VP shunt placement is increasing in the pediatric population, and with this comes the potential for increased complications. Complications can be grouped into 3 categories: mechanical failure, infection, and functional failure. Signs and symptoms frequently overlap and are often nonspecific; however, the best predictors of shunt complications are meningismus, peritonitis, decreased level of consciousness, lethargy, erythema along the shunt tract, bulging fontanel, and drowsiness. A focused history and physical examination is needed in each patient.
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