Taking Care of Children with Traumatic Brain Injury

By Juliet Haarbauer-Krupa, Ph.D., FACRM, Senior Health Scientist, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

Children ages 0-17 years old accounted for 7.8% of all traumatic brain injury (TBI)-related hospitalizations in 2017. Estimates of lifetime prevalence of a TBI range across different surveys from 3.6% to 7% for children ages 3-17 years, and among adolescents (ages 13-17 years) prevalence estimates range from 6.5% to 18.3%. A national survey of parents found that 2.5% of children (approximately 1.8 million) sustained a TBI in their lifetime. These estimates are likely an underestimate because they include only emergency and hospital care. These data include children who do not receive a medical evaluation for their injury or those who are seen by a pediatrician or in specialty clinics. Young children aged 0 to 4 years have the highest rate of emergency department visits across the pediatric lifespan, with falls being the leading cause of injury. Some of these injuries are unintentional and others are due to abusive head trauma.  

Any child who experiences a TBI, including a concussion, is at risk for changes in their daily life. TBIs of all levels of severity affect children differently than adults, in part because children are undergoing profound development changes. Children can experience changes in their physical health, thinking, and behavior as a result of a TBI that impacts their development. These changes can then affect their learning, self-regulation, and social participation, all of which contribute to becoming productive adults. Although most children recover physically from a TBI, they can experience changes in behavior and cognition that may not be recognized immediately. We know that the management of TBIs in children is complex and depends upon multiple service delivery systems (e.g., medical and educational) that may not provide systematic or coordinated care to ensure optimal outcomes.

In 2018, the Centers for Disease Control and Prevention’s Report to Congress: Management of Traumatic Brain Injury in Children provided a summary of the current burden pertaining to TBI and research and practices for preventing a TBI. Recommendations were offered for recognition of a TBI in both healthcare and school settings when the injury is experienced, the importance of monitoring children over time to watch for signs and symptoms across the pediatric lifespan, and ensuring access to care when needed.

We know that many children experience a TBI during childhood and it may not always be identified or diagnosed. Since pediatric TBIs occur during a period of significant developmental change, they can significantly impact a child’s health, school performance, and social skills. It is particularly important to recognize TBI in children soon after the injury, monitor these children over time, and ensure that they receive care when needed in healthcare and school settings to aid them in becoming healthy and successful adults.

References

• Arbogast, KB, Curry, AE, Metzger, KB, Kessler, RS, Bell, JM, Haarbauer-Krupa, J, Zonfrillo, MR, Breiding, MJ, & Master, CL. (2017). Improving primary care provider practices in youth concussion management. Clinical Pediatrics, 1-12: DOI: 10.1177/0009922817709555.

• Centers for Disease Control and Prevention (2021). Traumatic Brain Injury and Concussion: Get the Facts.

• Centers for Disease Control and Prevention (2021). Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations and Deaths-United States, 2016 and 2017. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

• Centers for Disease Control and Prevention (2018). Report to Congress: The Management of Traumatic Brain Injury in Children, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA.

• Haarbauer-Krupa, J, Haileyesus, T, Gilchrist, J, Mack, KA, Law, CS, Andrew Joseph, A. (2019). Fall-related Traumatic Brain Injury in Children Ages 0-4 years, Journal of Safety Research,70: 127-33.

• Haarbauer-Krupa, J, Heggs Lee, A, Bitsko, RH, Zhang, X, Kresnow-Sedacca, M, (2018). Prevalence of parent reported traumatic brain injury in children and associated health conditions. Journal of the American Medical Association (JAMA) Pediatr, DOI: 10.1001/jamapediatrics.2018.2740.

• Haarbauer-Krupa, J, Arbogast, KB, Metzger, KB, Greenspan, AI Kessler, R,  Curry, AE, Bell, JM DePadilla, L, Pfeiffer, MR,  Zonfrillo, MR, &  Master, CL. (2018). Variations in mechanisms of injury for children with concussion. Journal of Pediatrics, March, DOI: 10.1016/j.jpeds.2018.01.075.

• Haarbauer-Krupa, J, Ciccia, A, Dodd, D, Ettel, D, Kurowski, B, Lumba-Brown, A & Suskauer, S. (2017). Service Delivery in the Healthcare and Educational Systems for Children following Traumatic Brain Injury, Journal of Head Trauma Rehabilitation, published online ahead of publication: DOI: 10.1097/HTR.0000000000000287.