As a neurosurgeon, one of the conditions I often see in children is hydrocephalus — a word that can sound intimidating to any parent hearing it for the first time. But understanding what it is, how it happens, and how we treat it can help you feel more prepared to care for your child if this diagnosis ever comes your way.

In simple terms, hydrocephalus means an excess accumulation of fluid in the brain. Everyone has some fluid in their brain — this is called cerebrospinal fluid (CSF), and it plays an important role in cushioning the brain and removing waste. As I often explain to parents, “The brain is suspended in this fluid called CSF. It’s a normal system that circulates continuously every day.”

Problems arise when this fluid builds up faster than it can be absorbed. This can happen for different reasons. In children, the most common cause is congenital hydrocephalus, where a baby is born with a blockage that prevents the fluid from draining properly. Sometimes, hydrocephalus can also develop later due to infections like meningitis, bleeding in the brain, or even tumors that block the flow of CSF.

Hydrocephalus can look very different depending on your child’s age. In babies and toddlers, one of the first signs parents may notice is a rapidly growing head. Because a baby’s skull bones haven’t fused yet, the head expands to accommodate the extra fluid. Other signs can include a bulging soft spot (fontanelle), poor feeding, drowsiness, vomiting, and delays in milestones like head control or sitting up.

Older children may present differently. They might complain of persistent headaches, blurred vision, imbalance while walking, or changes in behavior or school performance. As I often tell parents, “In the past, we would see children coming in with very large heads because diagnosis was late. Today, with regular check-ups and head circumference monitoring, we can catch hydrocephalus much earlier.”

When it comes to treatment, I want parents to know that hydrocephalus is treatable. The main goal is to divert the excess fluid and relieve the pressure on the brain. We usually have two main options: a ventriculo-peritoneal (VP) shunt, which redirects the fluid from the brain to the abdomen where it’s absorbed, or an endoscopic third ventriculostomy (ETV), which creates a new pathway for the fluid to flow within the brain itself.

Choosing the right procedure depends on the child’s age and the type of hydrocephalus. For younger babies, I often prefer a VP shunt because, as I say in my practice, “In babies under two years, the Basal cisterns  are not fully developed, so a shunt gives us better results.” For older children with certain blockages, an ETV may be a good option.

After treatment, most children improve significantly. They begin to reach their developmental milestones and lead healthy, fulfilling lives. Regular follow-up is important to ensure the shunt or ETV continues to work well.

As a parent, the most important thing you can do is watch for signs, attend your pediatric visits, and seek help early. If you ever have concerns about your child’s head growth or development, please don’t hesitate to reach out. With timely treatment, hydrocephalus in children is a challenge we can manage — together.