Traumatic Brain Injury in Children
Traumatic brain injury (TBI) has been one of the primary public health problems under health concerns over several decades. Health statistics reveal that this problem has been common among the male adolescents, as well as the young adults under the age bracket of 15 to 24 years. Similarly, this disorder is common among the elderly people of both sexes under the age of 75 and above. However, this paper is of high concern about children of ages 5 and below, or 5 to 18 years, who are at high risk of traumatic brain injuries. TBI is among the leading causes of death and acquired disabilities among infants and children.
Traumatic brain injury is an acquired injury to an individual’s brain resulting from an external physical force exerted on the head, leading to partial or total disability and/or psychological impairment. This scenario may adversely impact on a child’s educational performance. This term TBI does not apply to degenerative or congenital brain injuries, or any induced brain injuries during birth trauma. It applies to any closed or open head injury that results to impairments on any body part (Fenwick, Manly, Anderson & Robertson, 2012). Such impairments may relate to language, cognition, memory, reasoning, attention, judgment, abstract thinking, speech, problem solving, sensory and motor abilities, physical performance, and psycho-social behavior of a child. TBI can thereby change how a child acts, moves, thinks and performs in the course of learning.
Motor vehicle accidents, falls, and playing with risky objects are the common contributing factors for unintentional causes while child abuse and assaults during infancy, young age, and adolescence ages are the ill-fated causes of TBI. Many research and health institutions thereby focus on limiting the primary brain injuries and minimizing the secondary brain injuries (Lazar & Menaldino, 2009). Today, many health institutions, understand the importance of a healthy brain and its traumatic responses. However, health research institutions still have much to do in order to understand the treatment and how to reverse the damage that results from head injuries (Porr, 2012).
Whereas the symptoms of brain injuries among the children may be similar to those experienced by the adults, the impact may be very different in terms of functionality (Povlishock & Christman, 2003). This is because the brains of children continuously develop as opposed to those of adults. In the past, people had an assumption that children with brain injuries would recover quicker and better than the adults due to the “plasticity” in younger brains. This cliche is no longer functional. The most recent health researches on brain injuries reveal that brain injuries in children has more devastating effects than brain injuries of similar severity within the mature adults. The perceptive impairment symptoms on children may take longer to appear, but may be apparent as the child grows into adult age. Lazar and Menaldino (2009) affirmed that such delayed impacts may lead to lifetime challenges on physical performance, learning, as well as the social life. The greatest challenge facing lots of children with brain injuries involve changes in formal social behaviors, and the ability to think and learn.
Mutual deficits upon brain injury may include impaired judgment, difficulty in reasoning and processing information. In adults, these deficits may become apparent just in months after the brain injury. On the contrary, the injury deficits may take years to become apparent, after which the impact advances to be so treacherous. At the time of damage incidence, the child may only show cranial fractures, contusions, cranial nerve injuries, intracranial or extra-parenchymal hematomas, and edema (Povlishock & Christman, 2003). Hematoma is damage to the blood vessel in the head region. After the head injury, cerebral damage may become secondary to the injury complications or primary to the trauma. The secondary damages encompass the subsequent insults after the impact or insults during the process of emergency medical interventions. The primary cerebral damage commonly becomes permanent; however, both of the damage types may result into limitations of body functional outcomes (Lazar & Menaldino, 2009).
Most of the primary focal injuries are temporary and frontal amongst children. A clinician may use a computer tomography scan after an injury in order to predict the degree and types of the subsequent functional limitations. Using the magnetic resonance imaging of the corpus callosum and brainstem, the clinician can identify the diffuse axonal injuries (DAI). These injuries are as a result of shearing forces during the time of impact and may also result into augmented intracranial pressure, edema and denervation hypersensitivity (Povlishock & Christman, 2003). A child’s brain tissues develop differently as compared developments within adults’ brain hence; young children and infants are always vulnerable damages caused by the secondary trauma. The complications involved in secondary trauma include cerebral edema, cerebral swelling, hematomas and vasospasm, which subsequently result into increased hypoxia, hypotension, ischemia, and increased intracranial pressure.
Immediately after the traumatic period, pressure necrosis, infarction, and herniation may occur. According to Hall and Cope (2007), damages from such secondary complications are more diffuse in children than in adults and may resolve during the rehabilitation and recovery period of a child. According to Lehmkuhl, High and Boake (2008), it is commonly advisable for parents of children recovering from traumatic brain injury to refer their children to rehabilitation services of any kind. In adolescent children with TBI, the most commonly observed, functional limitations are in the areas of speech, vision, self-feeding, hearing, dressing, bathing, walking, behavior, and cognition (Hall & Cope, 2007). During childhood, traumatic brain injury may have long-term effects on psychosocial and cognitive functioning; including unsatisfactory academic achievements resulting from significant deficits in the child’s working memory.
TBI may exhibit a wide range of both physical and psychological symptoms. As in adults, the signs and symptoms among children may be moderate, mild, or severe, depending on the magnitude of the brain damage. Some of these symptoms may be apparent immediately upon the traumatic event, whereas other signs and symptoms may become apparent days, weeks, months, or years later. A child with a mild traumatic brain injury may experience loss of consciousness or remain conscious over a given duration. In both children and adults, the mild traumatic brain injury may exhibit symptoms such as confusion, headache, dizziness, tired eyes, blurred vision, loss of appetite, fatigue, mood swings, change in sleeping patterns, and troubles with thinking, attention, memory and concentration.
