In older children, who are usually admitted to the hospital for elective or emergency shunt revision, the most valuable indicator of increasing ICP is an alteration in the child’s level of consciousness, complaint of headache, and interaction with the environment. Changes are identified by observing and comparing present behavior with customary behavior, sleep patterns, developmental capabilities, and habits obtained through a detailed history and a baseline assessment. This baseline information serves as a guide for postoperative assessment and evaluation of shunt function.