Brain Injury: What Every Parent Needs to Know

Hannah: [00:00:00] Hi. You don’t normally hear from me, but this is Hannah. I’m the producer for the Parenting Brief. I just wanted to hop on here real quick and let you know that today’s episode is heavier than usual and it talks about child abuse. We wanted to let you know that at the top of the show, but we do hope that you listen through ’cause there’s good takeaways in here for everyone.

Jessica Stewart-Gonzalez: Welcome to the Parenting Brief. I’m your host, Jessica Stewart-Gonzalez, an Arizona working mom and chief of the Office of Children’s Health at the Arizona Department of Health Services. We’ve got parents covered with everything they need to know to keep their kids safe as they grow.

Infants and children can experience brain injuries in many ways, making it a leading cause of death and disability. [00:01:00] Sometimes impact from injuries can happen immediately or even years later. What should you be looking for and what should you do to prevent traumatic brain injury? Today we’re covering all of that and more.

With us today is Dr. Sue Wolf, an educational psychologist with Empowerment Research. Thank you so much for being here today. Is it possible for a child to have a brain injury and not know it? 

Dr. Sue Wolf: Absolutely. We have clear and convincing evidence that you can take a child who’s had what looks to be a pretty serious injury, take them to the emergency room.

Um, the CT scans come back clean. Maybe they even do a MRI and nothing appears on that scan. But it doesn’t [00:02:00] mean that the electrical and chemical changes in the brain still don’t result in long-term consequences. So there are a lot of children actually that are kind of out bopping about with pretty significant implications from earlier injuries or even disease or trauma, and we don’t always know it.

Jessica Stewart-Gonzalez: What are the common ways an infant or a child experiences a brain injury? 

Dr. Sue Wolf: Well, in terms of common issues, I think that we start with sometimes, not the topic we always wanna talk about, but there is a lot of abuse that goes on, um, with young children, especially infants and toddlers. It actually accounts for a significant amount of head injury in young children.

Add to that, we also have accidental falls. Uh, those tend to be kind of the highlights, but we can’t forget about motor vehicle children who are not appropriately restrained in passenger safety restraints [00:03:00] or maybe inappropriately placed in vehicles, um, without proper restraint. And then you have all the kinds of accidents and early sporting adventures that happen for children as well.

So there are a number of different mechanisms that can lead to head injury in young children. I think the most important and startling statistic is that brain injury is still the leading cause of death and disability amongst children under the age of two. So when we have those data behind us, this topic becomes incredibly important for parents as well as community members and professionals.

Jessica Stewart-Gonzalez: When would some of those signs or symptoms from a brain injury appear? If it is from an earlier. Concern an earlier car accident, earlier abuse, um, earlier sports injury. When or how long does it take to see, uh, some of the impact of those injuries if you’re not able to see them [00:04:00] right away? 

Dr. Sue Wolf: Well, uh, the first answer is usually there are some children who present immediately, right?

Sometimes it is, um, a subsequent seizure disorder that happens at the time of the injury. Those are the obvious ones. The more what we call latent effects may not be seen for days or weeks or months or years. Post-injury, my son was injured as a two and a half year old, and even though he was seen in the emergency room and was cleared to go home, um, he was two and a half.

We didn’t really see the significant implications of his injury until he was screened for kindergarten. And it was during his vision screening that we identified that he was legally blind in his left eye and had significant neuro impairment and neurotrauma to his left eye as a result of that injury that happened at two and a half.

So, and, and I don’t know that we’re unusual in that respect. We have [00:05:00] other individuals, many who come to, um, our middle schools and junior highs, and it isn’t until they start demanding abilities from their frontal lobe, like higher order thinking skills or abstract thinking, that we begin to see the deficits show up academically in school.

We have other children who present with challenges and behavior, and that can be days, weeks, or months after injury. It just depends upon where the brain was injured, how it was insulted, and the level of resilience that children have physiologically. I think the other piece that we don’t talk about much is repetitive injury, which is definitely true in young children in sports, and it’s definitely true in cases of abuse.

Jessica Stewart-Gonzalez: When we are talking about those infants, those younger children who experience a brain injury, you talked about, um, the, those implications of abuse. And we know that when [00:06:00] we are educating families, um, about. Injury prevention, child safety. One of the things that we talk about is shaken baby. Um, and so is that one of the ways, or even a common way that we see that brain injury in infants specifically?

Dr. Sue Wolf: Absolutely. The field in general, in terms of neurology has moved away from the title Shaken Baby because it also happens to toddlers and it actually also happens to our frail elderly. In reality for young children, we now refer to that term as abusive head trauma, and we know that it’s preventable, right?

We know that it results from violently shaking an infant or toddler by their shoulders or their chest or their arms, and it also can result from an impact. A lot of times individuals don’t just shake children. They may shake them and throw them. They may shake them, put them down against a hard surface, um, and it’s actually the whiplash effect.[00:07:00] 

From shaking the child that causes bleeding in the brain, and sometimes we can even see it when we look in the eyes of that infant. And unfortunately, many victims suffer serious acute injuries. One in three suffer fatal injuries, and the reality is that most have long-term sequelae after abuse. 

Jessica Stewart-Gonzalez: For infants and children who may experience a brain injury, um, in, in any of the ways that we have, uh, briefly talked about, are there opportunities for recovery?

Dr. Sue Wolf: Absolutely. First, for those children who are severely injured, getting access to acute care. To the appropriate rehabilitation and having it be in a timely manner is very important. And we know that a lot of children who experience abuse their abusers don’t want them to seek medical care, and many times don’t take them in [00:08:00] Once we deal with the acute phase of the injury and we have opportunities for rehabilitation, once children come home after injury, it’s absolutely critical to continue therapies and to seek the resources necessary to rehabilitate children.

Many children do recover. There are some examples of spontaneous miraculous recoveries, but those are very rare. We also have other children who don’t recover and may end up in a persistent vegetative state requiring 24 hours care from nursing staff and family members, and it’s the gamut anywhere in between those two.

But it’s really important for parents to understand the critical role that they play in the recovery of their child after injury, regardless of how the injury occurred. And there are a number of recommendations about obviously, um, limiting potential for future injury. I think that’s, that’s really a big one.

And we talk [00:09:00] about being very observant of your child, child and their behavior. Do we see any identified places of developmental delays where children are not meeting their milestones? Do we see other kinds of impairments that may be very slight, like motor dysfunction, visual challenges? Uh, we also see concerns with behavior issues, and all of those need to be addressed.

Jessica Stewart-Gonzalez: We have more resources on TBIs and babies and toddlers in the episode show notes. These injuries can be hard to detect, so please share this episode with your friends and family to help with quick identification and appropriate interventions. Follow the show to get a notification when our next episode is live.

Until next time. This is Jessica. You’ve got [00:10:00] this.