SEQUELAE OF PEDIATRIC TRAUMATIC BRAIN INJURY

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Traumatic Brain Injury (“TBI”) is a major health concern for children. Research on the short-term neurological effects of brain injuries has been substantial. Unfortunately, the studies regarding the consequences of pediatric TBI is limited, and thus data on longstanding benefits from interventions is as well. Erroneously, parents, educators and many health care providers measure recovery based upon baseline abilities, without recognizing that the developmental trajectory of children creates an advancing target.

While most children who sustain concussions do make a complete recovery, the heterogeneity of head injury makes those statistics relatively meaningless. In studies of large groups of children who have sustained head injuries, a significant cohort of subjects were found to suffer from that troubling impairments for a significant period of time post-injury. Choe MC et al, “Targeting the Epidemic: Interventions and Follow-up Are Necessary in the Pediatric Traumatic Brain Injury Clinic”, Journal of Child Neurology (2015). Among the difficulties are problems with attention that can affect a number of other domains including memory and executive function, as well as cause behavioral problems. Königs M et al, “Pediatric Traumatic Brain Injury and Attention Deficit”, Pediatrics (2015). These problems occur even in the context of mild traumatic brain injury in the absence of radiographically confirmed pathology.

Overall, young children appear to sustain worse sequelae, both cumulative and ongoing, than those of older children and adults. The interruption of the normal developmental trajectory limits the acquisition of skills and knowledge that often has a compounding impact on future skills and creates a disadvantage relative to age matched peers.

Unfortunately, there are no established protocols regarding ongoing care of children who have suffered TBI, and the absence of guidelines likely contributes to poorer outcomes. Compounding the limitations of rehabilitation is the generalized limit on the adequacy of training received by the primary care provider for most children – the pediatrician. A recent survey showed that nearly one in three children suffering from a brain injury still have unmet health needs 12 months after injury. Thus it is important that primary services for concussion involve a provider knowledgeable in the field of neurological injury of children.
Appropriate therapy following an acquired pediatric head injury can include some combination of rest and exercise; medication; physical, occupational and/or speech therapy; education support; and psychological therapy for the patient and the family. It is important that parents, educators and health care providers closely monitor the child’s physical, cognitive, emotional and behavioral well-being.
By Stewart M. Casper. Posted August 5, 2015

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