Children and Brain Injury – BIAA

BIAA HOME : LIVING WITH BRAIN INJURY : CHILDREN

Incidence Symptoms Recovery Returning to School College and Brain Injury Concussion in Children Prevention

Among those ages 0 to 19, each year an average of:

Among children ages 0 to 14 years, TBI results in an estimated in:

In its 2004 Report to Congress,Traumatic Brain Injury in the United States:Emergency Department Visits, Hospitalizations, and Deaths, the Centers for Disease Control and Prevention notes falls are the leading cause of TBI for children age 0-4.

Approximately 1,300 U.S. children experience severe or fatal brain trauma from child abuse every year.

Sources: Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2004. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics. 2004 Sep;114(3):633-9. Shaken Baby Alliance Fact Sheet

speech

mood swings

vision

impaired concentration

denial

hearing

slowness of thinking

self-centeredness

headaches

limited attention span

anxiety

motor coordination

impairments of perception

depression

spasticity of muscles

communication skills

lowered self-esteem

paresis or paralysis

planning

sexual dysfunction

seizure disorders

writing

restlessness

balance

reading

lack of motivation

fatigue

judgment

difficulty controlling emotions

Any or all of the above impairments may occur to different degrees. The nature of the injury and its consequences can range from mild to severe, and the course of recovery is very difficult to predict for any given child. Withearly diagnosis and ongoing therapeutic intervention, the severity of these symptoms may decreasein varying degrees. Symptoms can vary greatly depending on the extent and location of the brain injury. Impairments in one or more areas (such as cognitive functioning, physical abilities, communication, or social/behavioral disruption) are common.

What makes a brain injury in children different?While the symptoms of a brain injury in children aresimilar to the symptoms experienced byadults, the functional impact can be very different.Children are not little adults.The brain of a child is continuing to develop.The assumption used to be a child with a brain injury would recover better than an adult because there was more plasticity in a younger brain. More recent research has shown that this is not the case. A brain injury actually has a more devastating impact on a child than an injury of the same severity has on a mature adult. The cognitive impairments of children may not be immediately obviousafter the injury but may become apparent as the child gets older and facesincreased cognitive and social expectations for new learning and more complex, socially appropriate behavior. These delayed effects can create lifetime challenges for living and learning for children, their families,schools and communities. Some childrenmay have lifelongphysical challenges. However, the greatest challenges manychildren with brain injuryface are changes in their abilities to think and learn and to develop socially appropriate behaviors.

Common deficits afterbrain injury include difficulty in processing information, impaired judgment and reasoning.When an adult is injured, these deficits can become apparent in the months following the injury.For a child, it may be years before the deficits from the injury become apparent.An example of this is described in the story of Betsy.

Betsy was an active, inquisitive 6 year old girl. She was involved in a motor vehicle accident and sustained a moderate brain injury. She was treated at the hospital and discharged to home with outpatient therapies to continue her recovery. She missed a little over a month of school as she recovered. She was able to return to her first grade class, and with help from teachers and her parents, was able to complete the school year with average grades. She needed help in learning new things, but was able to remember them with extra repetitions.

Betsy continued in school, getting average or above average grades. It wasn't until she reached fifth grade that her grades started to decline. Teachers and her parents did not understand the change. She went to school, she tried to do her homework every night. She complained that she just didn't understand the schoolwork anymore. She became more irritable and argued with the teachers at times. No one thought to connect the brain injury years ago with her current issues.

Betsy was experiencing the long term effects of brain injury in children Her schoolwork increased in complexity, and required more sophisticated problem solving. The areas of the brain responsible for those functions were injured in the accident. Until now, those skills of abstract reasoning and more complex problem solving were not expected to be present. It was only when Betsy grew into her injury that her deficits became more readily apparent.

Fortunately, the mom was able to find her local Brain Injury Association and ask them about why Betsy was having trouble now. Information about the neurocognitive stallafter a brain injury was sent to her, and she was connected with a professional that had experience working with children with brain injury. It will be a longer road to recover from her brain injury than anyone originally imagined, but Betsy, now connected with the right resources, has a much better chance of meeting the challenges of her brain injury.

When children with TBI return to school, their educational and emotional needs are often very different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child's family, friends and teachers also recall what the child was like before the injury and may haveadjusting their expectations of the child.

