Severe Brain Injury When Young May Have Long-Term Effects

MONDAY Jan. 23, 2012 -- 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.

Posted: January 2012


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