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Taking Care of Young Children who Experience Traumatic Brain Injury

Categories: Being a Caregiver

By Juliet Haarbauer-Krupa, PhD, FACRM

Department of Pediatrics, Emory University School of Medicine

When describing young children’s brains, people will often say things like “their brains are ‘plastic,’” and assume they will be “fine” after a traumatic brain injury (TBI). However, research is now finding that TBI or concussion in infants, toddlers, and preschool children can have lasting effects.

Young children are prone to falls and, because of this, may experience a TBI. Children younger than 5 years old have the highest incidence of emergency department visits for children with TBI at a time when they are just beginning to develop their cognitive, motor, and sensory skills. We are learning that signs and symptoms reported in young children during the clinical assessment are different than those observed among older children since their symptoms are typically observed and reported by parents.

Symptoms of Pediatric TBI

Recent reports describing symptoms in young children include:

  • Sleep issues
  • Increased irritability
  • Crying
  • Vomiting
  • Toilet training regression
  • Decreased appetite
  • Changes in sleeping patterns
  • Seeking more comfort than usual, such as needing to be held
  • Changes in speech
  • Refusal to play or engage in usual activities
  • Headache

The effects of early childhood TBI can include higher prevalence of chronic health conditions, education and therapy needs, and functional difficulties such as changes in activity participation and poor coordination.

For children with mild TBI, also known as concussion, it is possible that effects can disappear within a few weeks or months, with minimal risk of consequences for overall development.

Although studies examining long-term outcomes of young children are limited, we are learning that preschool children can have a more protracted recovery of symptoms and long-term cognitive and behavioral changes. As preschool-age children who experience TBI mature, they display differences in the rate of skill acquisition compared with children developing typically, especially with regard to communication:

  • First, the nature of the injury has effects on the developing brain in areas of language and cognition.
  • Second, reduced cognitive and language processing skills, well-documented effects from TBI, can affect language learning, particularly in areas of vocabulary and semantic development and behavior.

Although side effects of TBI or concussion can resolve as early as one to two months postinjury, deficits can emerge over time, indicating an impact on more complex skills as the child grows.

Education and Prevention

Providing TBI education and supporting caregivers and teachers of young children is critical for this age group, not only to address the child’s medical and educational needs but also to recognize the unique challenges families face. Education is also needed for emergency department and pediatric physicians about diagnosis, informing parents and caregivers about treatment and best practices, and follow-up.

Prevention efforts that target environmental changes, along with parental supervision practices to reduce fall risk, are also needed. Professionals in contact with caregivers of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls.

Some steps parents and caregivers can take to reduce the risk of children falling include:

  • Reducing clutter on floors
  • Protecting children from hazards with barriers, such as safety gates on stairs, guards on windows above ground level, and guard rails on beds
  • Supervising children around fall hazards such as stairs and playground equipment

References

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If you have any questions about brain injury in children or are looking for resources, the National Brain Injury Information Center (NBIIC) can help. You can reach the brain injury specialists at NBIIC by calling 1-800-444-6443 or filling out the contact form here.