Nonetheless, young children and infants may lack appropriate communication skills to report some of these feelings, such as sensory problems, headaches, and confusion. Most of the TBI’s signs and symptoms will thereby be apparent through observations and visualization (Lehmkuhl et. al., 2008). Some of these observable symptoms include change in nursing and eating habits, easy or unusual irritability, persistent crying, inability to pay attention, depressed moods, change in sleeping habits, and loss of interest in activities or favorite toys. These signs and symptoms may vary depending on the injured part of the brain and the level of severity.
Children who are capable of communicating and expressing their feelings and ideas are at a higher position of exposing the signs and symptoms of the TBI. According to Jennings and Blaskey (2013), they can show their physical disabilities hearing, speaking, seeing, and using other senses. They can communicate their feelings of headache and fatigue. When walking, parents, health doctors, or any other person can be able to see their difficulties in movement due to a paralyzed body or body part. Following the brain injuries, it is general that the child’s ability to utilize their brain will change drastically (Kinsella, Prior & Sawyer, 2006). The child may have problems with the short-term memory (the ability to remember from one minute to another). Similarly, the child may suffer from trouble of long-term memory (the ability to recollect information from a while ago). Kinsella et al. (2006) assert that these memory troubles may lead to forgetfulness of what the teacher just taught in class or the facts learnt from the previous lessons. The child will always be able to focus attention just within a short time or completely losses concentration, either at home or in class.
Children with TBI will always experience social troubles when interacting with fellow children since they commonly undergo sudden changes in anxiety, moods, and depression. They may laugh or cry a lot, lack control over their emotions, and sometimes become restless. It is thereby essential to understand that during growth and development of a child, both teachers and parents may be able to notice the child’s problems. This is because they both have high expectations on these children to use their brains in developing new skills and useful knowledge. However, it may be challenging for parents and educators to notice some of the problems related to TBI at earlier stages. The problems can then develop gradually to affect the child in learning and to develop such new skills (Fenwick, et al., 2012).
One of the most common but minor type of traumatic brain injury is the concussion. Technically, concussion is short-term loss of consciousness as a result of head injury. After an injury, a child may lose consciousness, seem dazed, or have a seizure. The symptoms occur immediately after the concussion and even some few days or weeks later. Concussion symptoms may be hard to notice since some children may act to be fine even if they are in traumatic brain troubles. During diagnosis of concussion, a child’s caregiver may check the child’s eyes, memory, strength of the child’s arms, and legs. Jennings and Blaskey (2013) elicit that this check (neurologic exam) may be sufficient to tell the caregiver how well the child’s brain works. Similarly, an X-ray of the child’s neck and the head may help in checking extra injuries.
Porr (2012) affirms that upon complete examination, TBI doctors commonly issue instructions on a child’s medications on the traumatic brain injury. Ibuprofen and/or acetaminophen are the commonly recommended medicines given to reduce a child’s pain from TBI. Use of ice on the child’s head for 15 to 20 minutes; two hours a day may help in reducing pain and swelling of the child’s head, as well as preventing further tissue damages (Fenwick, et al., 2012). After concussion, a child may take a rest on the bed or play quietly if one has to do so. Activity restriction is another method for managing a child’s TBI conditions and symptoms (Jennings & Blaskey, 2013). The child may be restricted from playing or involving in activities that may lead to a blow on the head.
In conclusion, traumatic brain injury is one of the leading causes of acquired disability during childhood. Therefore, parents, clinician, educators should be aware of the potential damages to a child’s brain; both immediate and late symptoms on a child. It is thereby recommended that the government, in compliance with the health sectors should encourage education for families and specialists about the impending challenges of TBI on children. This should cut across from moderate to mild injuries on a child’s brain. Through this education, both parents and educators will be able to acquire knowledge on how to tackle the traumatic brain injuries on children; its preventions, treatment, and symptom management.
Fenwick, T., Manly, T., Anderson, V. & Robertson, I. (2012). Attentional skills following traumatic brain injury in childhood: A componential analysis. Journal of Brain Injuries,
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Hall, K., & Cope, D. (2007). The benefit of rehabilitation in traumatic brain injury: A literature review. Journal of Head Trauma Rehabilitation, 26 (10), 1 — 13.
Jennings, M. & Blaskey, J.(2013). Traumatic brain injury: Decision making in pediatric neurologic physical therapy. New York, NY: Churchill Livingstone.
Kinsella, G., Prior, M. & Sawyer, M. (2006). Indicators and predictors of academic outcomes in children two years following traumatic brain injury. Journal of the International
Neuropsychological Society, 8(3), 108 — 116.
Lazar, M.R., & Menaldino, S. (2009). Cognitive outcome and behavioral adjustment in children
following traumatic brain injury: A developmental perspective. Journal of Head Trauma
Rehabilitation, 14(10), 55 — 63.
Lehmkuhl, L.D., High, W.M. & Boake, C. (2008). Critical analysis of studies evaluating the effectiveness of rehabilitation after traumatic brain injury. Journal of Head Trauma
Rehabilitation, 103(10), 14 — 26.
Porr, S. (2012). Children with traumatic brain injury; pediatric therapy: A systems approach.
Philadelphia F.A. Davis.
Povlishock, J. & Christman, C. (2003). The pathobiology of traumaticallyinduced axonal injury in animals and humans: A review of currentthoughts. Journal of Neurotrauma, 74(12),
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