Acquired Brain Injury in Children: What Is It and What Are the Implications?

By Brad G. Kurowski, M.D., M.S.

Acquired brain injury (ABI) in children is generally defined as a type of brain injury that occurs after the post-neonatal period. Although cerebral palsy is associated with a nonprogressive brain disturbance, the disturbance typically occurs in the developing fetal, neonatal, or infant brain and is usually not grouped with other childhood ABIs; however, there may be exceptions. The most common type of ABI is a traumatic brain injury (TBI) that can range from a concussion or mild TBI to a more severe TBI that may require acute/emergent medical interventions and is associated with significant long-term sequelae. Other acquired brain injuries may include strokes (both hemorrhagic and ischemic), central nervous system (CNS) infections/encephalitis, autoimmune disorders (e.g., multiple sclerosis, acute disseminated encephalomyelitis, anti-NMDR receptor encephalitis), CNS tumors, anoxia, and certain genetic or metabolic disorders. Some acquired brain injuries are associated with underlying medical conditions. For example, although stroke is rare in children in general; however, sickle cell disease is associated with a higher risk of stroke in children. Additionally, when compared to TBI, anoxic brain injuries are associated with more severe and worse outcomes. In the case of brain tumors, certain treatments used to manage the tumor (e.g., radiation, chemotherapy, surgery) may interfere with brain development acutely and over time. Therefore, difficulties may worsen over time or become evident only when a child is older. In totality, ABIs are a leading cause of death and long-term impairment and disability among children and young adults. Because many ABIs lead to long-term impairments, the medical and societal costs are significant. ABIs in childhood commonly meet criteria for designation as a chronic condition and require ongoing management across the lifespan.

Acquired brain injuries in children and young adults impact behavioral, cognitive, social, and physical functioning acutely and in the long term. These impairments affect a child’s functioning in the home, school, and community. Cognitive domains affected after ABI may include impairments in intellectual functioning, language and communication, memory, learning, processing speed, attention and concentration, problem-solving, and executive functioning. There may be a range of behavioral and emotional issues that also occur acutely and in the long term, including emotional lability, irritability, and other issues. ABIs also lead to significant family burden and stressors; therefore, family-focused problem solving and other cognitive-behavioral interventions for the child and family may be beneficial. Physical impairments may include problems with muscle weakness, coordination, spasticity, balance, and others depending on what areas of the CNS are affected. Medical issues related to the type and location of the ABI may also be an issue, especially seizures.

Because of the range of impairments and sequelae that may occur after ABI in children, it is crucial to monitor for impairments across a broad range of domains. It is also important to be aware of typical issues associated with certain types of ABIs and their associated treatments, e.g., chemotherapy side effects in the context of CNS tumors. As in all children, it is also important to monitor development over time and to screen for delays or when development does not continue at an adequate rate. For example, neurocognitive impairments may become more noticeable as children transition to school age and the academic demands increase. Overall, management approaches need to be tailored to the individual child in the context of the type of ABI, related sequelae, development, and their families. With many ABIs in children, it is critical that management include both short and long-term goals to optimize health, function, quality-of-life, and well-being over the lifespan.

References

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