Pediatric Traumatic Brain Injury
(Moderate to Severe)

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Condition: Traumatic brain injury (or TBI) results from head trauma that causes injury. to the brain tissues This condition may affect daily tasks, such as communication, swallowing, cognition, self-care, walking, and behavior.

Background: Brain injury can be caused from direct physical blows to the head or indirectly from brain swelling, seizures, or blood in the brain. In babies, the most common cause of brain injury is assault, while in toddlers, it is falls. In older children, the most common causes are bicycle accidents, motor vehicle collisions, and sports, and in adolescents, the most common cause is motor vehicle accidents.

Risk Factors: Children with learning disorders and attention deficit hyperactivity disorder (ADHD) are at greater risk. and TBI is more common in the spring and summer, in males than females. Appropriate use of helmets and transportation seats with safety belts is important in prevention.

History and Symptoms: Brain injury may initially be accompanied by changes in breathing and circulation affecting oxygen levels and blood pressure. In the acute phase, treatments aim to stabilize the patient and prevent secondary complications such as brain swelling, seizures, and brain bleeding. During the hospitalization, medical care focuses on mood, sleep, vision and feeding problems, muscle weakness, headaches, dizziness, and balance impairment. More long-term complications, such as fluid build-up, hearing loss, joint or muscle rigidity, scoliosis, speech impairment, hormonal imbalance and urinary and/or bowel incontinence, can also develop and need to be monitored closely.

Physical Exam: Physicians will record a detailed history of the event as well as perform an extensive physical examination, including a neurological and a musculoskeletal exam. Assessment of alertness, ability to smell, see, talk and move is important. Detailed neurologic exam will check for muscle strength and tone, reflexes, and motion. If the cause is abuse or a severe trauma like a vehicle collision, spine and extremities will be examined for additional injuries.

Diagnostic Process: A computed tomography (CT) scan is commonly performed acutely to evaluate bleeding or swelling in the brain. Magnetic resonance imaging (MRI) may be used to further assess brain injuries that may not be visible on the CT scan. X-rays may be used to rule out additional injuries to the neck or extremities. An electroencephalogram (EEG) may be used for detection of seizures, and specific assessments of hearing, vision, and swallowing may be necessary. Neuropsychological testing can fully elucidate cognitive and emotional issues a child may have after injury.

Rehab Management: An interdisciplinary approach led by a physical medicine and rehabilitation (PM&R) physician is essential. When stable, transfer to inpatient rehabilitation is important to improve outcomes. The PM&R physician may prescribe medications to manage behavior and enhance participation in therapies. After stabilization and prevention of secondary complications, patients may receive physical therapy, occupational therapy, speech therapy, and neuropsychological testing. Rehabilitation will include teaching of strategies to compensate for impaired or lost functions and for optimization of the use of abilities as they return. Partnering with a child’s school is paramount to making sure the child receives the services needed to achieve academically in a safe and appropriate manner. PM&R physicians also provide recommendations about return to school/sports.

Other Resources for Patients and Families: Following brain injury, patient and family education and support are important, and community support groups may be available.