Seating & Positioning 2012 Handbook

The Lasting Costs of Early Brain Injury

The timing of a traumatic brain injury (TBI) — in childhood or adolescence versus adulthood — can impact how much function a patient can eventually regain. But new research suggests brain injuries among very young children continue to significantly impact the rest of their lives.

A study published in February by Pediatrics, Official Journal of the American Academy of Pediatrics, researched intellectual, behavioral and social functions of children who sustained brain injuries before turning 3 years old.

Of the 53 children examined in the study, 20 had mild brain injuries and 33 had moderate to severe brain injuries. An additional 27 uninjured children served as the study’s control group. The children were 4 to 6 years old at the time of the study. On average, 40 months had passed since the affected children had been injured.

A report of the study said, “Although all group scores were in the average range, children with moderate/severe TBI performed significantly below uninjured children on an IQ measure. No significant differences were found on parent behavior ratings… No differences were found for social skills.”

Researchers concluded, “Moderate/severe TBI at an early age appears to be associated with lowered intellectual function and possibly behavior problems. A child’s environment infl uences cognitive and behavior after TBI.”

The study also noted TBI “is a major cause of death and disability in children, and children less than 3 years of age have a particularly high incidence of TBI.” That higher risk is due in part to differences in anatomy, such as “an increase in diffuse injury possibly due to the thin and pliable skull necessary for birth, a disproportionately large and heavy head with weak neck muscles increasing infant’s susceptibility to rotational and shearing forces, and elasticity of blood vessels.”

And while a younger brain may be able to more readily compensate for an injury than a brain of an older adult, when very young children are injured, they may have fewer resources to draw on to help them cope.

“Young children have few, if any, established skills,” the study said, “and thus damage to the brain is likely to impair their ability to acquire skills at the same rate as uninjured children.” One of the missing puzzle pieces, research wise, is the relative scarcity of studies that have examined TBI in very young children, though more studies of older children with TBI do exist.

“Consistent with previous research,” the study authors note, “there was an association between TBI severity and children’s cognition; children with moderate/severe TBI performed below uninjured children, although they still achieved scores in the average range.… Although children with moderate or severe TBI may perform within the average range on cognitive testing at a young age, this does not necessarily predict average cognitive abilities later on.”

The researchers will be following up with the children in the study every two years.

The study’s authors are Louise M. Crowe, Ph.D., from the University of Melbourne (Australia); Franz E. Babl, M.D., MPH, from Murdoch Childrens Research Institute, Melbourne; and Vicki Anderson, Ph.D., Royal Children’s Hospital, Melbourne.

This article originally appeared in the March 2012 issue of Mobility Management.

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