Signs of a Tethered Spinal Cord in Babies
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published AAP, NIH, Mayo Clinic guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect signs of a tethered spinal cord in babies, here is what the evidence says.
The short answer
A tethered spinal cord occurs when the spinal cord is abnormally attached to the surrounding tissue, restricting its movement as the child grows. Signs include skin markers on the lower back (deep dimple, tuft of hair, skin tag, or hemangioma above the buttock crease), changes in bladder or bowel function, lower extremity weakness or asymmetry, and foot deformities. Diagnosis is made by MRI. Surgical untethering prevents progressive neurological damage.
Key takeaways
- A tethered spinal cord occurs when the spinal cord is abnormally attached to the surrounding tissue, restricting its movement as the child grows. Signs include skin markers on the lower back (deep dimple, tuft of hair, skin tag, or hemangioma above the buttock crease), changes in bladder or bowel function, lower extremity weakness or asymmetry, and foot deformities. Diagnosis is made by MRI. Surgical untethering prevents progressive neurological damage.
- Usually normal when: A simple shallow sacral dimple within the gluteal crease (very common and usually normal)
- Call your doctor if: Sudden loss of leg function, new bladder or bowel incontinence, or rapidly progressive weakness
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to AAP, NIH, Mayo Clinic guidelines, a tethered spinal cord occurs when the spinal cord is abnormally attached to the surrounding tissue, restricting its movement as the child grows. Signs include skin markers on the lower back (deep dimple, tuft of hair, skin tag, or hemangioma above the buttock crease), changes in bladder or bowel function, lower extremity weakness or asymmetry, and foot deformities. Diagnosis is made by MRI. Surgical untethering prevents progressive neurological damage. At 0-3 months, tethered cord may be suspected based on skin findings on the lower back. A simple sacral dimple within the gluteal crease is very common and usually normal. Dimples that are above the crease, deep, or associated with other skin findings (hairy patch, hemangioma, skin tag) may warrant ultrasound or MRI. Your pediatrician examines the lower back at every visit. It is generally considered normal when a simple shallow sacral dimple within the gluteal crease (very common and usually normal). However, you should contact your pediatrician promptly if sudden loss of leg function, new bladder or bowel incontinence, or rapidly progressive weakness.
Normal vs. Concerning
By Age
What to expect by age
0-3 months
Tethered cord may be suspected based on skin findings on the lower back. A simple sacral dimple within the gluteal crease is very common and usually normal. Dimples that are above the crease, deep, or associated with other skin findings (hairy patch, hemangioma, skin tag) may warrant ultrasound or MRI. Your pediatrician examines the lower back at every visit.
3-6 months
Spinal ultrasound can screen for tethered cord in young babies (before 3-4 months, the bones are not fully formed and allow ultrasound visualization). After 4-6 months, MRI is needed for definitive evaluation. If tethered cord is confirmed, your neurosurgeon will discuss timing of surgical release.
6-12 months
If diagnosed, surgery is typically recommended before motor milestones like walking begin to prevent neurological damage. The surgery (tethered cord release) is performed by a pediatric neurosurgeon. Recovery time is usually 1-2 weeks. Most babies have excellent outcomes when treated before symptoms develop.
12-24 months
Tethered cord may present with walking abnormalities, gait changes, or changes in bladder function as the child grows and the cord becomes more stretched. Toddlers may develop foot deformities or leg weakness. Prompt evaluation and surgery prevent further neurological damage.
2-3 years
Children with previously repaired tethered cord need ongoing monitoring as retethering can occur during growth. Symptoms of retethering include new or worsening lower extremity weakness, pain, or bladder dysfunction. Regular follow-up with neurosurgery is important.
What to Tell Your Pediatrician
- Describe when you first noticed signs of a tethered spinal cord in babies and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if you notice a deep dimple, tuft of hair, skin tag, or unusual marking on your baby's lower back.
- Mention if your baby has asymmetric leg movement or one foot that seems different from the other.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- A simple shallow sacral dimple within the gluteal crease (very common and usually normal)
- Your baby's lower back examination is normal with no concerning skin findings
- Normal bladder and bowel function and symmetric leg movement
- You notice a deep dimple, tuft of hair, skin tag, or unusual marking on your baby's lower back
- Your baby has asymmetric leg movement or one foot that seems different from the other
- Urinary incontinence that persists beyond expected toilet training age
- Sudden loss of leg function, new bladder or bowel incontinence, or rapidly progressive weakness
- Progressive neurological symptoms in a child with known tethered cord
What You Can Do at Home
- Keep track of when you notice signs of a tethered spinal cord in babies — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that a simple shallow sacral dimple within the gluteal crease (very common and usually normal) — this is generally within the range of normal.
