Statistics | Symptoms | Recovery | Concussion in Children | Child Abuse | Prevention

Statistics

Traumatic brain injury (TBI) is the leading cause of disability and death in children and adolescents in the U.S. According to the Centers for Disease Control and Prevention, the two age groups at greatest risk for TBI are age 0-4 and 15-19.

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

  • 62,000 children sustain brain injuries requiring hospitalization as a result of motor vehicle crashes, falls, sports injuries, physical abuse and other causes
  • 564,000 children are seen in hospital emergency departments for TBI and released.

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

  • 2,685 deaths
  • 37,000 hospitalizations
  • 435,000 emergency department visits

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

Symptoms

 

Physical Impairments Cognitive Impairments Emotional Impairments
 speech short term memory deficits 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. With early diagnosis and ongoing therapeutic intervention, the severity of these symptoms may decrease in 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.

Recovery

What makes a brain injury in children different?

While the symptoms of a brain injury in children are similar to the symptoms experienced by adults, 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 obvious after the injury but may become apparent as the child gets older and faces increased 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 children may have lifelong physical challenges. However, the greatest challenges many children with brain injury face are changes in their abilities to think and learn and to develop socially appropriate behaviors.

Common deficits after brain 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.

Concussion in Children

Concussion in children is common. Parents often ask, “When it is safe for a child to return to play or other activities?” and “How can I help my child recover from a concussion?”

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 assessment can be difficult. Young children may have the same concussion symptoms as older children, but they do not express 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 should keep this in mind when considring the presence of concussion symptoms listed below. When in doubt, refer a child for immediate 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:

  • Vomiting
  • Headache
  • Crying and inability to be consoled
  • Restlessness or irritability

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 symptoms to determine if further evaluation is needed. The follow-up visit can also provide an important opportunity for discussion of age-appropriate injury prevention to minimize 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 county’s developmental program for young children. This is 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:

  • Excessive crying
  • Persistent headache
  • Poor attention
  • Change in sleep patterns

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.

Child Abuse

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

  • Approximately 1,400 cases of abusive TBI (including concussions) occur in the U.S. each year.
  • Injuries resulting from abusive TBI and other types of child maltreatment are often unrecognized or underreported.
  • Recognition of abusive TBI in young children is critical. If children are returned to a violent home, they are at very high risk of being hurt again or killed.
  • In any young child with injury to the head, it is imperative to assess whether the history provided for the injury is developmentally appropriate for a child that age. If not, it is important to consider child abuse in the differential diagnosis.
  • In some cases of abuse, caretakers do not report a history of any trauma either because (a) they do not know that there has been trauma because it is being inflicted by someone else without their knowledge or (b) because they don’t want to tell. As a result, if an infant or young child presents with the signs and symptoms listed above, it is important to consider the possibility of abusive TBI even in the absence of a history of trauma.
  • Seizures
  • Dizziness or confusion
  • Change in personality
  • Change in nursing or eating habits
  • Becoming upset easily or increased temper tantrums
  • Sad or lethargic mood
  • Lack of interest in favorite toys

Source: Centers for Disease Control and Prevention’s Toolkit for Physicians

Prevention

To reduce the risk of sustaining a TBI, individuals should:

  • Wear a seat belt every time they drive or ride in a motor vehicle.
  • Buckle children the car using a child safety seat, booster seat, or seat belt according to the child’s height, weight and age. Children should start using a booster seat when they outgrow their child safety seats, usually when they weigh about 40 pounds. Children should continue to ride in a booster seat until the lap/shoulder belts in the car fit properly, typically when they are approximately 4’9″ tall.
  • Wear a helmet and make sure children wear helmets that are fitted properly.
  • Make sure playground surfaces are made of shock-absorbing materials, such as hardwood mulch or sand, and are maintained to an appropriate depth.
  • Use the right protective equipment and make sure it is maintained properly.
  • Make living areas safer for children by:
    • Installing window guards to keep young children from falling out of open windows;
    • Using safety gates at the top and bottom of stairs when young children are around;
    • Keeping stairs clear of clutter;
    • Securing rugs and using rubber mats in bathtubs; and
    • Not allowing children to play on fire escapes or on other unsafe platforms.
    • Make sure playground surfaces are made of shock-absorbing materials, such as hardwood mulch or sand, and are maintained to an appropriate depth.

Sources:
Brain Injury Association of America