Traumatic brain injury (TBI) is the leading cause of death and disability in children. Depending on the extent of trauma, TBI is also referred as brain injury or head injury. Let us learn the symptoms, causes and treatment of traumatic brain injury.
Last Updated: 23 October 2020
What is traumatic brain injury?
Traumatic brain injury in children refers to a range of traumatic injuries to the scalp, skull, and brain or other tissue and blood vessels in the head. These injuries can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe which can be due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain.
TBI is most common in the teens. According to Centers for Disease Control and Prevention, TBI happens in approximately 475,000 people in the United States (per year), and among these, 90% return home with mild injuries, 37,000 are hospitalized, and 2,685 die because of their injuries. The annual death rate from traumatic injury in children younger than 4 years is 5 per 100,000.
How children have a different traumatic physiology?
Infants and toddlers have a different trauma pathology and physiology. Children's brain has a volume of 365 cm3 at birth, while adults have 1600 cm3. The weight in newborns is of 372 grams; in adults is of 1450–1500 grams. Infants and toddlers tolerate larger space–occupying traumatic lesions compared with adults, but the consequences are similar. The risk of head injuries is higher in boys than in girls.
Causes of Traumatic Brain Injury
The main causes of TBI are falls and motor vehicle accidents.
The table below describes the type of injuries commonly seen in newborns, infants and toddlers.
1. Delivery head injury
2. Intracranial hemorrhages
3. Cephalic hematoma
4. Subgaleal hematoma
Caused by head compression and traction through the birth canal (vaginal delivery) with obstetric instruments.
A low birth weight and hypoxemia are risk factors for intracranial hemorrhage.
1. Accidental head injury
2. Abusive Head Trauma
Caused by inappropriate childcare practices.
If mechanism of injury is not clear, careful consideration for diagnosis of child abuse is required. AHT is the most common cause of TBI-related hospitalization and death.
Toddlers and School children
Accidental head injury
Caused by accidents increase as children develop motor ability.
With increase in use of child safety seats, the severity of injury and the mortality has dropped.
Pedestrian injury also increases in this age group.
1. Bicycle and motorcycle-related accidents
2. Sports-related head injuries
1. Awareness of prevention must be raised.
2. Trainers and players those involved in contact sports (i.e., judo, rugby, American football) will require education about concussion.
Adapted from Araki et al., Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurol Med Chir (Tokyo). 2017 Feb; 57(2): 82–93.
Symptoms of TBI
The symptoms of TBI vary from person to person and also differs based on the extent of trauma. The common symptoms are nausea, vomiting, loss of consciousness, fatigue, and headache, sleeping difficulties, dizziness, blurred or double vision and irritability.
The common symptoms of TBI in children are change in eating or nursing habits, persistent crying and inability to be consoled, change in sleep habits, seizures, sad or depressed mood, drowsiness and loss of interest in favorite toys or activities.
Diagnosis of TBI
A thorough enquiry will be made by the doctors regarding the nature of injury, how it happened, when the child lost consciousness and which body parts got struck. The severity of the brain injury is checked by a 15 point scale called Glasgow Coma Scale. A higher score indicates less level of injuries. Imaging studies will be made with the help of x rays, CT and MRI scan. Pressure inside the skull is monitored through intracranial pressure monitors.
Treatment of TBI
Mild traumatic injuries will be relieved through rest and pain killers. However careful monitoring of the child is required to find out whether there is worsening of symptoms or if any new symptoms develop.
Common medications for TBI involve anti-seizure drugs and diuretics. An emergency surgery will be required for skull fractures and hematomas.
Some safety measures need to be taken to avoid head injuries.
· Safe playing environments for children
· Insist the use of helmets and seat belts while driving
· Installing safety gates at the top of a stairway
· Preventing falls by installing window guards and using non slip mats in bathrooms