Making a Difference #5: Brain Injury in Children

Module 5:Brain Injury in Children Severity of Injury Common Myths The impact of brain injury in children can be somewhat different than it is in adults. One of the things that tends to happen is that it will frequently derail the development process, so that as a child becomes injured at a certain place and time, their regular developmental milestones that would typically continue to occur in a normal child may become delayed or actually never really fully develop. The problems may really go unnoticed until the child starts to have problems in school. So, for example, if a younger child--a 2- or a 3- or a 4-year-old-- has a brain injury prior to going to school, sometimes some of the effects of that brain injury will not actually become apparent until they go to school. Because this is where they begin to be asked to be able to sit still, pay attention, begin to memorize information, begin to use their speech more, and there are more demands being made on them. They're also sitting in environments with a lot of other children, and there's lots of stimulation going on. Brain injury in children, especially concussions, is often unidentified. And frequently parents are unaware of how even a brief loss of consciousness or brain injury will affect the development of their child. Approximately 2,000 Texas children are permanently disabled by traumatic brain injury each year. During the 2002-2003 school year, only 1,119 Texas students received special education services in traumatic brain injury. What I would like to talk to you about now are the different levels of severity of brain injuries. Mild brain injuries account for 75-90 percent of all brain injuries. In this type of injury, individuals have a loss of consciousness of usually less than 20-30 minutes. One of the things that people don't understand is that normal concussion is a mild brain injury. So, for instance, if your child is playing football, and they have what we typically refer to as "getting their bell rung," or they kind of seem disoriented for a few minutes but never even lose consciousness, this is still a concussion. You can sustain a concussion without loss of consciousness. Most people will recover within hours or days following a concussion or a mild brain injury. However, a small percentage of the people may have problems over time, and some of these problems can include headache, attention problems, some short-term memory problems, some fatigue, and some emotional difficulties. One of the things that you want to be aware of with mild concussions is that they are cumulative over time. So if your child sustains a concussion while they are playing a sport, it is probably not a good idea to let them go back out and play that sport again, at least not for 6 months or a year. And even after that, if they continue to sustain concussions, these things accumulate over time and their injuries will become more severe with each concussion that they sustain. The next type of brain injury is the moderate brain injury. 8-10 percent of all brain injuries fall in this category. For someone to have a moderate brain injury, usually the loss of consciousness is less than 6 hours. Typically, 3 months post-injury or after the injury has occurred, at least two-thirds of these individuals have not returned to work. 35-50 percent will have residual problems over their lifetime. Some of these problems can include sexual difficulties, memory problems, problems controlling their temper, or with their planning and organizational skills. A severe brain injury is the last category. Fortunately, less than 10 percent of all injuries fall in this category. This is where somebody's loss of consciousness is 6 hours or more. Oftentimes what you hear referred to as someone in a coma is someone who has had a very, very severe brain injury. With this type of injury, you can have cognitive problems, emotional and behavioral problems, and physical problems. These people frequently become very socially isolated. They often have very significant psychiatric problems. And this is the group of people that are likely to have the long-term impairments that we typically associate with brain injury. Traumatic brain injury accounts for more years of lost productivity than any other type of injury. More than 5,700 Texans are permanently disabled by traumatic brain injury each year. One of the things that I would like to talk to you about now are the myths about brain injury. I believe that brain injury is very, very misunderstood, partly due to the fact that television and movies do not portray the effects of brain injury very realistically. One of the major myths associated with brain injury is that when someone has visibly healed and that their physical problems are completely healed that is a sign that the brain has healed. And in reality, that is not true. The cognitive and behavioral effects of a brain injury can last long after the person has healed on the outside. Another myth is that younger children are more resilient and can therefore bounce back easier and more quickly from a brain injury. However, in reality what is really going on is that it may just take longer for the effects of a brain injury to show up in a growing and developing brain. Another myth about brain injury is about mild injuries. Many people believe that a mild brain injury has no long-term effects. However, in reality even with a loss of consciousness of less than 60 seconds, or a very mild concussion, both of these types of injuries can result in diffuse axonal injury. We know this because we've seen this on autopsy. And this is something that many people do not understand about a mild brain injury. Finally, one of the biggest myths about brain injury is that time heals. This is primarily because television and movies do not depict the residual effects of brain injury. In reality, there is no cure for a brain injury. Individuals who have sustained a brain injury need a tremendous amount of help. They need rehabilitation, They need all types of services. Oftentimes it is very difficult for them to be able to find all the services. Their families have trouble finding these services. But this is the only thing that will help these people learn to be able to adapt and live productive, healthy, and useful lives. Hopefully this presentation will have helped you understand more about the causes of brain injury and how these injuries can affect people's lives every day. It is incredibly important for these people to be able to receive the appropriate services to help them become functional, whole people again.

A TBI can derail a child's normal development process. Learn some myths and facts about kids with TBI.

Posted on BrainLine April 8, 2011.

Produced by Texas Department of State Health Services and the Texas Traumatic Brain Injury Advisory Council.