By Matt Lalande in Pedeatric Injuries on April 22, 2021
Pediatric brain trauma is not completely unlike an adult brain trauma. A traumatic brain injury occurs when there is any type of damage to the skull or brain, tissues, or blood vessels inside the cranium. The impact of a blow to the head can cause the brain to move back and forward inside the skull, causing bruising, bleeding and the tearing of nerve fibers. Pediatric brain trauma is the leading cause of death and disability in children in Canada.
A pediatric head injury often involves delayed trauma. If the head injury is severe enough, the brain will experience swelling, which can push the brain against the skull, reducing the flow of blood and access to oxygen. Pediatric head injuries, like adult head injuries, are subdivided into mild TBI, moderate TBI and serious TBI’s. Typically, a serious TBI occurs when a child is unconscious for longer than six hours.
When a child experiences a brain injury, the outcome her prognosis can be worse than it would be if an adult suffered a similar injury. This is because the child’s brain is still developing and the brain injury is severe enough, it could lead to disturbance in the growth or development of the brain which, in turn could lead to a irrepairable damage. In fact, brain injury deficits may not be immediately apparent because the child is so young in the pediatric brain is still developing.
Childhood traumatic brain injury is a frequent cause of disability in kids and can have a severe impact on development across his or her lifespan. The consequences of early traumatic brain injury range widely with brain injury severity, with severe injuries usually resulting in more serious physical, cognitive and behavioral problems with the child, particularly as they age. A review of over 70 pubmed journals tells us that when kids suffer brain injuries, they will more likely than not suffer form residual deficits in a range of skills, including intellectual function, attention, memory, learning, and executive function. Psychological and social development problems may also increase post-injury.
Together, these problems and deficits will no doubt affect a child’s ability to function effectively at school, at home, and in their social environment, resulting in impaired acquisition of knowledge and overall reduced quality of life.
Can a child recover from a serious head injury? Ultimately, from talking with our experts, it depends on a range of complex biological, developmental and social factors making prognosis very hard to predict. One thing is for certain, however, the idea that such a devastating injury could happen to a young, vulnerable, innocent child can be unbearable, especially if you are a parent or a loved one close to a child that was hurt.
Sadly, accidents are the leading cause of pediatric death in Canada. According to neurological research, out of all of the unintentional injuries that could happen to a child, traumatic brain injury is the most likely to lead to long-term disability and/or death. Brain injuries are of particular concern in children because their brains are still developing, and brain damage can hinder this process – often permanently.
Children who suffer severe TBIs are at risk for long-term complications such as mental illness, delayed development, cognitive impairment, seizures or epilepsy, insomnia or changes to sleep patterns which could impact physical development, personality changes, and social adjustment issues. If the TBI is catastrophic, children could be rendered comatose at a very young age.
Typically, younger children cannot properly communicate the symptoms they experience or may have difficulty interpreting their symptoms, so it is important to understand the risk and be prepared in case the worst case scenario occurs. The leading causes of pediatric TBI vary depending on the age range of the child, but all of the causes listed below are still common in children and young adults of any age.
Skull Fractures – skull fractures (SF) and traumatic brain injury (TBI) are common in children admitted into the pediatric Emergency Departments with head trauma. Different types of skull fractures pose different clincial challenges. Linear skull fractures are cracks or breaks in the skull. The bigger problem is that the underlying force that created the fracture might have caused damage to the brain itself. Fractures to the base of the skull can be very problematic because it may cause damage to arteries, nerves and other structures. In a recent 2017 article entitled Pediatric Traumatic Brain Injury Characteristics, the writers tell us that linear fractures most commonly occur in the parietal bone, followed by the occipital, frontal, and temporal bones. Depressed skull fractures are more problematic. These fractures happen when a part of the bone presses on or into the brain itself. The article also tells us that depressed skull fractures in kids are more common, with compound depressed fractures accounting for 42%–66% of all fractures in children, and 9% of all fractures in children aged less than 1 year. Basal skull fractures occur less in kids, but are more dangerous as they can result in cranial nerve injury and vascular injuries.
Intracranial Injuries – when an escape of blood from a ruptured blood vessel leaks into the space that surrounds the brain, this kind of stroke caused by an external impact on the brain, is described as a traumatic subarachnoid hemorrhage. Post-traumatic Intraventricular hemorrhage. Intraventricular hemorrhage (IVH) is a type of injury uncommonly seen in adultsor children undergoing cranial CT after head trauma (>1.4%). Most commonly seen are cerebral contusions. Cerebral contusions are relatively common in pediatric TBI and tend to occur just below the site of impact of external force.
