What is Pediatric Traumatic Brain Injury?

Pediatric traumatic brain injuries occur when there is a direct or indirect blow to the head, and they can range from mild, to moderate or severe. This includes bumps, bruises, concussions, skull fractures, and more serious brain injuries. Symptoms vary depending on the site of the injury, the extent of the damage to the brain, and the child’s stage of development and age. TBI is different in children than in adults because oftentimes the brain is still developing. Furthermore, TBI in children is a chronic disease process rather than a one-time event, as symptoms may change or unfold over time. Unfortunately, TBI is a leading cause of death and disability in children.

Based on the nature of the injury, duration of loss of consciousness, the prevalence of posttraumatic amnesia, and the severity of confusion, TBI can range in severity from moderate to severe, and treatment will be based on these factors.

Signs and Symptoms of Traumatic Brain Injury in Children

Depending on the type of the injury, signs, and symptoms will vary in both severity and duration. The effects of TBI can be temporary or permanent, and each case should be evaluated on an individual basis. The following is a list of common things to look out for:

Physical Signs Of TBI

• Loss of consciousness
• Headaches
• Sensitivity to light and/or sound
• Nausea or vomiting
• Feeling sleepy OR trouble staying awake
• Impaired movement, balance or coordination
• Reduced muscle strength
• Double or blurred vision
• Numbness or tingling
• Ringing in ears

Cognitive (Brain) Signs Of TBI

• Slow thinking or processing
• Memory loss or confusion 
• Unable to concentrate
• Poor judgment
• Falling behind in school

Emotional Signs Of TBI

• Irritability or easily angered 
• Sad or nervous
• Lack of interest or motivation 
• Impatience
• Outbursts

Sleeping Signs Of TBI

• Trouble falling asleep OR trouble staying asleep
• Sleeping more OR less than usual

Since the pediatric brain is still developing, this can cause higher severity in children than in adults. If the TBI experienced severe enough to impact development, this could result in challenges related to educational and vocational demands, social relationships, participation in activities, and overall quality of life both in the immediate and future sense. TBI can emerge and/or persist into adulthood since TBI in children is seen as a chronic process rather than a one-time occurrence. 

It is also possible that signs and symptoms could co-occur with other existing developmental conditions (such as ADD, autism, etc), so it is important to manage this and advocate so your child gets proper treatment on all fronts. 

Causes of Pediatric TBI

Traumatic brain injuries occur when there is a direct or indirect blow to the head. Causes of pediatric traumatic brain injury vary and differ by age. Some common causes of TBI are

• Falling
• Being struck by or against something
• Motor vehicle accidents
• Assault (ie, shaken baby syndrome)

How is Traumatic Brain Injury Treated in Children?

Treatment for TBI should be assessed and developed on a per-child basis, as every injury is different and every child needs a unique treatment plan. Developing a plan needs to take into account the child’s age, levels of function, overall functioning, and developmental status. Further, any deficits that may have existed before the TBI must also be addressed and taken into consideration. 

In the early stages of injury, rest is critical for both the body and the brain. A slow return to normal activities happens over time, and since pediatric TBI is chronic, this allows for further observation and queues if additional treatment or rehabilitation might be necessary. Continuing to monitor your child through the coming weeks and even months after injury is strongly advised. 

Treatment of TBI should address the child’s ability to function in everyday life with efficiency and effectiveness. Depending on the severity of the injury, treatment could focus on: developing new skills, remediating lost functions, and mitigating unwanted behaviors

Below is a more comprehensive list of treatment options that you can discuss and decipher with your care team, finding the best combination for your child based on a variety of factors. 

• Behavioral therapy 
• Consultation with school specialists
• Rehabilitation therapies 
  • Occupational therapy 
  • Physical therapy 
  • Speech-language therapy 

Ongoing assessment of your child is encouraged, and this requires collaboration between family and medical, rehabilitation, and educational professionals.

General best practices after your child’s TBI

• Avoid activities that increase the risk of further injury 
• Amount of time off will depend on the severity of the injury, but the longer they have to recover, the better 
• Try to wean back into schooling – maybe experiment with a couple of hours at first, gradually returning to a full-day 
• Monitor your child’s schedule and activity levels 
• Coordinate with school specialists to make progression plans if necessary 
• Keep an eye out for troubles concentrating, competing or understanding schoolwork 
• It takes time for your child to heal emotionally – have patience with them

Rehabilitation for Pediatric TBI

An interdisciplinary approach is essential to treating TBI. After the initial stabilization of your child’s injury, patients should receive physical therapy, occupational therapy, speech therapy, and neuropsychological testing. A combination approach to rehabilitation is the best practice.

Rehabilitation will include the teaching of strategies to compensate for impaired or lost functions and for optimization of the use of abilities as they return. While receiving these treatments, you must partner with your child’s school if they are old enough to attend, as the child must receive the services needed to achieve academically safely and appropriately.

TBI Care at George Mark Children’s House

Transitional care facilitates an easier move between hospital and home, helping parents and caregivers gain more confidence about caring for their children. A transitional stay results in reduced stress, fewer emergency room visits, and fewer and shorter hospital stays. Our medical staff is available 24/7 to help parents and caregivers learn the appropriate safe care of their child, at their speed, in a warm and supportive home-like setting. This support helps parents feel more confident about caring for their children and managing issues that arise when they return home. We are an ongoing resource—just a phone call away. Transitional care can also help a child get ready for a medical procedure. Children have been referred to George Mark to achieve the necessary compliance and readiness for medical treatments.

We develop an individualized care plan for each child, coordinating services among the George Mark care team—pediatricians, nurses, nursing assistants, social workers, child life specialists, palliative aquatics specialists, psychologists, support staff, and volunteers.

Reach out to our team to learn more about our pediatric TBI care.