Traumatic Brain Injury in Children and Its Treatment

Although the symptoms of brain damage in children are similar to those in adults , the functional consequences can be different. Children are not little adults, their brains are still developing. Cognitive disorders caused by brain injury in children may not be obvious at first, but the consequences of brain damage may become evident when the child grows up. Brain damage can lead to lifelong difficulties.

Frequency of Brain Injury in Children

Brain injury or brain injury is one of the leading causes of death and disability in children and youth. Children between the ages of 0-4 and 15-19 are most at risk. Motor vehicle accidents, falls, sports injuries, physical abuse are the main causes of brain damage in children. Every year, hundreds of thousands of children are brought to the emergency room with head injuries and possible brain damage. Among these, falling is the most common cause for the 0-4 age group. Majority of the applications are mild injuries that are followed up on an outpatient basis and do not require intervention. However, severe brain injuries are hospitalized and examined and treated.

Brain Damage Symptoms

Brain damage can range from mild to severe, and its symptoms vary accordingly. The effects of a brain injury can be very different from child to child. The location and extent of the damage to the brain determines the clinical situation. Cognitive functions, physical skills, communication, behavioral problems can be affected in many different areas. With early intervention and rehabilitation, the severity of symptoms may decrease over time.

Physical effects of brain damage: Speech, vision, hearing impairment, headache, movement coordination disorder, involuntary muscle spasms (spasticity), muscle weakness or paralysis, epileptic seizures, balance problems, fatigue.

Cognitive effects of brain damage: Short-term memory problems, impaired concentration, slowed thinking, shortened attention span, perception problems, impaired communication skills, impaired planning skills, literacy problems, problems in judgment.

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Emotional effects of brain damage: Emotional fluctuations, denial, egocentrism, anxiety, depression, decreased self-confidence, sexual dysfunction, restlessness, lack of motivation, difficulty controlling emotions.

The Difference of Brain Injury in Children

Symptoms resulting from brain injury are similar to those of adult brain injuries, but the functional consequences on children differ from those in adults. Children’s brains continue to develop. Because children have greater brain plasticity, it was thought that brain injuries healed better than adults. However, recent research has shown that this is not the case. Brain damage in a child is more devastating than an adult brain injury of the same severity.

Cognitive effects of brain injury may not be evident in children in the early stages. These problems become more noticeable as the child gets older and is expected to behave more cognitively and socially. Sometimes physical limitations can continue throughout life. But impacts on the ability to think, learn, and develop socially appropriate behaviors can also be a major challenge for children, their families and loved ones. Brain damage can impair information processing, reasoning, and judgment processes. Although these effects may show symptoms immediately after injury in an adult, it may be years later for children to realize this.

Recovering from Coma After Brain Trauma

In severe brain damage, the child may be in a coma in the first days. Coming out of a coma is the first step towards recovery. This period can be a frightening process for the child. Usually the traumatic event is not remembered, the child may not understand where he is and may be afraid when he first comes out of the coma. It is also a very worrying wait for the family. Although coming out of the coma provides some relief, concerns remain for the next process. In the first days, the child may not always be aware of his surroundings and may not communicate. Being with his family, touching, calling out and supporting him is beneficial during this period. Various sensory stimuli can facilitate recovery from coma. Even if the child does not react, providing this support strengthens the bond of the family with the child. Bringing the items that the child is accustomed to and loved to the hospital room may facilitate the recovery period from the coma.

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Rehabilitation Period

Rehabilitation begins early after the child comes out of the coma so that he can return to his old life and continue to develop. A child with a brain injury may have difficulties in walking, personal care and communication. The inability to do things that he did effortlessly before can affect his psychology. In rehabilitation, goals and needs are determined so that the child can do what he was able to do before. Intense work begins in this direction. Every day, small steps are approached towards big goals. The effects of brain damage on memory, self-awareness, and mood can cause the child to become irritable, restless, and tired. These problems can make social interaction difficult.

The rehabilitation period progresses gradually and slowly, often without a definite end point. In addition to regaining old skills, targets are also set for the child to reach developmental stages that he has not yet reached before the accident. As the child gradually improves and his skills increase with physical therapy, problems that are not noticed in the first period or remain in the background come to the fore. Sometimes the child may be discouraged by the slow recovery. Rehabilitation does not always mean continuous improvement. Complications such as psychological problems and infection can sometimes lead to regression. The child’s pre-injury developmental level affects the rehabilitation process. For example, when very young babies are unaware of what is happening, brain damage during adolescence can cause effects such as grief, anger, decreased self-confidence, and depression.

During the physical therapy and rehabilitation period, it is necessary to focus on the small gains made every day, congratulate and encourage the child for what he has achieved. In his daily life, he should be encouraged to do his own work to the extent of his skills. However, it should be avoided to set goals for which it is not yet ready. In general, positive feedback should be provided, and negative and critical feedback should be kept to a minimum.

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Changes in Appearance Due to Trauma

Changes in a child’s physical appearance due to injury can also be a cause for concern. For this reason, the child may not want his friends or relatives to see him, and may be uncomfortable. During this period, everything should be done to ensure that the child is satisfied with his appearance. Talking to the child about things that affect their appearance, such as stitches, scars, plaster casts, braces, and haircuts, and trying to understand their anxiety can be a good start. It can be talked about how these physical changes make him feel, that it will take time to heal, that his hair will grow, that some wounds will fade and disappear. Some children, on the other hand, may not want to talk much about these physical changes, and they may be uncomfortable talking about these issues. Not bringing up these issues frequently may reduce the importance of physical changes due to injury in the child’s inner world. So in most cases, there is no one-size-fits-all approach. Try to understand the child’s feelings and concerns. The approach can be changed according to the reaction.

Back to School

The educational needs of a child with a brain injury may differ from the period before the injury. This sudden onset of disability causes many emotional and social difficulties. Both the child and his family, relatives and teachers may have trouble adapting to the new situation because they remember the old situation. Problems such as memory and attention problems, difficulty completing tasks in a specified time, and lack of energy can cause problems in school life. For this reason, the return to school of a child with a brain injury should be carefully planned.

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