What is a Pediatric Traumatic Brain Injury?
Traumatic brain injury is a broad term describing a range of symptoms that can differ in severity. They can be mild, moderate, or severe.
Traumatic brain injuries occur when there is a direct or indirect blow to the head. They can include bumps and bruises, concussions, skull fractures and serious brain injuries. Some traumatic brain injuries cause lasting damage. But most kids recover with no long-term problems.
The severity of a traumatic brain injury is determined by many factors. These include:
- A long loss of consciousness
- Certain neurological symptoms that happened at the time of the injury
- Memory loss about the injury and time surrounding it
- Abnormalities on head or brain imaging
What are the Common Signs and Symptoms of Traumatic Brain Injury in Children?
Traumatic brain injury signs and symptoms may be similar. With moderate and severe traumatic brain injury, the signs and symptoms may be more severe. They may go from better to worse. They may last weeks, months or longer after the injury. This is a normal part of the healing process.
- Physical Signs
- Sensitivity to light
- Sensitivity to sound
- Nausea or vomiting
- Feeling tired or sleepy
- Loss of balance or trouble walking
- Ringing in ears
- Double or blurred vision
- Numbness or tingling
- Loss of consciousness
- Cognitive (Brain) Signs
- Feeling foggy or confused
- Slow thinking or slow processing
- Memory issues
- Unable to concentrate
- Poor judgement
- Falling behind in school
- Emotional Signs
- Irritable or fussy
- More emotional than normal
- Sad or nervous
- Lack of interest or motivation in normal things
- Easily frustrated, angered or tearful
- Bolder than usual
- Not tolerating daily routine
- Sleeping Signs
- Change in sleeping pattern
- Trouble falling asleep
- Trouble staying asleep
- Sleeping more than usual
- Sleeping less than usual
A small percentage of traumatic brain injuries in children can include more severe symptoms. These include a long loss of consciousness, spasticity, muscle weakness, seizures, and more severe brain and functional problems.
How Are Traumatic Brain Injuries Diagnosed in Children?
Your child’s doctor will gather information on the history of injury and the symptoms after the injury. Depending on how severe the injury was, your child may have a physical and neurological evaluation. The doctor will test their memory, thinking, mood, behavior, vision, and concentration. They will also test your child’s balance, coordination, muscle strength, reflexes, and sensation.
In few cases, an MRI or CT scan may be needed to help assess severity.
How Are Pediatric Traumatic Brain Injuries Treated?
The early treatment for a brain injury is rest. This is for the body and brain. This is followed by a slow return to normal activities over time. Because all children and injuries are different, the treatment may also include one or more of the following:
- Behavioral Therapy: Behavioral therapy includes adherence strategies, cognitive behavioral therapy, coping skills training, biofeedback, and exposure-based therapies for pain management. This also includes treatment of anxiety, depression, and disruptive behaviors.
- Consultation with School Specialists: School specialists can help address post-brain injury symptoms in the school setting. They will help create a successful return-to-learn plan.
- Rehabilitation Therapies
- Occupational Therapy: Occupational therapy focuses on improving skills related to vision, coordination, problem solving and mental processing.
- Physical Therapy: Physical therapy focuses on improving skills related to motor function, walking, balance, postural control, activity tolerance, and management of musculoskeletal headaches.
- Speech-Language Therapy: Speech-language therapy focuses on improving speaking, listening, reading, writing, social, memory, attention, and problem-solving skills.
- Balance Therapy: Balance therapy targets dizziness and balance problems. These can cause safety and mobility problems.
- Vision: Visual treatments help get rid of blurry vision, double vision, eyestrain, headaches, and trouble with reading and computer work.
In very rare situations, surgery may be needed.
What Should I Expect After My Child’s Traumatic Brain Injury?
Returning to Activity
At first, your child should avoid activities that could worsen or increase their chance of injury. This includes gym class, recess, sports, high-speed activities (skate boarding, bike riding), or activities with a chance of falls or trauma. The amount of time off will depend on your child’s injury. Once your doctors feel it is safe to begin adding more activity to your child’s schedule, they will guide you on how to do this. It is important for athletes to get medical clearance. Athletes will need to follow activity progression plans.
Returning to School
Most children can return to school slowly after a few days as their symptoms improve. It may take longer depending on symptom recovery. In general, if your child’s symptoms are getting better, try going to school for one or two hours. Advance to going for full days as tolerated. Talk with the school nurse or school representative to plan for your child’s return.
Plan a return to school with these things in mind:
- Consider partial days as needed
- Increased time to complete assignments and tests
- Additional learning resources such as pre-printed notes or tutoring materials
- Allow water bottle at school filled with sports drink or water
- Rest breaks as needed
- Increased time to make up missed work
The school nurse or school representative should watch for:
- Problems paying attention or concentrating
- Problems remembering or learning new information
- Needing more time to do a task
- Not coping well with stress
If your child is having trouble in school, talk to your child’s doctor.
After a brain injury, your child may be tired, irritable, or show a change in mood. It takes time to heal. Use this time for rest and quiet activities. Play board games, read, or do small craft projects for short periods of time. Avoid screen time.
Infants and toddlers can be hard to distract and difficult to confine. Try putting your infant or toddler in a large crib or playpen. Ask family and friends to visit for short periods of time, during different times of the day.
After exposure to any traumatic event, some children may have symptoms of acute traumatic stress. If you notice your child having nightmares, flashbacks, nervousness, avoidant behaviors, irritability, or any other concerning emotional symptoms, please talk with your doctor. Short-term therapy may be needed to help children heal and recover emotionally after trauma. Learn more about post-traumatic stress disorder.
Medications and Pain Management
Tell your doctor what medications your child was taking before their injury. Get approval to resume these medications after their injury. Give acetaminophen (Tylenol) for pain or headache. Keep the use of medication to treat headache to a minimum. Using medication too much can make symptoms worse. Medication should not be used more than three times per week.
Your child's doctor may write a prescription for stronger pain medication for other injuries. This medication is not to treat headaches. Give the stronger medication if the pain does not go away one hour after giving acetaminophen. Follow the directions on the prescription. Your child may need a stool softener while taking prescription pain medication to prevent constipation.
Do not give your child NSAIDs or Ibuprofen (also known as Motrin, Advil, or Aleve) until your doctor says it is okay.
Your child’s follow-up will depend on the severity and kind of brain injury. Your doctor will talk to you about follow-up care during discharge from the hospital.
Your child will need a doctor’s note to return to activity such as sports, gym, or recess.
How Can I Prevent My Child from Having a Traumatic Brain Injury?
It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate restraint every time they ride in a car. Children under 13 are safer in a backseat in the correct restraint.
Make sure your child wears the correct helmet when riding a bike, using other wheeled toys, or in other active sports. Make sure protective sports gear fits correctly.
When Should I Seek Emergency Care for my Child?
If you notice any of the following, your child needs to be taken to the emergency room immediately:
Changes in Behavior
- Drowsy and hard to wake up
- Infants with increased irritability and are unable to be consoled
- Does not recognize familiar people
- Unable to be comforted
- Confused speech
- Does not know where they are
- Not acting like usual self
- Continued vomiting
- Weakness or stumbling
- Constant severe headache
- Seizures (shaking/twitching of the body)
- Double vision
- Blood or clear fluid draining from ears or nose
- Infants with scalp or head swelling