- At 0-3 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
- While monitoring at home, seek immediate care if sudden loss of leg function, new bladder or bowel incontinence, or rapidly progressive weakness.
Related Conditions
Signs of Hydrocephalus in Babies
Hydrocephalus occurs when cerebrospinal fluid accumulates in the brain ventricles, causing increased pressure. In babies, the most noticeable sign is rapidly increasing head circumference (head growing faster than expected). Other signs include a bulging or tense fontanelle, prominent scalp veins, downward gaze of the eyes ("sunsetting"), irritability, vomiting, and developmental delays. Treatment typically involves surgical placement of a shunt or endoscopic third ventriculostomy to drain excess fluid.
When Should My Baby See a Pediatric Neurologist?
A pediatric neurologist specializes in disorders of the brain, spinal cord, nerves, and muscles in children. Referral is appropriate for seizures, abnormal head size or growth, significant hypotonia or hypertonia, developmental regression, movement disorders, headaches, suspected neuromuscular conditions, and abnormal neurological examination findings. These specialists perform detailed neurological evaluations and may order EEGs, MRIs, and other specialized testing.
Related Resources
Frequently asked questions
Is signs of a tethered spinal cord in babies normal?
When should I call the doctor about signs of a tethered spinal cord in babies?
When is signs of a tethered spinal cord in babies normal?
What causes signs of a tethered spinal cord in babies?
What should I mention to my pediatrician about signs of a tethered spinal cord in babies?
Is signs of a tethered spinal cord in babies normal at 0-3 months?
Is signs of a tethered spinal cord in babies normal at 3-6 months?
Should I go to the ER for signs of a tethered spinal cord in babies?
Does signs of a tethered spinal cord in babies go away on its own?
References
- [1]American Academy of Pediatrics. Sacral Dimples. HealthyChildren.org. AAP
- [2]National Institute of Neurological Disorders and Stroke. Tethered Spinal Cord Syndrome. NIH
- [3]Mayo Clinic. Tethered spinal cord. Mayo Clinic
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Signs of a Tethered Spinal Cord in Babies.
Things to mention
- Describe when you first noticed signs of a tethered spinal cord in babies and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if you notice a deep dimple, tuft of hair, skin tag, or unusual marking on your baby's lower back.
- Mention if your baby has asymmetric leg movement or one foot that seems different from the other.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- You notice a deep dimple, tuft of hair, skin tag, or unusual marking on your baby's lower back
- Your baby has asymmetric leg movement or one foot that seems different from the other
- Urinary incontinence that persists beyond expected toilet training age
Urgent signs to report immediately
- Sudden loss of leg function, new bladder or bowel incontinence, or rapidly progressive weakness
- Progressive neurological symptoms in a child with known tethered cord
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of signs of a tethered spinal cord in babies are normal. Talk to your pediatrician if sudden loss of leg function, new bladder or bowel incontinence, or rapidly progressive weakness.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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Related Medical Concerns
Signs of Hydrocephalus in Babies
Hydrocephalus occurs when cerebrospinal fluid accumulates in the brain ventricles, causing increased pressure. In babies, the most noticeable sign is rapidly increasing head circumference (head growing faster than expected). Other signs include a bulging or tense fontanelle, prominent scalp veins, downward gaze of the eyes ("sunsetting"), irritability, vomiting, and developmental delays. Treatment typically involves surgical placement of a shunt or endoscopic third ventriculostomy to drain excess fluid.
When Should My Baby See a Pediatric Neurologist?
A pediatric neurologist specializes in disorders of the brain, spinal cord, nerves, and muscles in children. Referral is appropriate for seizures, abnormal head size or growth, significant hypotonia or hypertonia, developmental regression, movement disorders, headaches, suspected neuromuscular conditions, and abnormal neurological examination findings. These specialists perform detailed neurological evaluations and may order EEGs, MRIs, and other specialized testing.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.
Adrenoleukodystrophy (ALD) in Babies
X-linked adrenoleukodystrophy (X-ALD) is a genetic disorder affecting about 1 in 17,000 newborns, caused by mutations in the ABCD1 gene on the X chromosome. It primarily affects boys and impairs the breakdown of very long-chain fatty acids (VLCFAs), which accumulate and damage the myelin sheath in the brain and the adrenal glands. The most severe form, cerebral ALD, typically affects boys between ages 4-10 with rapid neurological decline. Newborn screening now enables early detection, and hematopoietic stem cell transplant or gene therapy performed before significant brain involvement can be life-saving.