Official diagnosis: pros and cons.

My 3 month old son had a weird butt crack when he was born. Babies are crinkly and stuff anyway, so I eyeballed it a bit but kept my concerns to myself until his two month check up when it still looked the same. I showed his doctor and he was very careful not to say anything definitive but advised that we just keep an eye on his gross motor movements and report any changes.

A couple weeks later he had an episode of nystagmus* so I brought him to my own doctor, mostly because his doctor was off but also because my doctor would have been his doctor too except he took off to Korea for a baby of his own right before my due date. I like him a bunch and trust his opinion even more. So while we were there I said, “Hey, check out his butt crack and tell me what you think.”

I’d have to go to Children’s for an official diagnosis, but the popular opinion is that he has spina bifida occulta. It doesn’t seem to affect him at all. Bowel and bladder are fine, lower extremity movement is fine, his reflexes are all intact, etc. He’s perfect except for a triangle shaped dimple just north of his butt crack.

He’ll go for his next well baby check/immunizations in a couple weeks. I can request a referral whenever I want to but I’m going to face to face with his doctor before I make up my mind. And right now my mind is saying, “Well, why bother?” My husband is deferring to me.

So. Pros to getting a diagnosis: ??? Cons: Could it impact his life later? E.g. if he wants to join the military (he comes from a long line of proud Marines), is he going to be able to if that’s in his record? If the answer to that is no he would not, is it unethical to withhold information that would otherwise disqualify him? Even if the defect doesn’t actually affect him at all?

Sigh. What do you think? What are the pros?

  • Several episodes over the course of the day, but it was just that ONE DAY; I’ve noticed nothing since, so WTF. Not that I’m bitching. No more, please!

I can’t understand why you are even considering trying to hush this up. It might be nothing, but it might have major impacts on your son’s future health, and, like many childhood medical issues, it might be something that can be fixed if treated in time, but will cause his serious problems in later life if it is left alone. You cannot possibly know which of these is the case. You need to find out.

If it is something that would make him ineligible to join the marines (or for any other job), if they knew, there are probably good reasons why they would not accept people with such a condition (whatever it really is). Presumably, if they do not accept people with such a condition, they have reasons, probably because they know that to accept someone would be to risk putting that person and/or their comrades in unnecessary danger. In any case, it is absurd to be thinking about such things now. He may well have absolutely no interest in being a marine when he is older, and you and his father had damn well better be be ready to accept that, if that is how it turns out.

If you care about your son, get him properly checked out as soon as possible.

Pros to getting a diagnosis? You may save him from a lifetime of being a cripple.

Cons? I really do not see any. (Well, unless your medical insurance is crappy, I guess, and you have to pay a lot just for the tests.)

Hmm. That seems… angrier than it needs to be. Re: the military, I’d actually prefer that none of my children join but, given that military personnel abound on both sides, I’d bet at least one will. The whole “damn well better accept that” is a little silly.

I thought I mentioned this in the OP. Forgive me, I’m on my phone. My doctor leads me to believe that a diagnosis is entirely optional because there isn’t really any treatment consideration when there are no symptoms and, as mentioned, there aren’t. This is one of the things I’ll discuss with his doctor when I see him.

Don’t let the “spina bifida” part throw you off. SBO, in the vast majority of cases, is considered insignificant. Most people don’t even know they have it until they get back imaging for some unrelated thing later in life.

His medical insurance isn’t too bad, but I’m not sure if they’d use ultrasound or MRI so I don’t have much of a concept at this point how much it would cost.

Cost is not a factor at all.

Missed the edit. I think his doctor will probably agree with the “optional diagnosis” thing, just because he previously told me to monitor for changes and report back at that time.

My OP makes more sense with the part about me being told the diagnosis is kind of useless. So when I say “why bother” that’s because I’m under the impression that, provided he continues to grow and develop normally, it doesn’t really matter either way.

So an example of a pro for getting diagnosed now is so that if something develops later I can point to that diagnosis and get the ball rolling right away on whatever treatment may be necessary.

Could be a con, too. I get him diagnosed now, something happens later, and doctors fall back on this diagnosis rather than exploring other possible options and then they miss something.

My companion of 41 years has this same condition and it has never amounted to any more than a curiosity. One does not notice it even on the occasion of observed nudity and he has an active sports oriented life with zero symptons. I doubt even lovers would notice during intamacy. I see no reason for a recorded diagnosis and think it would only have the downside of confusion regarding the conditions inconsequential nature ( it sounds serious to the uninformed).

Oh, thank you so much for your post! My husband has dreams of teaching his boys to skate and play hockey (this baby is 3 of 3, all boys) and wonders if this might impact his activity later.

As far as sports go, I’m more worried about the congenital heart defect my husband has that wasn’t discovered until he was a teen and later (possibly) caused another heart issue discovered the day before I went into labor with this baby. That was a great week… I almost thought he’d still be in the hospital and they’d have to wheel him over to the maternity ward!

I go with “Why bother”. 5% of babies have a small sacral dimple like that.
The GP has confused you, it is very very likely to be ONLY sacral dimple. It is very very unlikely for there to be a " spina bifida occulta", given that the GP has checked the vertebrae are normal and checked that there is no other symptom.
(eg if there was also a 2nd birthmark in the area, it may be actually be a spina bifida symptom… )

He has a small birthmark on his left “cheek”, closer to the leg than the back.

