what can I do?
You don’t need to do anything to the pits, dimples, or tufts other than getting the pediatrician’s attention. The area should be kept clean and bathed regularly. Normal pits, pits or tuffs do not require special care.

When does my doctor need to be involved?
If you can see the bottom of the pit when you gently pull the surrounding skin aside, the pit is shallow and you don’t need to worry about it. If you can’t see the bottom of the dimple, or if only a clump of hair comes from the dimple — not the small clumps of hair that are usually distributed in the lower back area — then your doctor needs to be involved. You also need to contact your doctor if the area has a thick tuft of hair growing from a relatively small piece of skin, or if the irregularity is in the form of a skin tag, skin swelling, or unusual markings.

If a pit or dimple looks red, inflamed, swollen, or tender, it may be infected. The clear or yellowish fluid draining from the pit may be the fluid that normally surrounds the brain and spinal cord. The white fluid may be pus, indicating an infection. If your baby has any of these problems, your doctor should see him.

Most dimples, dimples, and tufts are at the base of the spine, just above (or even tucked in) the hip crease. When a dimple is visible higher up the back, a doctor should be involved. Your doctor should also evaluate whether the pit is off to one side (not in the midline) or the general area for other skin abnormalities.

Finally, let your doctor know if your child has any other obvious defects, especially those in the midline of the body. The midline of the body is the imaginary line connecting the navel and nose, going up and over the head to the middle of the back of the neck, and down to the crease of the buttocks. This “line” will separate the left and right.

The structures on both sides should be fairly symmetrical, and the structures along the lines should be intact.some examples of midline defect Including cleft palate and hypospadias.

What tests need to be done and what do the results mean?
Most sacral depressions, pits, or clusters are normal, so testing is usually not needed. If testing is done, then ultrasound is usually the first choice. The ultrasound is placed on the baby’s lower back so the doctor can see if the spinal canal and the skin are connected in any way. An MRI may be done if the ultrasound is too difficult to interpret, or if the baby is older than 6 to 12 months.

An ultrasound or MRI can help show if there is a direct connection between the skin in the lower back and the spine below. MRI can also illustrate the structure of the spinal cord. A normal result shows no connection between the spine and any surrounding structures.

What treatments are available?
Children who have a connection between a sacral pit, depression, or cluster and the underlying spinal cord need surgery. Ultimately, this connection can restrict the growth of the spinal cord, damaging the nerves in the spinal cord. In some cases, it can also cause an infection of the spinal cord or the fluid around the spinal cord (meningitis).

Antibiotics are usually required if the skin around the pit becomes infected. These must be taken orally; they cannot be applied to the pit site. Drainage may be required if there is a lot of fluid or pus. If the spinal cord or the fluid around the spinal cord becomes infected, intravenous antibiotics may be needed.

What are the possible complications?
When the area looks red or inflamed, it may be infected. Infections may involve only the skin or deeper tissues, including muscles, nerves, the fluid around the spinal cord, and the brain.

The area of ​​the dimple—or the adjacent area, for that matter—may be filled with fluid.At this stage it is called pilonidal cyst And often need to drain.

If the sacral pit or tuff extends down the spinal cord and involves these nerves, then bowel and bladder function can be impaired. The most common presentation is a urinary tract infection caused by the inability to empty the bladder effectively due to poor neurological function. The resulting stagnation of urine in the bladder can breed infection. Chronic constipation can also result if the nerves of the gut are involved.

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