In our practice we have seen a variety of causes the pediatric head injury, the most common being kids involved in a car crash, pedestrians struck by moving vehicles, kids riding their bikes and getting struck by vehicles, falls from bikes will writing, falls from elevations, falls down the stairs, sports injuries and other mechanisms of injury. The following are several of the main repeat causes we have seen in pediatric injury cases:
Falls – Falls and unintentional falling are the leading cause of pediatric TBI in children 14 years old and under. The Journal – Clinical Indicators of Traumatic Brain Injury and Skull Fracture in Pediatric Head Trauma Patients, tells us that many studies of pediatric head injury cite falls as the most common mechanism of injury, ranging from 32% to 91% and head trauma is the most frequent injury offall-related injuries in childhood. Craniocerebral trauma is
the most common injury in fatal falls.
Children under 5 are particularly susceptible to concussions, as they are still working on their balance, mobility, and coordination at such a young age. Additionally, children this young are often still learning about the risks of falling and safety in general, and do not know how to brace themselves for impact like adults do. While children are typically relatively durable at this age, their brains are still developing and are therefore extremely vulnerable to the impact of a hard fall.
Children are at risk for falling in many daily activities, such as walking down the street, slipping in the bathtub, falling down stairs, or even falling out of bed. Falling from a higher level, such as from stairs or a ladder, or even off a balcony, can increase the chances of your child suffering a severe TBI.
If your child falls and suffers a severe TBI on someone else’s property, such as an icy sidewalk that was not cleared or construction equipment that was left out, you have the right to hold the property owner liable for your child’s injuries.
Motor Vehicle Accidents – Injury to the brain as a result of car accidents represents a frequent cause of pediatric disability – in both children fitted and not fitted with car seat restraint systems. An article published in the Journal of Neurosurgery reported that the data is dramatically different for infants who suffered head injury in restraint vs non-restaint systems – the likelihood of sustaining no head injury was 15.2% for unrestrained infants compared with 92.8% for properly restrained infants. The vulnerability of children in motor vehicle accidents is the reason that there are car seat laws and requirements in Ontario. Fitting a child in the proper car seat may not guarantee their complete protection in the event of an accident, but it can drastically reduce their risk of TBI, catastrophic injury, and death.
Types of motor vehicle accidents that can lead to severe TBIs in all age groups include:
Bicycle Accidents – Children ages 4 to 8 are at high risk for TBI from bicycle accidents, but all children under 14 are typically at an increased risk in general.
Bicycles are a common way for young children to travel independently around their neighborhood or to school. They are also a great way for kids to get physical exercise and enjoy the fresh outdoor air. However, bicycle accidents can be devastating for children, especially with the risk of pediatric TBI. According to Safe Kids Worldwide, approximately 47% of youth under 14 who are hospitalised for bicycle injuries suffer a TBI, and approximately 60% of bicycle-related deaths are due to head injuries. In the United States, 25 children suffer bicycle-related injuries every hour.
Children may suffer a TBI while riding a bicycle in a variety of ways, such as flipping over their handlebars, being struck by a car, losing control of the bicycle and colliding with an object, or accidentally swerving into traffic. Riding a bicycle at low-light hours, such as dawn or dusk, can also increase the chances of a bicycle accident due to decreased visibility for drivers and bicyclists.
Birth Injuries – As the term suggests, birth injuries are a common cause of TBI in newborns and infants. Babies and infants do not have the strength in their neck, head, or brain to protect themselves from an impact. Their brains are completely new and just beginning to develop, rendering them extremely vulnerable at birth and into their first year.
Typically, a birth injury may occur when there is some type of complication during labour. This could occur due to a baby being premature, having a large birth weight, breeching, or remaining in an abnormal position. It may also occur during prolonged labour or if the mother’s pelvis is not adequately shaped for a natural birth. In the past, some birth injuries were caused by the forceps used to deliver babies in difficult positions, but in recent years this has been less of a concern as it is no longer as common for doctors to use forceps.
There are various types of birth injuries and infant injuries that could cause a pediatric TBI. These include:
Sports Injuries – Injuries sustained while playing sports are more common in children of adolescent age and young adulthood. According to Canada Public Health, the majority of sport-related TBI in males and females ages 5 to 19 occurs from hockey, rugby, and tobogganing. Equestrian activities and ringette also have a higher prevalence rate for TBI among females ages 10 to 19 years, primarily due to the fact that these activities have a higher participation rate among female populations.
Contact-based sports in which many young children and adolescents participate are strongly associated with head injury and TBI. In recent years, there has been an increase in research and awareness surrounding concussions and chronic traumatic encephalopathy (CTE), which is a neurological condition caused by repeated head injuries.
Pedestrian Accidents – The Clinical Indicators of Traumatic Brain Injury and Skull Fracture in Pediatric Head Trauma Patients tells us that although falls may be the most commonly cited reason for pediatric head trauma, car accidents, particularly pedestrian accidents and kids getting hit by cars have been reported to have more significant intracranial injury.
