What Parents Should Know About Pediatric and Childhood Brain Trauma

It is hard enough when adults suffer a traumatic brain injury. Life can be even more difficult and more upsetting when a toddler or a child suffers a traumatic brain injury (TBI). TBIs are often life changing. Treating a youngster for a TBI can be especially difficult because children aren’t fully developed physically, emotionally, and cognitively. The symptoms of a TBI in children are likely to change over time.

According to the American Speech-Language-Hearing Association (ASHA), a TBI is a “form of nondegenerative acquired brain injury resulting from a bump, blow, or jolt to the head (or body) or a penetrating head injury that disrupts normal brain function.” The symptoms can vary depending on the location of the wound, the severity of the brain damage, and the child’s age and stage of development.

How are TBIs classified?

Generally, a traumatic brain injury is classified as a primary injury (the injury due to the accident) or a secondary injury (the after-effects of the initial force or jolt). The severity of a TBI is graded as mild, moderate, or severe – depending on the nature of the personal injury, the length of time the victim is unconscious, post-traumatic amnesia (PTA), the ability of the child to respond to various stimuli, and other factors. The common test used to determine the severity of a TBI is the Glasgow Coma Scale test (including a pediatric Glasgow Coma Scale test).

How serious are pediatric and childhood TBIs?

The ASHA (which relies on various definitions, studies, and analyses that it cites) states that a traumatic brain injury is the leading cause of disability and death in children ages 0–4 years and adolescents ages 15–19 years – according to the Centers for Disease Control and Prevention. As of 2015 (the most recent year available for such data) “about 145,000 children and adolescents (ages 0–19 years) are living with lasting cognitive, physical, or behavioral effects of TBI.”

Each year, about 500,000 children (0-14) are evaluated at an emergency room for a TBI. Children and adolescents (15-19) are the two highest categories by age of TBI visits to an ER yearly.

Males between 0-9 years old were 1.4x more likely than females to suffer a TBI. Males between 10-20 years old were 2.2x more likely than females to have suffer a TBI.

What types of accidents cause traumatic brain injuries in children?

The ASHA report states that for children and adolescents ages 0 to 14, the leading causes of a TBI are:

• Falls (50.2%)
• Struck by/against events (24.8%)
• Motor vehicle accidents (6.8%)
• Assault (2.9%)
• Unknown/other (15.3%)

The report goes on to say that “TBI secondary to velocity injury (e.g., motor vehicle or bicycle accidents, sports injuries) occurs more often in elementary school children and adolescents.”

What must be considered before developing a treatment plan for a pediatric TBI?

The medical team that develops a treatment plan for a child needs to consider many factors, including:

• The child’s prior levels of function
• The child’s age
• The developmental status, sensory skills, and motor skills of the child
• Any prior speech, language, or cognitive defects – such as “attention-deficit/hyperactivity disorder, autism spectrum disorder, childhood apraxia of speech, acquired apraxia of speech, learning disabilities, speech sound disorders, spoken language disorders and written language disorders.”

TBI treatment plans need to consider the child’s everyday environment (home, school, community, and work). Other factors include cultural backgrounds, learning styles, and many other factors.

Each type of childhood treatment plan should be individualized. Treatment plans also need to include a focus on the child’s family and schools.

What are the different treatment approaches for a pediatric or childhood TBI?

There are many different approaches depending on the various treatment factors. Some of these approaches include:

• Restorative Approaches. This approach focuses on improving or restoring impaired function(s) through retraining.
• Habilitative Approaches. These approaches “target skills that have not yet developed.” Per ASHA:
  • Habilitative interventions help children learn, keep, or improve skills and functional abilities following their injury rather than restore skills that they had mastered prior to injury. These approaches often are used in treatment when the injury occurs before some developmental milestones have been met.
• Compensatory Approaches. These methods focus on helping the child adapt to deficits by learning new or different ways of doing things. Examples of these approaches include changes to the child’s accommodations. For example, “academic accommodations for students with TBI may include using note takers, listening to recorded lessons, receiving extra testing time, taking rest breaks, or reducing environmental noise and distractions in the classroom.” Modifications may include changes to the curriculum or to acceptable responses (such as using multiple-choice questions and short answers instead of long essays).
• Functional/Contextualized Approaches. These approaches “focus on personally meaningful goals, routines and activities with generalization of skills to relevant social, vocational, and educational activities.”

The child’s treatment options for a TBI may include the following, in addition to other treatments:

• Alternative and Augmentative Communication
• Behavioral Intervention
• Cognitive-Communication Interventions
• Language Intervention
• Social Communication Intervention
• Speech Intervention
• Feeding and Swallowing Intervention
• Hearing and Balance Intervention

Additional pediatric, childhood, and post-secondary education considerations for TBI victims

There are different treatment options for infants, toddlers, and preschoolers. Treatment considerations include focusing on school readiness schools, understanding when disorders are due to the TBI or to the child’s development, and many other issues.

There are special disability plans (individual family service and individual education plans) that must be drafted for children to help them attend school. Generally, the treatment considerations for a student with a TBI also include understanding and complying with The Individuals with Disabilities Education Improvement Act of 2004 (IDEA). Different treatment plans will be needed for each grade and school. Additional treatment plans will be needed as your child transitions from secondary school to post-secondary schooling, a vocation, and independent living settings.

Learning that your child has a TBI due to any type of accident is frightening. You want to know what type of life your child can lead. You need to know how much all his/her care will cost. You have a right to hold the responsible people and companies accountable. At McNicholas & McNicholas, we’ll help answer all your questions, work with the doctors who can properly evaluate your child’s short-term and long-term needs, and guide you through the claims process. To schedule a consultation with a Los Angeles TBI lawyer, call our offices or complete our contact form today.

Please note that this blog is not to be construed as legal advice. Because every case is fact-specific, you should consult directly with an attorney to obtain legal advice specific to your situation.