Traumatic Brain Injuries in Children

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• QHow does the pediatric intensivist treat brain injuries in children?

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  A Alvin Jeffery , Pediatric Nursing, answered on behalf of Sigma Nursing

  Treatment of brain injuries is very complex and serious. Some of the most important components include:

  • Airway Management - As the brain swells due to injury, the ability to breathe is hindered. Also, the gag reflex is frequently lost. Therefore, a breathing tube is placed in the child's airway to keep the child from choking. A ventilator is used to ensure adequate breathing.
  • Reduction in Brain Swelling - Any degree of injury can cause some form of brain swelling. However, if swelling becomes severe, it could be fatal. Therefore, medications are given which keep the brain from swelling. This could include medications like Mannitol or concentrated saline. If medications cannot prevent the brain from swelling to a fatal level, a portion of the skull may be removed in surgery to allow the brain to swell without causing harm.
  • Reduction in Oxygen Consumption - The brain requires a large amount of the body's oxygen. During the treatment of brain injury, we want to ensure other organs are not competing for the oxygen the brain needs. To assist with this, healthcare providers will make sure the child maintains a normal temperature (no fever) and adequate pain control. We will also keep the room as quiet as possible with very little activity occurring which could cause the child to get scared.
• QWho treats traumatic brain and spinal injury in children?

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  A Dr. Shannon E. Babineau, MD , Pediatrics, answered on behalf of The Mount Sinai Health System

  In the more severe cases of traumatic brain and spinal injury a neurosurgeon is the first doctor involved in care. The neurosurgeon will help determine if there is life threatening swelling or bleeding in the brain or injury to the spinal cord that needs to be addressed surgically. In more mild to moderate cases, or after a neurosurgeon has cleared a patient, usually a pediatric neurologist will help treat patients with traumatic brain and spinal injury. Neurologists can help identify areas of deficit and monitor for resolution of symptoms. Neurologists can also help treat the symptoms of concussion/traumatic brain injury (TBI) including headaches, vision problems and attention problems. It is also possible a patient will need additional therapy to help with balance, focal weakness or changes in sensation which can be helped by doctors specially trained in physical medicine and rehabilitation as well as physical therapists. Lastly, if there are ongoing issues with depression or anxiety psychiatrists and psychologists can be very helpful.

• QWhat are the symptoms of traumatic brain and spinal injury in children?

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  A Dr. Shannon E. Babineau, MD , Pediatrics, answered on behalf of The Mount Sinai Health System

  In more serious cases of TBI, symptoms can include significant alteration or loss of consciousness and can progress to coma. It can cause seizures as well as bleeding in or around the brain, which can lead to weakness, alteration of consciousness and increase in pressure in the head. In traumatic spinal injury there can be weakness, paralysis, or loss of sensation in limbs or dysfunction in bowel or bladder control. In milder TBI and concussion, there will be brief alterations in consciousness and then over the next few hours the child may develop headache, nausea and vomiting. In the subsequent days, there can be problems with ongoing headache with light and sound sensitivity, difficulties with balance or a sense of spinning (vertigo). Cognitive difficulty can occur with impaired concentration and memory. Children may feel slower than usual and may take longer to complete homework. Some children will experience insomnia and some will experience changes in mood including being more irritable, depressed or anxious. 

• QIn what sports can children suffer traumatic brain injuries?

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  A Dr. Karen L. Gorton, PhD, MS, RN , Emergency Room Nursing, answered on behalf of Sigma Nursing

  Any sport in which contact to the head can occur has the potential to cause traumatic brain injuries. Those sports which are considered to be contact sports have higher risk than the non-contact sports.
• QCan my child get a traumatic brain injury when wearing a football helmet?

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  A Darria Gillespie, MD , Emergency Medicine, answered

  Wearing helmets has been shown to reduce the risk of head injury. As an ER doctor, I've seen cases when wearing a helmet was literally the single thing that saved a child's noggin. So, they're crucial for football, bicycle riding, skiing, and other potentially risky activities.
  
  However, it's also important to know that wearing a helmet alone does not prevent all concussions or traumatic brain injuries. That's because many of these conditions occur from the movement of the brain within the skull itself. With fast enough movement or a sufficiently hard hit, even the best helmet cannot prevent this movement. So, while wearing a helmet is the first step in protection, you still must be very aware of your child's play habits, hits, and time in "contact play". Also, be aware of the signs and symptoms of concussion so that the child can be removed from play if they show any signs of these. 
• QWhat should I know about children and traumatic brain injury (TBI)?

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  A Darria Gillespie, MD , Emergency Medicine, answered

  Children's developing brains can be even more susceptible to the injuries caused by concussions and Traumatic Brain Injury (TBI), which is why it's SO important to protect them.  Consequences of TBI in kids can range from mild and temporary (headache, foggy thinking, nausea, memory difficulties) to fatal brain swelling.  
  What I always tell my patients (and their parents) when they come in with a concussion is that it is a "brain injury," and --like you would for any other injury in your body--it needs time to rest and heal.  Otherwise, each successive concussion increases your chances for another one, and these effects accumulate over time.  Also, a second injury before the brain has healed can possibly result in a fatal condition known as "Second Impact Syndrome."  
  Keep in mind that in children, symptoms of a concussion may be harder to decipher.  I always get concerned when I hear a Mom or Dad simply say "He's just not behaving right."  Other symptoms include headaches, nausea, vomiting, sluggish behavior or confusion, mood changes (ie: a normally stoic child crying or laughing excessively), or pain with loud noises or bright lights.  
  If you feel that your child has any of the above symptoms, then you should have your child checked out by their doctor.  They'll give you information on what to avoid (physical activity, bright lights, cell phone/texting/video gaming use), and how to know when they're starting to improve.