I think the only pro worth considering is if it will help you get him treatment or services that he might need. From what you know so far, it sounds like he probably won’t need any, so it may not be an issue, but if it were me, I’d want to know exactly how likely that is, and how having a diagnosis will affect his treatment down the line, if any such treatment becomes necessary.

My spouse has spina bifida NON-occulta which has impaired him somewhat, but he still played sports in between necessary childhood surgeries, and did activities like scuba diving and hang gliding. There are some things he can’t do, but not many. When we met able-bodied me couldn’t keep up with him. Granted, he was better off than most people of his generation with SB, and had a relatively mild case of it, but kids with disabilities can be surprisingly active even with limitations.

SBO is almost always a non-issue. In the past, it was usually discovered in adulthood when the person got a back x-ray for something else. If there are no symptoms it’s not something to worry about.

From a slightly different side of the story, minor tailbone malformations run in my family. One line of the family, because of them, gets pilonidal cysts bad enough to need surgery. My line gets them badly enough that they get irritated once or twice when we’re teenagers, then we learn not to sit on our tailbones. My dad didn’t even know he had it until he got his physical for Vietnam–and no, that didn’t disqualify him for military service.

Mine manifests as two or three deep dimples at the top of my butt crack.

None of us have ever been barred from doing anything we want to do because of it.

How much to worry about findings near the base of the spine is an issue of some various opinions.

A dimple inside the crack (a sacral dimple) for example gets some excited but really should not. A dimple above that level worries most of us, as would a hairy birthmark or a fatty growth. Uneven gluteal cracks alone not so much so but some do have it cross the line.

IF the finding in question does cross the line of concern (a big if) then waiting is not a good idea. The concern is a tethered cord and if that IS the case you want something done before there is damage done, not after.

The test is an MRI, a fairly big deal. I’ve known some pediatric neurosurgeons to just say order for every little oddity and some wo use a lot of judgement based on specifics.

Not sure if that helps.

Not sure why you wouldn’t want to know. You want to give your child every possible advantage in life, right? Pretending a possible medical condition doesn’t exist because he might want to join the military in 18 years isn’t helping him. It’d be better for him to know that he’s ineligible for the military as soon as possible, rather than letting him prepare to join and getting turned down at the last second (see: Little Miss Sunshine).

Calling it a “weird butt crack” is sort of inaccurate. The crack itself looks like every other baby crack I’ve seen, straight and not shorter or longer than usual, and the dimple is not inside the crack; you don’t have to spread the cheeks to see it. Without close inspection though, the dimple is close enough that it looks like a continuation of the crack, like the crack is just weirdly long, and when I first pointed it out to his doctor but before the doctor did more than look at the butt while the baby was on his belly, he thought it was just a little extra skin fold. With closer inspection, you find that the crack itself terminates normally and then there’s a dimple.

No tufts of hair or growths of any kind.

I know they use ultrasound, not MRI, for infants but I think he may be old enough now that they wouldn’t. When my doctor told me he’d send us to Children’s if I wanted, it was for an ultrasound they aren’t equipped to do at my local hospital.

How do you get MRI from a baby??

Rachel: Military aside (honestly, that was just the first example I could think of; I’m not “duurr, he might wanna join the miluhtury so can’t have no doctorin’*!” at all), and given what I’ve been told - that a diagnosis changes nothing at all because they don’t treat it without symptoms - what’s the advantage of diagnosing now? Of course, if they can anticipate from imaging that problems WILL arise even if they haven’t yet and do something about it, I’ll do it. I wasn’t told that though and it’s something for me to ask about because then they need to explain why they wouldn’t just go ahead with imaging rather than telling me to come back if there are issues (and that’s two doctors and a pamphlet that said that).

  • I know a guy who wouldn’t get help for his severe sleep apnea because the diagnosis would DQ him from flying planes. I know at least three parents who were, and one who still IS, hesitant to get their kids therapy/medication for mental issues (ADHD, depression/anxiety) because they think a diagnosis will harm their kid’s chances of college and even some jobs. In my defense, at least to my knowledge (and, again, that may be wrong according to what DSeid says) I’m not withholding treatment because, to my knowledge, there is none at this stage.

MRIs that age require sedation.

Generally at 3 months and older they go with MRI and US when under.

Dimple above the gluteal folds … I’d go with having a good pediatric neurosurgeon look at it unless they think they can still do the US.

If it is a sign of a tethered cord then it should be surgically repaired before growth puts tension on the spinal cord and causes damage.

Thank you.

Interesting that none of the materials I was given/found on my own (CDC, WebMD, Mayo, NIH, etc) mention tethered cord, nor is there any information about the significance of dimple location. Most of it is very, “Ho hum, it’s nothing at all. Let’s talk about For Real SB now.” Search for SBO with dimple above gluteal fold though and there’s all kinds of info.

Thanks, DSeid.

I’d get a definitive diagnosis - better to know and deal with the reality than wonder and never know for sure.

Waiting to hear back on my request for a referral to neuro. :confused:

I’m going to stop reading the internet now.