Most children with cerebrospinal fluid (CSF) shunts who present with irritability, headache, vomiting, and fever are more likely to have a viral illness than a shunt malfunction. Almost all CSF shunt systems have intraventricular tubing, a valve apparatus, and distal tubing. Distended scalp veins or bulging of the fontanel or a craniotomy site indicates high intracranial pressure (ICP) in the process of inspection of the shunt system. A sunken fontanel and sunken craniotomy site indicate low ICP. Proximal obstruction of the ventricular catheter of the CSF shunt system occurs from cellular debris, fibrosis, infection, envelopment by the choroid plexus, and catheter migration. Furosemide (1 mg/kg per day) with or without mannitol is also used to lower elevated ICP. In addition to the shunt malfunction, the two commonly encountered complications of long-term CSF shunt systems are slit ventricle syndrome and ventriculitis.