Child Brain Injury: what you need to know

By Cathy Catroppa and Nick Ryan

Traumatic brain injury (TBI) is a common cause of childhood disability, with recent estimates suggesting that up to one in every 30 children will sustain a TBI before the age of 16. The majority of these injuries are mild, and have few, if any, ongoing consequences (in comparison to moderate and severe injuries). Mild injuries are often sustained by falls or during sport, while more severe injuries commonly via pedestrian and motor vehicle accidents. The figure below depicts the number of children presenting to The Royal Children’s Hospital across a one year period.

Reproduced from Crowe, L. et al. (2009). The epidemiology of paediatric head injuries: Data from a referral centre. Journal of Paediatrics and Child Health, 45, 346-50

TBI in Australia

In Australia, it has been estimated that the total community cost of TBI is a staggering $9 billion per year. Following adult TBI, the lifetime cost per individual is reported to be $5 million for severe injury and $3.7 million for moderate injury (Access Economics, 2009). While no such estimates are available for children, it is reasonable to assume that, for the preschool child, who has 60 years or more to live, the associated costs are likely to be far greater, especially if functional physical, cognitive and social problems are not recognised and treated early.

The outcomes following mild TBI/concussion in childhood

Most children with mild injuries experience rapid recovery within weeks of their injury. There is however, a small proportion of children who continue to experience persisting difficulties with post-concussive symptoms, cognition, and behaviour.

In order to increase awareness and understanding of the outcomes of childhood concussion, our team is conducting a longitudinal study to identify factors that contribute to better and/or worse outcomes following these injuries and to plot recovery trajectories. The project, which is a collaboration of the Murdoch Children's Research Institute and The Royal Children’s Hospital, will assist in identifying and targeting children at risk of long-term difficulties after concussion. The study is uniquely positioned to provide medical advice and psycho-education to children and their families on the impact of concussional head injury on thinking and behaviour. The findings of this study will ultimately inform guidelines for return to sport and school, as well as assist to identify “at risk” children who may benefit from ongoing monitoring and intervention after their initial presentation to the emergency department.

The outcomes of moderate and severe TBI in childhood

Although a large proportion of children with mild TBI show rapid recovery from injury, patients with more severe injuries demonstrate persisting difficulties in cognitive areas such as memory, processing speed, attention, planning and organising, as well as social behaviour. In particular, since brain regions commonly affected by TBI include those areas involved in cognitive areas and social behaviour (see diagram below), it is perhaps not surprising that children with more severe TBI experience difficulty with these skills. In order to improve our understanding of outcomes following TBI, our team is currently using standardised neuropsychological assessments as well as state-of-the-art neuroimaging techniques to identify children at risk for persisting cognitive and social dysfunction.

Rotational acceleration-deceleration causing shearing injury to nerve fibers (Adapted from Anderson & Yeates, 2010)

TBI research at Murdoch Children's

Clinical research at the Murdoch Children's Research Institute aims to improve the lives of children, adolescents and young adults by understanding what happens after a brain injury and by developing interventions to treat presenting difficulties. This in turn will increase the independence of those individuals afflicted with a brain injury as they mature into adulthood. Our current areas of interest include:

• long-term outcomes of young adults with childhood TBI
• mental health outcomes from mild TBI (concussion)
• neuroimaging studies looking at brain-behaviour relationships
• development of intervention programs that target cognitive, behavioural and psychological difficulties
• development of tools to assess social skills

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