{"id":22736,"date":"2025-01-31T08:54:12","date_gmt":"2025-01-31T08:54:12","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=22736"},"modified":"2026-09-21T11:26:36","modified_gmt":"2026-09-21T10:26:36","slug":"sacral-dimples","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/medical-paediatrics\/sacral-dimples\/","title":{"rendered":"Sacral Dimples"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>I<\/strong><strong>nformation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sacral dimples are usually minor congenital anomalies. They occur in 3-8% of children<sup>1<\/sup>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rarely, dimples can be associated with Occult Spinal Dysraphism (OSD). OSD describes a broad spectrum of underlying spinal cord abnormalities. Most abnormalities are picked up antenatally on anomaly scans.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In the newborn, isolated sacral dimples and small pits, without any concerning features listed below, can be safely ignored. Only atypical dimples are associated with a high risk for OSD.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ultrasound is the initial investigation of choice in babies &lt; 3 months of age. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Over 3 months of age, we would recommend clinical review prior to consideration of imaging. The reason for this is that the sacrum is ossified so it is not possible to visualise the cord using ultrasound. MRI would be the imaging modality of choice (if required). This cannot be requested from primary care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.R.M. &amp; C.H. &#8211; 21-9-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">If <strong>two<\/strong> or more features are present:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Multiple dimples<\/li>\n\n\n\n<li>&gt;5 mm diameter<\/li>\n\n\n\n<li>Dimple is oriented cephalically (i.e. toward the head), not straight down (i.e. caudal)<\/li>\n\n\n\n<li>Distance &gt; 2.5 cm from anus<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If babies have a sacral dimple and any&nbsp;<strong>one<\/strong>&nbsp;of the following features are present:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skin abnormalities \/ masses &nbsp;(in the area of the dimple):\n<ul class=\"wp-block-list\">\n<li>Hypertrichosis (excessive hair)<\/li>\n\n\n\n<li>Lipoma or other mass<\/li>\n\n\n\n<li>Pigmented lesions<\/li>\n\n\n\n<li>Skin tags or tail-like appendages<\/li>\n\n\n\n<li>Vascular lesions \u2013 haemangioma, telangectasia<\/li>\n\n\n\n<li>Signs of infection such as skin erythema or induration<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Abnormal neurological examination (need to be referred in absence of sacral dimple)<\/li>\n\n\n\n<li>Anorectal abnormalities (need to be referred in absence of sacral dimple)<\/li>\n\n\n\n<li>Aplasia cutis congenita (congenital absence of skin in any location)<\/li>\n\n\n\n<li>Orthopaedic:\n<ul class=\"wp-block-list\">\n<li>Congenital dislocation of the hip<\/li>\n\n\n\n<li>Leg length discrepancies<\/li>\n\n\n\n<li>Pes cavus<\/li>\n\n\n\n<li>Scoliosis<\/li>\n\n\n\n<li>Talipes<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Infants with small (&lt;5mm), isolated midline dimples or small pits that do not meet the criteria listed above.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"text-decoration: underline\">For infants &lt; 3 months of age:<\/span><\/strong><\/h5>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Request an urgent ultrasound spine via Sci-Gateway: &nbsp;<\/strong>(Please ensure that the referral states the features that have triggered the referral)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>RHCYP &gt; Clinical Radiology &gt; LI Radiology Ultrasound &gt; select Ultrasound Paediatric Spine from drop down menu<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If <strong>normal<\/strong> &#8211; no further action is required. Parents can be reassured.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If <strong>abnormal<\/strong>, please refer to medical paediatrics Sci-Gateway. &nbsp;This should be URGENT if the report states that there is a connection to the spinal canal, otherwise it can be routine. RHCYP &gt; General Medicine &gt; LI Basic Sign Referral<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong><span style=\"text-decoration: underline\">For infants\/children over 3 months of age:<\/span><\/strong><\/h5>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Refer urgently to medical paediatrics:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">RHCYP &gt; General Medicine &gt; LI Basic Sign Referral<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">If OSD is suspected, the infant should be referred urgently to medical paediatrics. Please attempt to reassure the parents appropriately and try to avoid use of the term \u2018spina bifida\u2019 as this may lead to unnecessary anxiety.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ol start=\"1\" class=\"wp-block-list\">\n<li>Pediatriceducation.org. Does This Sacral Dimple Need to be Evaluated? URL: <a href=\"http:\/\/www.pediatriceducation.org\/2009\/07\/20\/does-this-sacral-dimple-need-to-be-evaluated\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/www.pediatriceducation.org\/2009\/07\/20\/does-this-sacral-dimple-need-to-be-evaluated<\/a>. Updated 20\/07\/2009. Accessed 23\/11\/2009<\/li>\n\n\n\n<li>Robinson AJ, Russell S and Rimmer S. The Value of Ultrasonic Evaluation of the Lumbar Spine in Infants with Specific Reference to Cutaneous Markers of Occult Spinal Dysraphism. Clinical Radiology 2005 60:72-77<\/li>\n\n\n\n<li>Elton S and Oakes WJ. Dermal Sinus Tracts of the Spine. Neurosurgery Focus 2001. 10(1):1-4<\/li>\n\n\n\n<li>There are some good pictures of various suspicious and reassuring dimples\u00a0<a href=\"https:\/\/thejns.org\/focus\/view\/journals\/neurosurg-focus\/10\/1\/foc.2001.10.1.5.xml?tab_body=pdf-27560\" target=\"_blank\" rel=\"noopener\">here<\/a><sup>3<\/sup>.<\/li>\n<\/ol>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information Sacral dimples are usually minor congenital anomalies. They occur in 3-8% of children1. Rarely, dimples can be associated with Occult Spinal Dysraphism (OSD). OSD describes a broad spectrum of underlying spinal cord abnormalities. Most abnormalities are picked up antenatally on anomaly scans. In the newborn, isolated sacral dimples and small pits, without any concerning<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":21301,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1219],"class_list":["post-22736","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-sacral-dimples"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/https-apps-nhslothian-scot-refhelp-medical-paediatrics\/https-apps-nhslothian-scot-refhelp-sacral-dimples\/\" rel=\"tag\">Sacral Dimples<\/a>","rttpg_excerpt":"Information Sacral dimples are usually minor congenital anomalies. They occur in 3-8% of children1. Rarely, dimples can be associated with Occult Spinal Dysraphism (OSD). OSD describes a broad spectrum of underlying spinal cord abnormalities. Most abnormalities are picked up antenatally on anomaly scans. In the newborn, isolated sacral dimples and small pits, without any concerning","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22736","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=22736"}],"version-history":[{"count":2,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22736\/revisions"}],"predecessor-version":[{"id":30108,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/22736\/revisions\/30108"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/21301"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=22736"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=22736"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}