Traumatic brain injury in children
Most children with significant brain injury spend time in a PICU. Like most experienced pediatric intensivists, I have seen hundreds of these children over the years, with dozens at least in the severe category. In one sense the term “traumatic brain injury” has limited usefulness because it covers such a wide range of injuries, from mild concussions to more extensive injury, to lethal damage. In another sense, however, it is a very useful diagnostic category because the brain responds to a wide variety of injuries in a very similar, stereotypic way.
Our understanding of the manifestations of TBI has grown over the years considerably. When head CT scans became available we could for the first time assess such things as bleeding inside the skull or swelling of the brain easily and safely. I remember how exciting it was in 1974 to see the first simple CT images taken on grainy Poloroid snapshots. Now we have sophisticated computer reconstructions of the brain. The technology represented such a breakthrough that its inventors received the Nobel Prize for it.
We soon realized, however, that some injuries to the brain, particularly what we call shear injury, are not well seen on CT — it takes an MRI scan to do that. We also came to realize that the most important thing we could do in the PICU for a child with severe TBI was to make sure the injury did not get worse: simple supportive measures like relieving pain and keeping the heart and lungs working well were key supportive measures to use while we waited for the child’s brain to heal.
Increasing understanding of milder forms of TBI have made us realize it is much more common than we once thought. For children, although the long-term outcome for mild to moderate TBI is good, persistent problems with such things as headache, mood changes, and difficulties in school are not uncommon, and these can last for months. There is a great deal of information available about TBI. There are many misconceptions about it, too. You can find authoritative, respected advice from the National Institutes of Health here and from the Brain Trauma Foundation here, and many more useful links here.
I followed you from AW. Very interesting blog, and very informative. I taught special education for fifteen years and saw my share of Traumatic Brain Injuries, both mild and catastrophic. When we tested a child who had simple difficulties learning, for learning disabilities, it almost became a joke amongst the testing team. One of the questions asked was whether the child had ever fallen and hit his/her head. The parent almost always said, “no.” So after a couple of years of doing this,and hearing the same stories, I learned to be more specific and ask if the child had ever fallen from a shopping cart onto his head. The answer was very often, “YES.” A check of hospital records would often reveal a “minor head injury.” And the parent was told the child would be fine. Now, I haven’t read any studies or anything. This is all anecdotal, but it is curious, don’t you think?
Thanks for your note. Indeed, milder forms of TBI and the relationship to learning disability is something we are just learning about. Not surprisingly, the brain turns out to be a delicate organ indeed.