Making Connections Between a TBI and Later Developmental Issues
Pediatrician Rachel Berger talks about the importance of parents and doctors being aware of a child's early concussion in case later he or she has trouble reading or is acting out ... the two may be connected.
See more videos with Dr. Rachel Berger.
I think that a lot of people have this perception that it's better to have a brain injury when you're a child. But in fact, that's probably not at all true, and for most kinds of brain injuries that we see-- which are more diffuse injuries--that's not true at all. I think one of the issues is how long it takes a brain injury to manifest itself, and we often tell parents who bring their child in--who's 2, who falls down a flight of stairs-- we'll say to them everything looks fine. The CT looks fine. But if your child injured the part of their brain they need to read, you may not notice that until they need to learn to read. Because at 2, it's not developmentally appropriate to know how to read. Sometimes--and you need to expect that--you may not see anything for quite some time. The other example to give as executive function is where it's totally normal for a 2-year-old to blurt out whatever they're thinking at the time, and that's normal for a 2-year-old. But if they're 9 and they're still blurting out whatever they're thinking in their head, then it's no longer normal; and so I think the most important thing is to let parents be aware that they may not see everything right away. The ones we worry about more are children who were admitted for injuries-- admitted to the hospital, have CT's that are normal, and so parents are often very comforted. Oh, well, they're completely fine, and we try to explain that a normal CT does not mean you're fine. We really don't know. How many children fall down stairs? Probably every child falls down a flight of stairs once. Do all those children have brain injuries? Probably not. So, I wouldn't want to get parents concerned that every time your child falls down the stairs they may have a brain injury. The ones that we're aware of are usually the ones where children are admitted to a hospital. They lose consciousness, but the imaging that we have is normal. Those are the kids we get more concerned about. Or there are very mild abnormalities on a brain MRI but the children seem to be fine. Those are the ones that probably need to get followed much more closely, or for people at least to be aware that there may be a problem. It's important for parents to make that connection and also for medical care providers to make that connection. We've seen children who come in for behavioral problems. And I'll get a copy of the medical record, and it will turn out they nearly drowned when they were 3 years old, or they had brain injury that people knew about-- but now that they're coming in and they're 11 or 12-- neither the parent nor the medical provider is making that connection. Sometimes it's just being aware that you probably need to make that connection between those 2 problems.
Posted on BrainLine January 9, 2013.
Produced by Victoria Tilney McDonough and Jared Schaubert, BrainLine, and Dan Edblom.
Rachel Berger MD, MPH is part of the Child Advocacy Center at Children’s Hospital of Pittsburgh and a member of the hospital’s Child Protection Team. She has been involved in the evaluation of thousands of children with suspected child abuse and neglect.