Children With Head Injuries Can Face Lifetime of Problems

Study documents persistent skill deficits two years after moderate or severe trauma

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THURSDAY, Oct. 27 (HealthDay News) -- Children can face a lifetime of problems after suffering head injuries from falls, car accidents and other mishaps, according to a new study.

From communication deficits to trouble with daily self-care, the effects of moderate to severe brain injuries can lead to "substantial long-term reduction" in quality of life for children with traumatic brain injury, the researchers found.

The findings "emphasize the need for prevention," said study author Dr. Frederick Rivara, professor of pediatrics at the University of Washington School of Public Health in Seattle. "Many of these injuries can be prevented by using bicycle helmets, and kids being buckled up in seatbelts, making sure there are gates on stairways." Schools also should consider different rules for football, he added.

The study, published online Oct. 24 and in the November print issue of Pediatrics, looked at 729 children under 18 years old treated for brain injuries at emergency rooms in Seattle and Philadelphia between 2007 and 2008. Most of the injuries resulted from falls and car crashes, the study noted. Few were related to assault or abuse, said Rivara.

Levels of the children's functioning before they were injured were determined through phone interviews, usually with parents. Tests were done three months, one year and two years later to assess different skills and behaviors. They included whether the children were depressed, played or interacted with others, were teased, had trouble concentrating or remembering, and could do things "that other children can do," said Rivara.

The children were further assessed to see if they could "have a conversation, discuss a topic," and do things such as use the toilet, brush their teeth, and feed and dress themselves, he said.

Comparisons also were made to a separate group of 197 children who had visited the same emergency rooms with arm injuries in the same period.

The research found most of the children with head injuries, about 85 percent, suffered from mild trauma.
Some of those had deficits at three months, but few suffered lasting loss of social and daily life activities.

But lasting effects were seen in those with mild injury who also suffered a brain hemorrhage and those who suffered a moderate or severe brain injury. These kids faced obstacles in day-to-day life, school activities and sports at the end of the two-year research period.

The more seriously injured children had a lower quality of life than children undergoing active treatment for cancer, the researchers said.

Children in the control group had no significant deficits after two years, according to the research.

Kids with significant problems after two years are unlikely to make big gains in their condition, but researchers are still collecting data on youths in the study, said Rivara.

The data showed that boys were more than twice as likely as girls to sustain head injuries, and that the
youngest (under 4 years old) and the oldest (15 to 17 years) were most likely to sustain moderate to severe injuries.

Of the total number of severe injuries, more than half were suffered by 10- to 17- year-olds, which another expert attributed to organized sports.

"This is the age group where they're playing more sports," said Dr. Gail L. Rosseau, a neurosurgeon in the department of neurosurgery of NorthShore University Health System in Chicago.

Rousseau called the study "well-designed" and said it pointed to the need for more states to enact legislation similar to Washington's Zachery Lystedt law, which was designed to protect student athletes. It was named after a high school student who sustained permanent brain damage playing football.

She said laws in 30 states and Washington, D.C. require that players with symptoms of concussion, a mild form of brain injury, be cleared by a health care professional before returning to play. Concussion symptoms include dizziness, nausea and headaches.

"Professional football has changed some rules to try and decrease the incidence of concussions, and high schools need to look at that as well," Rivara said.

"It's not only football," said Rosseau, noting that girls' soccer is the second leading sports-related cause of concussion among children.

The academic performance of the children in the study will be presented separately.

The study authors acknowledged several limitations with the study, including the fact that the children's level of functioning beforehand was assessed by their parents, not professionals.

In order to better understand why symptoms persist in some children, they said additional research is needed.

SOURCES: Frederick P. Rivara, M.D., M.P.H., professor of pediatrics, University of Washington, Seattle; Gail L. Rosseau, M.D., neurosurgeon, department of neurosurgery, NorthShore University Health System, Chicago; November 2011, Pediatrics

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