This letter is regarding the May 25th article on traumatic injuries in children. One case of a severe head injury due to a skating accident was described. Most of the information was focussed on physical injuries. We would like to address the serious issues that arise after a head injury, especially in children.
Traumatic brain injury primarily affects cognitive abilities, such as short-term memory, attention, concentration, and learning new materials. Children have difficulty returning to their previous level of functioning at school. They may become hyperactive, irritable, aggressive and show other changes in their personality. They may show signs of ADHD with lack of concentration, easy distractibility, and difficulty to grasp new concepts. Their grades could start to decline. They may show significant mood swings ranging from rage outbursts to depression. These changes in a young child’s life lead to frustrations for parents, teachers, and the child himself. The children start to withdraw and develop problems with self-esteem and self-confidence. They may even become apathetic.
Other symptoms of head injury may include physical, emotional, behavioral, and neurological changes. These may include – headache, sleep problems, chronic pain, seizures, anxiety, depression, nightmares, disruptive behaviors, etc. Anxiety syndromes manifest as fearfulness, worry, and persistent tension. Depression is not easy to recognize in children and it can be very disabling. Unlike most injuries, such as a broken leg or a third-degree burn, the evidence of the trauma is often intangible, and the symptoms can be puzzling and unclear. Such an experience oftentimes is very stressful for the patient, his family, and his doctor.
Children are especially at high risk for head injury because of involvement in sports, bike riding, skating, swimming, vacation travel etc., more so in summer months. The use of a helmet, which for the state of Pennsylvania is a law for all children under the age of 12, is essential when riding a bike. Making sure the children are wearing a seatbelt and preferably ride in the back seat of an automobile. The effects of a head injury can be life long.
Most children show good recovery from a mild head injury over one to three months while the symptoms of severe head injuries usually persist. Anyone with symptoms beyond three months should seek further evaluation and treatments from specialists such as neurologists, child psychiatrists, or neuro- psychiatrists. Educating the family, teachers, and the patient is very important. Depression, anxiety, irritability, and problems with self-esteem and self-confidence can be treated with education, counseling, and medications. There are many organizations that provide support and information for patients and their families about brain injury. (Brain Injury Association at 703-236-6000; www.biausa.org )
Ravi Kant, MD
Head Injury Clinic
Pittsburgh, PA 15017