Peter G. Rumney, MD, FRCPC
Physician Director, 24 Hour Rehab & Complex Continuing Care
Holland Bloorview Kids Rehabilitation Hospital
What are the signs and symptoms of brain injury in Children?
Brain injury presents with the same signs and symptoms of adults with the acute changes affecting an individual’s alertness, memory, and the ability to process information. Depending upon the severity of the injury from mild traumatic brain injury and concussion through to the most severe, you can have the entire range of motor and cognitive problems develop. Most commonly, however, traumatic brain injury will lead to problems with attention, speed of information processing, short-term memory, and word recall. But, there may be specific problems that relate to small areas of the brain that have been injured. This could be either from blood clots, tumours, or strokes.
Children, however, do seem to recover physically in a quicker and more effective way than young and older adults do. And so it appears that the recovery is better. The reality is that the cognitive effects of the traumatic brain injury are in fact amplified by their young age. Therefore, the younger you are, the cognitive and neurobehavioural outcome is likely to be long-term.
What impact can age have on brain injury?
As stated in the previous questions, the younger you are the worse the outcome can be. This is because the injury is occurring to the brain and the traumatic brain injury affects your ability to learn new information rather than affecting your ability to retain old information. Young children are just starting out their academic learning career and if they have an acquired brain injury, it affects the efficiency of their learning, or their speed and effectiveness of learning. This puts them at a real disadvantage over the long-term in comparison to adults who with a similar brain injury will have retained a great deal of old information that they have already learned and can build upon.
How do brain injuries differ in children and adults?
Apart from the developmental changes that I have just discussed, we also know that an infant’s brain in physically softer, the blood vessels are more friable, or easily torn. The brain does not have myelination, the insulating material around the nerve fibres. This means that in the case of traumatic injury, often the impact is worse physically on the brain tissue than it would have been for the older child or adult. Also, the relative size of the head in children to their body is dramatically greater than the size ratio in adults. This, therefore, puts the head at a mechanical disadvantage in the case of trauma.
What are some of the behavioural and emotional changes that might appear in adolescents, after a brain injury?
Similar to adults, there are often issues relating to attention and concentration. This might result in the person being more impulsive and more distractible. With frontal lobe trauma, they will often have reduced ability to control impulses and reduced ability to learn to modulate their responses. In other words, there is a reduced ability to inhibit inappropriate behaviour. As a result of the changes in learning, children often become quite frustrated with school. This is because they are not achieving and developing at the same rate as their peers. They also will have a perfect recollection of who they were before the trauma and so they will be quite frustrated at the change and their challenges at school.
What are some of the behavioural and emotional changes that might appear in children after a brain injury?
Adolescence is the time when an individual is trying to establish their identity as they mature. It is extremely important that an adolescent be part of a group and identify with a group. The brain injury often makes it very difficult, for this often affects their ability to keep up socially from a cognitive standpoint. It makes them different when it comes to learning and success in school. They often need extra help, which identifies them as different. As well, the frontal lobe is beginning to mature and so any damage to the frontal lobe in childhood actually becomes more evident and more problematic during adolescence. This is because thinking styles and behaviour styles that are immature are quite acceptable in young children, but less acceptable and more problematic as you become a young adult.
How do parents adjust and handle these new behaviours?
The increased impulsivity, agitation, social disinhibition, anger and frustration can be very trying for all family members, parents and siblings the like. This is extremely stressful to the families. Often support in the way of counseling, education, and respite can be extremely helpful for the individuals and for their family members.
How can parents educate family and friends about their child’s brain injury?
Clearly, discussing the brain injury is quite important. Friends and family members, where appropriate, should be directed to resources that objectively describe the traumatic or acquired brain injury and their affects. Such resources are available through the brain injury associations and through numerous professional websites. It is very important to sit down and discuss and answer questions about the individual themselves i.e. how it affects them, as well as how it affects their family and their school. It is important to demystify the process; underscoring that brain injury changes the way someone may think or learn, but does not negate the ability to think or learn, or behave appropriately.
How do parents deal with the siblings of a child with a brain injury?
Raising children when one child is disabled in any way often focuses a great deal of energy and attention on the disabled child. This detracts from the non-disabled child. Ensuring that parents spend time with all their children individually, getting to know them, getting to develop their relationships, is extremely important. They should be taught about the brain injury and how it has affected their sibling and why they may be asked to take on greater responsibility, and why the parents need to spend so much time with healthcare and rehabilitation professionals.
Support groups for siblings and family members of survivors of acquired and traumatic brain injury can be extremely helpful in sharing this information. More importantly, they can teach the individuals that they are not alone and that others are dealing with similar challenges.
How can parents prevent the incidence of a second brain injury?
Preventing a second brain injury is also quite important. Prevention is the best treatment for all traumatic brain injury. The risk of concussion should be minimized. This would include wearing helmets in sports where someone is travelling at a speed faster than they can run (cycling, rollerblading, using a scooter, riding a bike and tricycle, even starting with a wagon). They should wear helmets with downhill skiing. They should avoid high risk sports i.e. full contact hockey, rugby, football. These also include any of the martial arts where blows to the head are allowed, such as boxing, kick boxing, and mixed martial arts. They should avoid the use of trampolines in the home, bungee jumping, and unsupervised use of motorized equipment, such as minibikes, motorcycles and snowmobiles; below the age of fourteen. A sample of the activity restriction guidelines are available through the Holland Bloorview Children’s Rehabilitation Hospital website for download, if individuals are interested.