Referral Pathway for Infants with Sacral Dimples

Assessment of Sacral Dimples

Infants with sacral dimples located above an imaginary line connecting the tops of the gluteal cleft should be referred to a pediatric neurosurgeon for evaluation, while those with dimples below this line (coccygeal dimples) require no further workup or referral, as recommended by the American Academy of Pediatrics 1, 2
The location of the sacral dimple can be determined by drawing an imaginary line between the tops of the two forks of the gluteal cleft, with dimples at or below this line being normal coccygeal dimples (no referral needed) and dimples above this line on the flat part of the sacrum being lumbosacral dimples (require referral) 1, 2

The presence of surrounding cutaneous manifestations, such as vascular anomalies or hemangiomas, tufts of hair emerging from the dimple, skin tags near the dimple, subcutaneous masses or dermoid cysts, or a deviated gluteal cleft, warrants prompt referral to a pediatric neurosurgeon, according to the American Academy of Pediatrics 1, 2

All infants with lumbosacral dimples (above the gluteal cleft line) should be referred to a pediatric neurosurgeon for evaluation, as recommended by the American Academy of Pediatrics 1, 2
Any infant with a sacral dimple plus associated cutaneous findings should be referred to a pediatric neurosurgeon, as recommended by the American Academy of Pediatrics 1

Dermal sinus tracts can lead to serious complications if not addressed, including CNS infections, aseptic meningitis, spinal cord compression, and neurologic deterioration, as reported by the American Academy of Pediatrics 1, 2

The American Academy of Pediatrics recommends avoiding reliance on visibility of the dimple base to determine if referral is needed, as this is an incorrect approach 3, 4
The American Academy of Pediatrics also recommends avoiding confusion between coccygeal dimples (benign) and lumbosacral dermal sinus tracts (pathologic) 1
Delaying referral for dimples with concerning associated findings can lead to serious complications, and the American Academy of Pediatrics recommends early intervention 1
The American Academy of Pediatrics recommends avoiding unnecessary imaging for typical coccygeal dimples, as these are benign variations 1, 2