Which of the following is a sign of shunt malfunction in infants?

• A. Sunset eyes
• B. Hearing loss
• C. Clear lungs
• D. Normal appetite

Answer: (A)

Shunt malfunction in infants is tied to a buildup of cerebrospinal fluid and resulting increased intracranial pressure. A classic sign of this pressure change in infants is sunset eyes, also called the setting sun sign, where the eyes appear driven downward so the upper white of the eye is visible above the iris. This happens because the pressure affects the brain’s gaze centers and the muscles around the eyes, producing that distinctive downward gaze.

Other typical consequences of rising intracranial pressure can include a tense or bulging fontanelle, poor feeding, vomiting, irritability, lethargy, and a high-pitched cry. The options listed that aren’t signs of shunt malfunction—hearing loss, clear lungs, and normal appetite—don’t reflect this specific intracranial pressure problem. So, sunset eyes is the sign that points to shunt malfunction in an infant.