It is extremely important to plan carefully for the child's return to school. Parents will want to find out ahead of time about special education services offered in their community.This information is usually available from the school's principal or special education teacher. The school will need to evaluate the child thoroughly. This evaluation will let the school and parents know what the student's educational needs are. The school and parents will then develop an Individualized Education Program (IEP) that addresses those educational needs.

Rememberthe IEP is a flexible plan. It can be changed as the parents, the school and the student learn more about what the student needs at school.

Learn about TBI. The more you know, the more you can help yourself and your child. See the list of resources and organizations below.

Work with the medical team to understand your child's injury and treatment plan. Don't be shy about asking questions. Tell them what you know or think. Make suggestions.

Keep track of your child's treatment. A 3-ring binder or a box can help you store this history. As your child recovers, you may meet with many doctors, nurses and others. Write down what they say. Put any paperwork they give you in the notebook or keepit in the box. If you are asked to shareyourpaperwork with someone else, make a copy. Don't give away your original.

Suggested Resources:

Teaching Strategies for Children with a brain injury Students with Traumatic Brain Injury Returning to the Classroom Mild Brain Injury and Returning to School NICHCY Fact Sheet

College or any type of post secondary education for people with brain injury used to be considered an "unrealistic expectation" of life after brain injury.However, there are more students with brain injury investigating and attending college.The Brain Injury Association's National Brain Injury Information Center notes that inquiries about college options for students with brain injuries has significantly increased over the last decade. There are now a range of resources available to families to help them work through the decision making process.

Suggested Resources:

Young Adults and College- an article originally published in THEChallenge! newsletter. Financial Aid for Students - a publication from the HEATH Resource Center.

Infants, Toddlers and Preschool Children Very young children (i.e. infants, toddlers, and preschoolers) frequently sustain bumps and bruises to their heads from a host of mechanisms including falls (down stairs or from heights such as counter tops or beds), direct impacts (e.g. getting hit in the head with a ball), motor vehicle crashes, tricycle/bike accidents or child abuse.

Sometimes these events can be significant enough to result in a concussion. Deciding whether a child who has hit his or her head needs an immediate concussion assessmentcan be difficult. Young children may have the same concussion symptoms as older children, but they do notexpress them in the same way. For example, young children cannot explain a feeling of nausea or amnesia or even describe where they hurt. Parents and physicians shouldkeep this in mind when considring thepresence of concussionsymptoms listed below.When in doubt, refer a child forimmediate evaluation. Primary care physicians (PCPs) should ask caregivers about all bumps on the head and should consider referring a child with a bump on the head to the emergency department if they suspect a concussion.

Acute signs and symptoms of a concussion:

Follow-up in Young Children who have Sustained Concussions

All children with concussion or suspected concussion should be followed closely by their PCP. A follow-up visit with the PCP after the event can offer the opportunity for families to ask questions and for the PCP to assess the child for ongoing symptoms. Although diagnosing post-concussion syndrome in young children is difficult, it is important to assess for these symptomsto determine if further evaluation is needed.The follow-up visit can also provide an important opportunity for discussion of age-appropriate injury prevention tominimize the possibility of subsequent concussions.

Infants and young children less than 3 years of age who have had a concussion can have their development tracked by their countys developmental program for young children. Thisis particularly important for children who have sustained a complicated concussion (i.e., a concussion with contusions or hemorrhage apparent on imaging), those who have had multiple concussions and/or those with underlying neurologic disease.

Persistent signs and symptoms to assess for during follow-up:

Children who display these symptoms for more than several weeks after a concussion may require further assessment and/or evaluation by a neuropsychologist, neurologist, or other specialist.

Young children may also sustain mild to severe TBIs from abuse.

Source: Centers for Disease Control and Prevention'sToolkit for Physicians

To reduce the risk of sustaining aTBI, individuals should:

SuggestedResources:

Centersfor Disease Control and Injury Preventionfact sheetson prevention Which helmet for which activity? A guide from the Consumer Product Safety Commission SCORE Program Resources for families and youth coaches CDC Concussion Education Materials National Highway Traffic Safety Administration:Bicycle Helmet Laws and injury prevention information ThinkFirst Foundation ThinkFirst for Teens Brain injury prevention messages for teens Shaken baby syndromeinformation Children's Safety Network

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Children and Brain Injury - BIAA