Bumps and bruises are a part of every childhood. Fortunately, most kids bounce back like champs. But for the thousands of children who experience traumatic brain injuries each year, there can be long-term consequences, according to Ronald Savage, Ed.D., president of the North American Brain Injury Society and an expert in pediatric brain injury. “Most people [with brain injuries] don’t lose what they previously learned,” says Savage. “What they lose is their ability to learn new information. They have problems going forward.”
Brains do not reach full development until around age 25, which means a child’s brain is more fragile than a fully developed brain. Children and adolescents are especially vulnerable to brain injuries because they tend to find themselves in situations where they can be injured, Savage says, such as climbing play structures, peeking over balconies, riding bikes, and playing contact sports.
While most children will heal from their injuries and suffer no lasting effects, for some the outcomes can be devastating. Traumatic brain injury can have profound effects on cognition, mental capacity, behavior, personality, and motor skills such as hearing, vision, and balance, says Savage. Without as much stored cognitive capacity, children are much more vulnerable to long-term deficits than adults, he says.
“Brain injury for adults is highly disruptive, but for children, you steal their future. You rob it,” says Savage. The Centers for Disease Control and Prevention reports that each year in the United States, emergency rooms treat approximately 283,000 sports- and recreation-related traumatic brain injuries, including concussions, among children aged under 18. According to the Brain Injury Association of America, the other leading causes of pediatric brain injury are vehicle crashes (either as passengers or pedestrians), falls, and violence.
The two most common types of brain injuries are bruising due to impact and diffuse injury from a rapid movement of the head, during which the brain is bounced around the skull. A whiplash-like injury damages the brain’s delicate axonal fibers — the filaments through which the brain’s billions of neurons communicate. In diffuse injuries, a large area of the brain’s white matter can be affected, and measuring this kind of injury is especially difficult, says Savage.
For children who suffer a brain injuries caused by impact, damage is typically localized in the brain’s frontal and temporal lobes. In the case of damage to the frontal lobe — considered our emotional and personality control center — researchers say that damage isn’t always readily apparent, because the frontal lobe doesn’t reach full development until late adolescence. Thus, the effects of a childhood injury to the brain’s frontal lobe may not be noticeable until much latter in life.
The Good News
The encouraging news is that brain injury is highly preventable. Savage is active on several fronts persuading legislators to adopt national safety standards and regulations that protect children from brain injury. He is also working to enact a nationwide law that would require the use of concussion management tools in high school sports. “A lot of children get brain injuries because we haven’t done enough on the prevention side to protect them,” Savage says. “Prevention is the only cure for brain injury.”
Here some ways to reduce the risk of pediatric brain injury:
Prevent Falls
Younger children and toddlers are at high risk for falls from heights, especially from improperly secured windows, balconies, and decks, says Savage, pointing out that New York City has mandated that all windows above the second floor be gated. Make sure that home windows have safety gates — not just window screens, which Savage points out are “made to keep bugs out, not to keep kids in.” Jungle gyms and other play structures are also a source of potential injury. Avoid playgrounds with asphalt, concrete, grass, and soil surfaces, and look for shredded mulch or loose surfaces like pea gravel and crushed stone.
Practice Safety in and Around Cars
Motor vehicles pose a brain-injury risk to children, both as passengers or pedestrians. The Child Pedestrian Safety Program at Harborview Injury Prevention and Research Center says that 50,000 children annually are hit by motor vehicles, often suffering serious brain injuries. The group says that kids are particularly vulnerable because traffic threats exceed their cognitive, developmental, behavioral, and physical abilities. Teach kids to look left, right, and left again before crossing, and to watch for turning cars. When biking or skateboarding, kids should obey all traffic signals and be aware of drivers, and when they go out at night they should wear reflective clothing. Savage stresses the importance of using proper safety restraints for children who are passengers in vehicles. He notes that children should use booster seats with lap and shoulder belts until they are about 4 feet 9 inches tall and weigh between 80 and 100 pounds. Many children will be between 8 and 12 years old before they exceed these requirements.
Use Protective Gear
Brain injury is the leading cause of sports-related death, according to the Brain Injury Association of America. Contrary to what you might expect, as kids grow, the risk for injury rises, due to their increased body mass and the amount of force involved. Whether on a bike or skateboard or playing football or baseball, using protective gear that’s specifically designed for that activity can go a long way toward reducing risk. “In those states that have helmet laws, just as many kids get banged, but helmets protect brains,” says Savage. “States that have enacted helmet laws have a reduced death and injury rate on bikes, scooters, and skateboards. We know that helmets work.” The American Association of Neurological Surgeons recommends using properly fitted equipment that is also approved by the American Society for Testing and Materials (ASTM) for specific sports.
When In Doubt, Sit It Out
For the most part, 99 percent of concussions clear up with rest, but it’s essential that kids take it easy after a head injury, especially after a concussion. A child shouldn’t go back to rough play or sports until the injury has healed, says Savage. Second Impact Syndrome — which occurs when someone experiences two concussions within a short period of time — can cause neurochemical damage to the brain, he says. Reinjuring the brain will extend healing time and put children at risk for additional, cumulative damage. Thanks to the work of Savage and his colleagues, legislation may soon be in place to prohibit athletes from returning to play on the day they suffer a concussion and until receiving a doctor’s clearance.
This article is updated from its initial publication in Brain World Magazine’s Fall 2010 issue.
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