Health Library

Traumatic Brain Injury in Children

Traumatic brain injuries occur when there is a direct or indirect blow to the head. They can include bumps and bruises, concussions, skull fractures and serious brain injuries.

Traumatic brain injury is a broad term describing a range of symptoms that can differ in severity. They can be mild (also known as concussion), moderate or severe.

Some traumatic brain injuries cause lasting damage. But most kids recover with no long-term problems.

The severity of a traumatic brain injury is determined by many factors. These include:

• A long loss of consciousness
• Certain neurological symptoms that happened at the time of the injury
• Memory loss about the injury and time surrounding it
• Abnormalities on head or brain imaging

What are the Common Signs and Symptoms of Traumatic Brain Injury in Children?

Traumatic brain injury signs and symptoms may vary. With moderate and severe traumatic brain injury, the signs and symptoms may be more significant. They may go from better to worse. They may last weeks, months or longer after the injury. This is a normal part of the healing process.

Physical

• Headache(s)
• Sensitivity to light
• Sensitivity to sound
• Nausea or vomiting
• Fatigue or sleepiness
• Dizziness
• Loss of balance or trouble walking
• Ringing in ears
• Double or blurred vision
• Numbness or tingling
• Loss of consciousness

Cognitive (Thinking)

• Feeling foggy or confused
• Slow thinking or slow processing
• Memory issues
• Unable to concentrate
• Poor judgment
• Falling behind in school

Emotional

• Irritability or fussiness
• More emotional than usual
• Sadness or nervousness
• Lack of interest or motivation in usual things
• Easily frustrated, angered or tearful
• Impatient
• Bolder than usual
• Outbursts
• Difficulty tolerating daily routine

Sleep

• Change in sleeping pattern
• Trouble falling asleep
• Trouble staying asleep
• Sleeping more than usual
• Sleeping less than usual

Signs and Symptoms for Moderate to Severe Injuries

• These symptoms are less commmon but are more likely with moderate to severe injuries
• Prolonged loss of consciousness
• Spasticity (muscle tightness)
• Muscle weakness
• Seizures
• More severe functional problem

How Are Traumatic Brain Injuries Diagnosed in Children?

Your child’s medical team will gather information on the history of injury and the symptoms after the injury. As part of your child’s injury assessment, your child will have a physical and neurological evaluation. The team will evaluate memory, thinking, mood, behavior, vision and concentration, as well as balance, coordination, muscle strength, reflexes and sensation. In some cases, an MRI or CT scan may be needed.

How Are Pediatric Traumatic Brain Injuries Treated?

The early treatment for a brain injury is a short period of rest. This is for the body and brain. This is followed by a gradual return to usual activities over time. Because all children and injuries are different, the treatment may also include one or more of the following:

• Behavioral Therapy: Behavioral therapy includes adherence strategies, cognitive behavioral therapy, coping skills training, biofeedback and exposure-based therapies for pain management. This also includes treatment of anxiety, depression and disruptive behaviors.
• Consultation with School Specialists: School specialists can help address post-brain injury symptoms in the school setting. They will help create a successful return-to-learn plan.
• Rehabilitation Therapies
  
  • Occupational Therapy: Occupational therapy focuses on improving skills related to vision, coordination, problem-solving and mental processing.
  • Physical Therapy: Physical therapy focuses on improving skills related to motor function, walking, balance, postural control, activity tolerance and management of musculoskeletal headaches.
  • Speech-Language Therapy: Speech-language therapy focuses on improving speaking, listening, reading, writing, social, memory, attention and problem-solving skills.
  • Balance Therapy: Balance therapy targets dizziness and balance problems. These can cause safety and mobility problems.
• Vision: Visual treatments help treat blurry vision, double vision, eyestrain, headaches and trouble with reading and computer work.

What Should I Expect After My Child’s Traumatic Brain Injury?

Returning to Activity

At first, your child should avoid activities that could worsen or increase their chance of injury. This includes physical education (gym) class, recess, sports, high-speed activities (like skateboarding or bike riding) or activities with a chance of falls or trauma.

The length of activity restrictions will depend on your child’s injury. Once your medical team feels it is safe to begin adding more activity to your child’s schedule, they will guide you on how to do this. Athletes will need to follow return-to-activity progression plans.

Returning to School

Most children can return to school slowly after a few days as their symptoms improve. It may take longer depending on symptom recovery. In general, if your child’s symptoms are getting better, try going to school for one or two hours. Advance to going for full days as tolerated. Talk with the school nurse or school point person to plan for your child’s return.

Plan a return to school with these things in mind:

• Consider partial days as needed
• Allow more time to complete assignments and tests
• Provide additional learning resources such as pre-printed notes or tutoring materials
• Allow a water bottle at school filled with sports drink or water
• Allow rest breaks as needed
• Allow more time to make up missed work
• Excuse the child from tests or quizzes until the child says they are ready

The school nurse or school point person should watch for:

• Problems paying attention or concentrating
• Problems remembering or learning new information
• Needing more time to do a task
• Not coping well with stress
• If your child is having trouble in school, talk to your child’s medical team.

Emotional Recovery

After a brain injury, your child may be tired, irritable or show a change in mood. It takes time to heal. Use this time for rest and quiet activities. Play board games, read or do small craft projects for short periods of time. Avoid screen time.

Infants and toddlers can be hard to distract and difficult to confine. Avoid activities that put your toddler at risk for falls, such as wheeled toys or playgrounds/jungle gyms.

After exposure to any traumatic event, some children may have symptoms of acute traumatic stress. If you notice your child having nightmares, flashbacks, nervousness, avoidant behaviors, irritability or any other concerning emotional symptoms, please talk with your medical team. Short-term therapy may be needed to help children heal and recover emotionally after trauma. Learn more about acute stress/post-traumatic stress disorder.

Medications and Pain Management

Tell your medical team what medicines your child was taking before their injury. Get approval to resume these medicines after their injury. Give acetaminophen (Tylenol) for pain or headache. Keep the use of medicine to treat headaches to a minimum. Using medicine too much can make symptoms worse. Medicine should not be used more than three times per week.

Your child's medical team may write a prescription for stronger pain medicine for other injuries. This medicine is not to treat headaches. Give the stronger medicine if the pain does not go away one hour after giving acetaminophen. Follow the directions on the prescription. Your child may need a stool softener to prevent constipation while taking prescription pain medication.

Do not give your child NSAIDs or Ibuprofen (also known as Motrin, Advil or Aleve) until cleared to do so in follow-up.

Follow-up Care

Your child’s follow-up will depend on the severity of their brain injury. Your medical team will talk to you about follow-up plans.

Your child will need clearance in follow-up to return to activities such as sports, physical education or recess.

How Can I Prevent My Child from Having a Traumatic Brain Injury?

It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate restraint every time they ride in a car. Children under 13 are safer in a backseat in the correct restraint.

Make sure your child wears the correct helmet when riding a bike, using other wheeled toys, or in other active sports. Make sure protective sports gear fits correctly.

When Should I Seek Emergency Care for my Child?

If you notice any of the following, your child needs to be taken to the emergency room immediately:

Changes in Behavior

• Difficult to wake up
• Infants with increased irritability and are unable to be consoled
• Does not recognize familiar people
• Unable to be comforted
• Uses confused speech
• Does not know where they are
• Not acting like usual self

Physical Changes

• Continued vomiting
• Weakness or stumbling
• Constant severe headache
• Seizures (shaking/twitching of the body)
• Double vision
• Blood or clear fluid draining from ears or nose
• Infants with scalp or head swelling