Nursing care
Spina Bifida nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Spina bifida nursing care starts with protecting the exposed sac: cover it with sterile saline-soaked gauze, never dry gauze, and keep the infant prone to avoid pressure on the defect. Assess head circumference for developing hydrocephalus and monitor for latex allergy, which affects most children with spina bifida for life due to repeated early exposure to latex products.
What it is and why it happens
Spina bifida is a neural tube defect where the vertebral arches fail to close completely around the spinal cord during the first month of gestation, before many people know they are pregnant. It ranges from spina bifida occulta, a hidden defect with intact skin and no neurological involvement, through meningocele, where only the meningeal sac protrudes, to myelomeningocele, the most severe form, where spinal cord and nerve roots lie exposed within the sac.
Folic acid deficiency before and during early pregnancy is the best-established modifiable risk factor, which is why folic acid supplementation and food fortification are standard public health measures. Maternal serum alpha-fetoprotein screening and fetal ultrasound usually detect myelomeningocele prenatally, so many families arrive at delivery already aware of the diagnosis and its likely level of involvement.
How it presents — what you will actually see
Myelomeningocele appears as a visible sac on the infant's back, most often lumbar or lumbosacral, sometimes leaking cerebrospinal fluid. Neurological deficit below the level of the lesion is the rule: a lesion at L5, for example, typically leaves some hip and knee function intact but affects ankle and foot movement and continence.
Look for the classic triad below the defect: flaccid paralysis or weakness, sensory loss, and bowel and bladder dysfunction, which shows as constant dribbling or an flat, patulous anus rather than normal voiding patterns. Clubfoot, hip dysplasia, and other lower-limb deformities are common associated findings because of abnormal muscle pull in utero. Watch the head as well as the back: hydrocephalus develops in the majority of infants with myelomeningocele, often linked to Arnold-Chiari II malformation, and can appear at birth or emerge over the following days to weeks.
Nursing assessment priorities
Assess the sac itself first: size, whether it is intact or leaking, and any signs of infection such as redness, warmth, or purulent drainage, since an infected sac risks meningitis with direct access to the CNS. Measure head circumference on admission and at every shift, because a rising trend, a bulging or tense fontanelle, or a widening suture line signal hydrocephalus before other symptoms appear.
Assess neurological function below the lesion level: spontaneous leg movement, response to stimuli, anal sphincter tone, and bladder status, ideally documented before surgical closure so any postoperative change can be identified. Measure legs for symmetry and check hips for dysplasia. Ask directly about any prior exposure to latex products, gloves, catheters, balloons, because sensitisation can begin from the very first procedures these infants undergo.
Interventions and what to do first
The sac is covered with sterile saline gauze and the infant is nursed prone. Cover the defect immediately with saline-soaked sterile gauze, never dry dressings, which would adhere to and damage exposed neural tissue on removal, and change it per protocol to keep it moist without pooling fluid. Position the infant prone or side-lying, never supine, to keep pressure off the sac and prevent rupture; a doughnut-shaped support or foam pad around the defect protects it further during handling.
Handle the infant with the sac supported and avoid placing a nappy that presses against it; keep the perineal area clean since stool contamination is a direct infection risk to an open defect. Monitor temperature closely, as these infants are prone to both hypothermia and infection. Institute latex precautions from the first contact: latex-free gloves, catheters, tape, and equipment for every interaction, not only after surgical repair, since sensitisation begins with early and repeated exposure.
Complications to watch for
Meningitis and ventriculitis are the acute infective risks before and shortly after surgical closure, usually within the first 24 to 72 hours of life. Watch for fever, irritability, lethargy, poor feeding, and a bulging fontanelle. Hydrocephalus is near-universal in myelomeningocele and usually needs a ventriculoperitoneal shunt; monitor for signs of shunt malfunction later in life, including headache, vomiting, altered level of consciousness, and setting-sun eyes in infants.
Neurogenic bladder and bowel are lifelong issues, raising the risk of urinary tract infection and, over years, renal damage from reflux if not managed with intermittent catheterisation. Latex allergy deserves its own vigilance: repeated bladder catheterisation and multiple surgeries expose these children to latex from birth, and a reaction can range from contact dermatitis to anaphylaxis. Every care setting these children pass through, school, dental, other hospitals, needs to know this allergy exists.
Patient teaching before discharge
Teach parents wound and shunt-site care, and make sure they can describe the signs of shunt malfunction and CNS infection in plain language before they leave: fever, vomiting, irritability, a change in feeding, or a bulging fontanelle should prompt an immediate call, not a wait-and-see approach. Demonstrate clean intermittent catheterisation if the infant needs it, and have the caregiver return the demonstration before discharge, since this becomes a daily skill for years.
Teach latex avoidance as a lifelong habit, not a hospital-only precaution: latex-free gloves and equipment at every future medical, dental, and school encounter, and a medical alert bracelet is reasonable to discuss. Cover skin care over insensate areas, since these children cannot feel injury below the lesion and are prone to unnoticed pressure sores and burns. Connect families with physical therapy, urology, neurosurgery, and orthopaedic follow-up early, since spina bifida is managed by a team across childhood, not resolved at the initial surgery.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our pediatrics practice questions are the closest set to what this page covers.
Common questions
Why must the spina bifida sac be kept moist rather than covered with a dry dressing?
The sac often contains exposed neural tissue that has no skin covering, and a dry dressing adheres to that tissue and causes tearing and further neurological damage on removal. Sterile saline-soaked gauze keeps the tissue moist and protected until surgical closure, usually within 24 to 72 hours of birth.
Why are infants with spina bifida nursed prone?
Prone or side-lying positioning keeps pressure and friction off the exposed sac, reducing the risk of rupture, leakage, and infection before surgical repair. Supine positioning is avoided for this reason until the defect is closed.
Why does spina bifida cause a latex allergy?
Children with spina bifida undergo frequent early procedures, catheterisation, surgery, and repeated hospital contact, that expose mucous membranes to latex products from infancy, and this repeated exposure sensitises a majority of them over time. Because the risk is so consistent, latex-free precautions are used from birth rather than waiting for a reaction to occur.
How is hydrocephalus linked to spina bifida?
Most infants with myelomeningocele have an associated Arnold-Chiari II malformation, which obstructs cerebrospinal fluid flow and leads to hydrocephalus, often requiring a ventriculoperitoneal shunt. Head circumference is tracked closely because hydrocephalus can develop before or after the back defect is surgically closed.
What bladder problems should nurses expect long term in spina bifida?
Neurogenic bladder is near-universal below a functionally significant lesion, causing incomplete emptying, incontinence, and a raised risk of urinary tract infection and reflux-related kidney damage. Clean intermittent catheterisation, taught to caregivers and later to the child, is the standard long-term management.