Traumatic Brain Injuries in Children

Unfortunately, head injuries in children are quite common. An annual number of hospitalizations accounts for approximately one hundred thousand traumatic brain injury cases affecting children. The causes of such injuries are road accidents, bike falls, sports injuries, falls from a height and child abuse. There are some features peculiar only to children's injuries. Both symptoms and effects of traumatic brain injuries in children are very different from those of adults. For example, it is much more difficult to determine the degree of brain damage and any possible dysfunctions in a child. After analyzing the results of studies at school and higher educational institutions, the coefficient of mental development and professional activity (for adults), doctors can determine the severity of the injury. At one time it was believed that children are more resistant to brain injuries than adults, because their growing brain could restore itself faster over time. However, more and more studies point to the opposite. In fact, compared with adults, children are more susceptible to irreversible brain damage, even if the force of the blow is the same.

Blow and countercoup

• 1. As a result of direct injury, a blow to the back of the skull leads to an injury of the front of the brain.
• 2. The countercoup causes exfoliation of the brain and its hit against the back of the skull. As a result, the damage occurs twice.

Some neurologic disorders caused by head injury do not manifest itself until a long time. For example, the functions of the frontal lobe are not involved from the very birth of the child. As a result, doctors will be able to fix their damage only when the child reaches adolescence. Since frontal lobes are responsible for social interactions and interpersonal skills, the brain injury sustained in early childhood will not be fixed until the child reaches a certain age when these skills will be required. In addition, damage to the part of the brain responsible for reading and writing skills will only become apparent when the child reaches school age and manifest the signs of delay in reading and writing skills.

It is very difficult to maintain the normal functioning of blood vessels after trauma in children. In some cases, TBI can cause a sudden expansion of all blood vessels of the brain. This contributes to a strong blood flow to the head. The excessive blood and cerebral edema resulting from a rapid blood flow cause a sharp increase in intracranial pressure, which reaches a very high level. Children feel normal right after the accident, but a few hours later they lose consciousness because of a sudden increase in the intracranial pressure.

Studies have shown that the child’s skull is eight times weaker than the adult one. Thus, children are more likely to suffer from both skull deformity and fracture, which lead to brain damage.

Also, the effects of traumatic brain injury are difficult to detect in adolescents due to the features of their age development. During this period, they often experience anxiety and behavioral changes.

Effects of TBI in children

Over the years, there was a belief in medicine that with an equal force of the blow the child suffers a less brain damage than the adult. Based on the studies of monkeys, this hypothesis was suggested by Kennard. However, subsequent studies have shown that this assumption is erroneous. In fact, the effects of TBI in children are much more serious than in adults.

The development of frontal lobes in a child lasts up to 16 years. Any changes in their development lead to inconspicuous, but serious problems. The impairments developing in this area of the brain provoke a failure of "executive functions", which are fundamental in human development. Unfortunately, some of these disorders manifest themselves only at later stages of development.

As the child grows up, they face a number of difficulties. For example, math homework is becoming more difficult. The grade progression, college difficulties and increasingly complex social interactions await a person as they grow and develop.

Parents cannot know in advance how their child will cope with these obstacles and whether he/she will be able to overcome them.
There was a study conducted on the "Effect of TBI sustained in childhood on the future working life". In the course of the study, it was noted that injuries caused by falls and accidents related to road accidents constitute more than 70% of all injuries at a preschool age. Such traumas lead to severe closed brain injuries, but more to the injuries of the frontal lobe. Since frontal lobes grow rapidly during the first five years of the child's life and then continue to develop until late adolescence, the lack of executive functions caused by these injuries remains neglected. Thus, others notice such significant abnormalities in the psychosocial sphere rather late, when the body has already been significantly damaged.

This study involved 33 children with severe TBIs. They performed at a normal academic level at school. Having completed schooling, 8 out of 21 patients managed to start their professional life, while 9 of them did not. The children who had sustained injuries before the age of 7 showed lower results. This indicates that the injuries affected the brain function that is responsible for the intellect.

Scientists also found that children after TBI are better at school because it is a well-structured environment, but in the working environment that is more independent and less structured they perform worse.

In most cases, children who have suffered a head injury experience normal mental abilities, sometimes even an above-average IQ. But, in spite of this fact, they face other serious problems. Such children are not able to organize their lives and make reasonable daily decisions. They have serious problems with organizational skills in their daily activities, but good results in language and intellectual testing.

The difficulty in determining the degree of brain damage is that in most cases personality changes, such as attention deficit disorder and fatigue syndrome, impaired planning and problem solving, lack of initiative, flexibility, impulsiveness, irritability and outbursts of anger, opposition and socially inappropriate behavior go unnoticed.

Disinhibition is one of the most common symptoms of the traumatic brain injury. A person who has had TBI and suffers from disinhibition often speaks of what is considered to be socially incongruous. This leads to difficulties in communicating with others and further social development. In some cases, the effect of disinhibition results in negative consequences, such as drug addiction and alcoholism.

Lead poisoning

Studies have shown that millions of children are at risk of lead poisoning, since even its smallest doses cause brain damage. The children aged between 1-5 years are at risk. Children under 1 years of age, have minimal contact with the environment. By the age of 5, the digestive tract absorbs lead less intensely. The following reason is related to the development of the brain between the age of 1 to 5 years. Each nerve cell of the brain consists of the cell body, the nucleus of which is responsible for the production of proteins and neurotransmitters. The body cell has two types of processes, namely dendrites and axons. The current, which stimulates the work of other nerve cells, flows through the axons. The neurotransmitters accumulate on their upper part. Dendrite is a dichotomously branching outgrowth of a nerve cell that either perceives signals from other neurons, receptor cells or directly from the external stimuli. It conducts nerve impulses to the neuron body. Dendrites are usually very short, whereas the length of the axon varies from a few centimeters to several meters. Each nerve cell has hundreds and sometimes thousands of dendrites. Lead has a detrimental effect on dendrites and leads to their reduction. This, in turn, causes thinning of the bonds between the axons. As a rule, the greatest number of dendrites falls between the age of 1-5 years. Over time, they become thinner. The best way to slow down this process is to actively use these nerve cells at the age of 1-5 years. That is, one should strive for preschool stimulation and education.

At an early stage of development, any amount of lead in the blood has a detrimental effect on the development and work of the brain. Doctors recommend taking lead out of the body to minimize any further damage to the brain. It can be removed by injecting a chemical into the bloodstream. By interacting with this substance, lead is excreted from the body with urine. However, studies have shown that this treatment method does not lead to an improvement in IQ.

Here you can also read other articles on this topic:

• Smell and taste after TBI
• Statins and TBI
• Traumatic brain injury and Parkinson's disease

To receive professional advice on the treatment of traumatic brain injury in children in Germany
Please call us: +49 228 972 723 72
or write an Email here