Severe Brain Injury When Young May Have Long-Term Effects

MONDAY, Jan. 23 (HealthDay News) — Although many people believe
young children are extremely resilient after they are seriously hurt, the
opposite may be true with traumatic brain injuries.

Two Australian studies looked at the impact of traumatic brain injury
in children as young as 2 years, and found that these injuries affected
cognitive function, IQ and even behavior for some time. However, the
researchers also found that recovery from traumatic brain injury can
continue for years after the initial injury. And, a child’s home
environment can positively influence recovery if the child lives in a
stable, caring home.

“Many people think that the soft skull of a baby may give them some
advantage because if they fall they are not likely to sustain a skull
fracture. Also, because a baby’s brain is growing so quickly, it seems
like the brain may be able to fix an injury. In reality, the soft skull
and growing brain of a baby put them at a greater risk of future
problems,” said the lead author of one of the studies, Louise Crowe, a
postdoctoral research officer at the Murdoch Childrens Research Institute
in Melbourne.

“Children with significant head injuries do recover, but they are
generally slower to learn concepts, and some high-level skills are often
too difficult for them,” she added.

Results from both studies were released online Jan. 23 and are
scheduled to appear in the February issue of Pediatrics.

By age 16, at least one in 30 children will experience a traumatic
brain injury, according to background information in one of the studies.
Traumatic brain injuries (TBIs) occur after a blow or bump to the head,
according to the U.S. Centers for Disease Control and Prevention.

Young children — those under 4 years old — are particularly at risk
of experiencing a traumatic brain injury, according to the CDC. Such
injuries can occur from a fall, a car accident, deliberate child abuse,
sports or being hit with a moving object. Fortunately, most of these
injuries aren’t fatal, but about one-third of children who survive a TBI
will have lasting damage, report the researchers.

Very few studies, however, have followed youngsters from the time of
their injury through adolescence, to assess the full effect of the brain
injury.

The first study looked at 40 children between the ages of 2 and 7 who
had experienced a traumatic brain injury. They were compared to 16 healthy
children. The children were examined 12 months, 30 months and 10 years
after the injury, according to the study.

Not surprisingly, they found that children with the most severe
injuries had the worst cognitive outcomes.

But, the news wasn’t all bad. Initially, while the brain was recovering
from the injury, the children didn’t make significant developmental gains
for about three years. However, after that period, and at least up until
10 years after the injury, the children began to make some age-appropriate
developmental gains.

That means that even many years after an injury, interventions and
therapies for these children may be effective, said the study’s lead
author, Vicki Anderson, a professor in critical care and neuroscience
research at the Murdoch Institute.

“Although this does not suggest that children catch up to peers, it
does imply that the gap does not widen during this period,” she said.

This study also found that the home environment and relationships could
make a difference in a child’s recovery. More stable homes with less
family conflict appeared to contribute to a child’s recovery.

“It’s difficult to predict outcome,” said Anderson. “A quality home
environment and access to appropriate rehabilitation is critical to
maximize outcomes. Or, the young brain is plastic, and so the better the
environment, the better the outcome.”

The second study, led by Crowe, followed a group of 53 children who had
sustained a traumatic brain injury before they were 3 years old, and 27
non-injured children. They followed up with these children when they were
between 4 and 6 years old. The average time since the injury occurred was
40 months.

Children who had moderate-to-severe TBIs scored lower on IQ tests by
about seven to 10 points, according to the study. Mild traumatic brain
injuries didn’t seem to significantly affect IQ. However, mild and
moderate-to-severe TBIs were associated with an increased risk of behavior
problems.

And, as with Anderson’s study, this study also found that a child’s
environment has an effect on cognitive function and behavior after a brain
injury.

“Children from cohesive family environments and children whose parents
had lower levels of stress showed better recovery,” Crowe said. “Why this
is so is unclear, but it may be due to a parent spending more time with
their children, and children also growing up in a less stressful
environment.”

One expert noted that the findings make an important point.

“We still don’t understand all of the factors that affect outcomes.
But, these studies do give us important data. We don’t necessarily want to
close the door on treating these children too soon. There may still be
room for improvement over time, but there are persistent deficits,” said
Dr. Mandeep Tamber, an assistant professor of pediatric neurosurgery at
Children’s Hospital of Pittsburgh.

Meanwhile, Crowe advised parents to be vigilant with young children.
She said traumatic brain injuries can result from seemingly minor
accidents, such as a baby rolling off of a bed or couch.

More information

Learn more about traumatic brain injuries from the U.S. Centers
for Disease Control and Prevention
.

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