Pediatric Head Injury Considerations

Children under the age of four and teens between ages 15 and 19 are the two age groups at highest risk for TBI. During childhood, approximately one in ten children will experience traumatic loss of consciousness. In children under age ten, falls are the most common cause of head injuries. Motor vehicle accidents are the most common cause of head injuries in adolescents. Accidental falls are a major cause of morbidity and mortality in children and adolescents. The distance of the fall and the landing surface (concrete, sand, etc.) determine the severity of the injury. Children are more likely than adults to suffer a head injury related fall because of the proportionately greater weight of their head in relation to their body. In children under the age of four, more than 89% of fall-related injuries occur in the home. In the United States, among children and adolescents under 20 years of age, an average of 247 traumatic brain injury deaths and 140,000 head injuries were related to bicycle accidents. Wearing a helmet might have prevented as many as 184 deaths and 116,000 head injuries.

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A child’s brain is anatomically different than a fully mature brain. The pediatric brain is more susceptible to an acceleration-deceleration injury because it has a higher water content. It is difficult to predict how a child will recover from a traumatic brain injury. Cognitive and behavioral impairments may emerge over time as the brain matures. It may take months or years for the full impact of a brain injury to become apparent. A TBI can make it difficult for children to learn new skills. Sometimes, parents and teachers may not even recognize that an earlier brain injury is causing the student’s problems. After a TBI, it is important to plan for the child to return to school. Individualized educational programs (IEP) can be developed to address the student’s unique educational needs.

Sometimes after a pediatric brain injury occurs, the natural inclination of parents may be to overlook possible future consequences. This can occur not out of a lack of concern for the child, but rather, because of a sense of optimism, of wanting the child “to be okay, to be normal”. However, the failure to fully investigate the extent of a pediatric brain injury can have significant, even devastating, effects on a child’s future development. Left unrecognized and untreated by the application of compensatory measures, a pediatric head injury can result in difficulties in the adolescent and teenage years, including learning disabilities, emotional disturbances, difficulty in social interaction, promiscuity, substance abuse, and even psychiatric disturbances. Moreover, such problems can lead to adult difficulties in the ability to obtain and hold employment, establishing and maintaining interpersonal relationships, the creation and maintenance of healthy marital and family relationships, and the exercise of judgment and decision-making.