Pedestrian accidents are another leading cause of TBI in toddlers and elementary-aged children, as well as adolescents. Canada Public Health data states that between 2011 and 2017, 34.1% of Canadian pedestrian injuries that resulted in TBI were attributed to children ages 10 to 14 years, while 4.5% were attributed to younger children who were struck by vehicles while travelling in strollers or wagons.
Children are at a higher risk of being struck by a motor vehicle as a pedestrian for a variety of reasons. Firstly, due to their smaller size, they are more difficult for drivers to see. Secondly, children tend to be less versed in road safety and proper safety precautions when crossing the street, such as learning to look both ways or avoiding running out onto the street from between parked cars.
When a pedestrian is struck by a motor vehicle, they are at risk for severe injuries, including TBI and death, because they have little to no protection against a 3,000-4,000 pound vehicle with reinforced steel walls.
Other Common Causes of Pediatric Brain Trauma
In addition to the leading causes listed above, data from Health Canada indicates other common causes of pediatric TBI with instance rates varying by age group. These include:
Most traumatic brain injury suffered by kids are minor concussion related injuries, which resolve quite quickly. However, there are signs that a pediatric head injury could be serious, which can include both what your child may tell you, and what you may notice:
Neurosurgery – if there is a hematoma (clot) large enough to damage the brain, a cerebral edema, or a pooling of blood, surgery will be required. A flap of bone is removed from the child’s skull over the site of the clot. The clot is removed, and the arteries will be repaired. The skull heals rapidly, and the operation is usually straightforward and without much risk. If the child’s skull was penetrated and the wound goes through to the brain, surgery will also take place. With proper treatment, these wounds normally heal very well. A future tendency to develop epileptic seizures (post-traumatic epilepsy) can occur. This can be treated with medication to reduce the risk. Neurosurgery is very time-consuming, and recovery can take a long time because of the injury to the brain. The severity of the brain injury, rather than the skill of the surgeon, is often the main determinant of success.
Intensive Care – after the child’s brain surgery, he or she will be likely be moved to the intensive care unit (ICU) where treatment and condition will be monitored 24-hours per day. Heart rate, blood pressure, brain function, food, and fluid intake will be monitored continually. Intracranial pressure will be monitored by the insertion of an intracranial pressure monitor (ICP). A brain oxygen monitor will be placed through a small hole in the skull and positioned in the brain tissue. The oxygen levels and the temperature of the brain are constantly monitored.
Oxygen is optimized for the brain to heal. A cerebral blood flow monitor will also be placed next to the Licox to evaluate blood flow throughout the brain. For some head injury victims, a ventilator might be needed to help them to breathe. It is connected to the child via an endotracheal tube placed into the child’s mouth and down the windpipe. The machine can then push air in and out of the lungs.
A feeding tube will be added to children on a ventilator and with decreased alertness. A nasal gastric feeding tube may be inserted and passed down the throat to the stomach for delivery of liquid nutrition and medication delivery. To monitor the child for seizures due to abnormal electrical discharge from the brain, all he or she will be monitored with an EEG (electroencephalogram) for 72 hours after the injury.
Medication – medication will form a critical part of the acute management phase of treatment. Pain medication is normally offered for all persons who have more injuries than just head wounds. It is often necessary to sedate patients with severe traumatic brain injuries. These sedatives can be quickly turned off to awaken the patient and check for alertness and mental status. Because people with moderate to severe brain injuries are prone to seizure during the first week after the injury, they will likely be given anti-seizure medications to prevent the same. Infections are always are a risk, irrespective of all the preventative measures taken. Any device placed within the child can introduce a microbe into the system. If an infection is suspected, tests will be done, and if so, antibiotics will be introduced as treatment.
If your child has suffered a pediatric brain injury or serious brain trauma, talk to a Hamilton brain injury lawyer as soon as you can. You, as the parent or guardian of the child, have the full right in Ontario to seek fair and reasonable compensation to assist the child with his or her recovery. Often times, brain injury victims will never be the same and will require lifelong future care costs to assist them with their living environments, rehabilitation, personal support workers, medication etc. Severe traumatic brain injury (sTBI) is one of the most common causes of death and disability among children – and the cost of their care can no doubt be lifelong.
Such costs that need to be quantified can also include:
Call us provincewide at 1-844-LALANDE or local in the Hamilton/GTA at 905-333-8888 to book your no obligation consultation. Alternatively, send our Hamilton Brain Injury Lawyers a private email through our website and we will get back to you without delay. We are happy to meet via Zoom, Google meets, in person, or simply have a telephone conversation to discuss your particular situation.