used as a “guinea Pig” for the INTERN to practice on! She has been a very fussy baby from day 1!! Everyone told me she had colic but she did not have the “usual” colic symptoms.
 
Is it possible that she is experiencing severe headaches and is there anything I can do for her?

In order to respond I’ll need to know a few more details.

1) What were the baby’s symptoms at 2 days that prompted the ER visit; and, what was the temperature and how was it taken?
2) What, specifically, were the “usual” symptoms of colic that you mentioned that your baby hasn’t had, making you feel that there is something else wrong?

Also, a “migraine” headache is different than a “spinal leak” headache and doesn’t respond to a blood patch. What you describe in your sister seems to be a “spinal leak” headache which is not common but a known side effect of spinal taps especially in adults. When it occurs, most of the time it heals itself over time – but unfortunately, there is the somewhat unusual case that needs a blood patch – which is usually performed by an anesthesiologist or pain specialist.

1.) My daughter had an 102 degree fever, wasn’t eating, wasn’t sleeping and crying 20 out of the 24hours. The temperature was taken rectally.
 
2.) The unusual symptoms was that she would cry for about 30min-2 hours and it was very sporadic. It didn’t happen at a constant time of day. She would be calm one minute then hysterical the next.
 
3.) I described my sisters headaches as migraines because of the way they felt to her, I didn’t mean that they were actual migraines, sorry for not being more specific.

3) I thought that’s what you must be doing – no problem. A blood patch is not the first thing to try with a spinal headache but it is one that works in many cases which are unresponsive to first line conservative measures.

1) As you may have read in my article – true fever (102 rectally is a true fever) in a 2 week old MUST be presumed “sepsis” (bacteria in the blood stream) until ruled out. Unfortunately the neonates physical response is nearly always very general and nonspecific. You didn’t say, but I’m assuming that Sepsis was “ruled out” by all the tests and the fever was either due to a viral illness or environmental factors (such as overdressing or heat in room.) In viral illnesses of Neonates, the mother is usually also ill with the virus, or becomes so. In “Presumed” Sepsis cultures MUST be taken of all bodily fluids BEFORE antibiotics are started – and they must be given until the cultures are finalized to be negative.

Spinal taps, although mandatory, are usually not that difficult for a trained pediatric specialist. The baby is usually not that difficult to restrain and the joint spaces are open. Retrieving actual spinal fluid is another matter. It is not uncommon to have a “dry tap” because the spinal sac may not be full of fluid or it may not be extended the usual distance BELOW the actual spinal chord (nerve tissue).

We always start at the lowest point that we think will “miss” the nerve tissue when we insert the needle. Unfortunately, the need to obtain a spinal culture is so great when we’re dealing with an infant that when the first tap is “dry” a second tap is usually performed. In a teaching situation that second tap is usually performed by an attending or senior resident even though it probably wasn’t the first doctor’s fault.

3) Fussiness and irritability in an infant (a baby over 2 months) is also very non specific and truly can range everywhere from true illness, to gas, to food, to environmental conditions and parenting techniques. Although we would never be able to tell for sure, unless we could read infants thoughts or they could speak, a spinal pressure headache would probably be very unlikely due to the flexibility and unusual healing ability of infants tissues and the “open ness” of their soft spot and bone joints in the head. A spinal headache in adults is usually slow in onset and fairly constant – not the “spasmodic” nature one would describe to “colic.”

Crying and fussiness from colic can occur randomly, usually lasts under 1 hour, frequently develops a “pattern” that the parents can spot. Fussiness from gas, food, environmental and other issues usually show’s itself over time and can be corrected. Fussiness from colic always goes away within 2 -3 months; fussiness from temperament – usually does not.

Hope this helps, that you can find and establish a good relationship with a knowledgeable pediatrician, and that the problem can be resolved.

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