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Traumatic Brain Injury in Children: Signs, Symptoms and Preventive Measures 

January 26, 2024 by Anindita Chaudhuri, Psy.D., NCSP

Traumatic Brain Injury (TBI) may occur when the human brain suffers trauma due to the impact of an external mechanical force on the head or skull. The Centers for Disease Control and Prevention (CDC) states that an acquired brain injury may be caused by “a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.” Each year, nearly half a million children suffer from TBI. The impact varies with the nature and severity of the TBI but usually results in physical, cognitive, emotional and behavioral difficulties following the injury. Falls account for most cases of TBI with the highest rates occurring in children aged 0 to 4 as well as in older adults. Although traumatic brain injury can result from various causes, sports have been recognized as a significant factor in the occurrence of TBI with higher incidence rates in males under the age of 18. Research has shown that children with TBI have an increased risk of developing behavior problems with both externalizing symptoms (such as increased aggression) and internalizing symptoms (such as depression and anxiety) in addition to other symptoms of Conduct Disorder. Other factors such as existing pre-injury behavior problems, age of injury, gender and overall family functioning are also thought to contribute to the development of behavioral problems post-TBI. Additionally, the severity of the TBI is thought to be associated with post-injury psychiatric disorders, which include personality changes, problems with anxiety, depression, inattention, hyperactivity and oppositional behaviors, among others. Moreover, behavioral problems post-TBI are also associated with poor academic functioning, adverse social outcomes and delinquency. Clearly there is a lot at stake when it comes to taking a closer look at and preventing TBI. 

Implications for School Functioning related to sustaining TBI: 

TBI sustained in early childhood (6 years of age and below) is usually associated with poorer outcomes across several behavioral, cognitive and educational domains. Pediatric TBI is also typically associated with executive functioning deficits that include problems with attention, cognitive flexibility, goal directed behavior and information processing. The development of executive functioning begins early and continues through childhood, maturing through adolescence into young adulthood. Executive functioning and problem-solving skills are important and help children succeed academically, socially and behaviorally. Thus, an early sustained TBI can disrupt this process and create lasting and severe repercussions for children. A TBI is likely to result in negative effects on overall functioning in school aged children. Executive functioning deficits are also associated with poor social skills and poor social outcomes in young adults sustaining a TBI in late childhood or early adolescence (8 to 12 years of age) suggesting that the effects of TBI are detrimental and pervasive, affecting overall everyday functioning. Current research on early childhood TBI provides evidence of persistent effects, particularly among younger children with more severe injuries. 

Short and Long Term Effects of TBI in children: 

Traumatic Brain Injury is typically associated with significant impairments within the domains of cognition, achievement, language processing, attention problems, executive functioning deficits and problematic behavior following the traumatic event. Poorer outcome measures have been related to difficulties with disinhibition, irritability, anger, aggression, social deficits, withdrawal and depression among other similar effects following a TBI. Research in the field suggests that externalizing behaviors are more commonly seen in children following TBI, while a TBI sustained at younger ages (6 and younger) at the time of the injury predicts a higher incidence of internalizing symptoms. Several treatment approaches following TBI may be adopted to ensure better outcome measures and prognosis in the long term. Treatment approaches may include psychoeducational information, cognitive remediation, behavioral approaches, family-centered treatments, positive behavioral supports and medication. The nature of the intervention depends on the nature and severity of the TBI and the consequence. Other research in the field has suggested that direct attention training, specific treatments of visuospatial deficits, long term cognitive therapy and learning of compensatory techniques may be successful interventions in general. 

Each year, nearly half a million children suffer a Traumatic Brain Injury. TBI is also reported to be the most common cause of death and long-term disability in children under the age of 15 years. Taking steps to ensure safety is likely to prevent more incidents of TBI. 

Brain Trauma Symptoms to watch out for: 

Children are likely to need immediate care if they experience a head injury with a loss in consciousness or amnesia and have any of these symptoms: 

Changes in attention span, cognitive functions, language or memory functions, experience headaches or fatigue, impairments in balance accompanied with changes in sleep patterns, mood changes, increase in anxiety, aggression and impulsivity, muscle weakness and other motor deficits, nausea and vomiting with vision changes and increased sensitivity to light. 

Additional symptoms associated with severe TBI may include: 

Dilation of pupils, draining of clear liquid from eyes or nose, marked confusion, slurred speech, and seizures accompanied with numbness in extremities. 

These symptoms may appear immediately or set in after days or weeks and linger for weeks or even months after injury. While returning to their usual activities, they may need accommodations at school as they heal. 

Some Preventive Measures: 

It is important to note that trauma to the head may be avoidable in many instances. Some safety recommendations for young children may include installing safety gates at the top of staircases, installing window guards, securing area rugs, securing heavy furniture and removing other objects in and around the home, supervising young children at all times, using non slip mats in tubs and showers, using safety restraints in cars and keeping sharp objects, such as knives, out of reach and locking up guns in the house. 

While sports and an active lifestyle are encouraged, some recommendations outdoors may include avoiding playgrounds with uneven and hard surfaces while cycling and skateboarding, not sliding head first while playing baseball, skipping sports related activities when feeling tired or ill, obeying traffic signals when playing on roads, supervision of children when using sports equipment, such as bats and hard balls, and wearing safety helmets or protective headgear at all times when involved in sports. 

Anindita Chaudhuri, Psy.D., NCSP

Dr. Anindita Chaudhuri earned her Psy.D. in school psychology from the Graduate School of Applied and Professional Psychology at Rutgers University, specializing in Clinical Child Adolescent Family and Pediatric Psychology and Multicultural Psychology. Dr. Chaudhuri is also a certified school psychologist and has worked with children and adolescents in schools for several years.

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