Answers to questions families often have about caring for their child with traumatic brain injury (TBI)

Traumatic brain injury (TBI) is caused by a sudden trauma to the head resulting in damage to the brain and is sometimes referred to as a “head injury” or “acquired brain injury.” TBI is not hereditary, congenital, degenerative, or related to birth trauma. The individual may or may not have experienced a loss of consciousness at the time of the trauma. TBIs are categorized as mild, moderate, or severe.

Symptoms can range from relatively mild (dizziness, fatigue, headaches) to extremely serious (seizures, slurred speech, confusion, loss of coordination, vegetative state).

After a head trauma, doctors assess children for signs and symptoms of TBI. Sometimes a TBI is very obvious, whereas other times it may be subtle, such as a mild concussion. Brain imaging either by CT scan or MRI may be performed to allow further assessment of damage to the brain.

Prognosis depends on the severity of the TBI and many other factors. Children with a mild concussion usually heal completely, whereas those with more severe TBI may have lifelong problems such as difficulty walking and thinking. Most improvements are seen in the first year post-injury, but progress continues because of the plasticity (ability to heal) of children’s brains. Every child's recovery is different.

There is no genetic risk to TBI and, therefore, no risk to other family members.

Treatment will depend on the severity of injury but there are many treatment options. If your child has a severe TBI, he will receive rehabilitation therapy to ensure optimal function is achieved. Depending on the injury, these treatments may involve speech/language, physical, or occupational therapy; educational help; injections to help manage muscle tightness (spasticity) that sometimes develops after brain injury; and other treatments. It is important to receive early, effective, and intensive therapy for the best outcomes.

The degree to which you and your child will be impacted will depend on the extent of the TBI. Children who have a mild concussion will usually be back to normal quite quickly, whereas those with severe TBI may need lifelong help with activities of daily living.

It can be difficult to have a typically developing child who has an injury occur that may impact them for the rest of their life. Seeking support from a mental health professional or support group is helpful in coping with the feelings that can come up. See the Portal’s Support Groups and General Counseling Services (see NW providers [1]) listings for more information.

Finding balance when caring for a child with a serious injury can also be challenging. The Portal’s Caring for Yourself page has tips on taking care of yourself physically and mentally so that you are ready to care for your child’s needs. Caring for Your Other Children offers suggestions on balancing care for all of your children. Support from a mental health professional can also help caregivers balance multiple responsibilities.

There are many reasons why it is difficult to predict the outcome of brain injury in children. It is more difficult to determine pre- and post-injury function in a toddler than in an adult where work and academic records are available. It used to be thought that children were more resistant to residual effects of a brain injury because their brains could "rewire" connections lost during the brain injury. However, we now know that children may be more susceptible to injury, although the damage may not be evident for years. For instance, injury to the brain's reading and writing areas won't be obvious until the child reaches school age and is expected to learn these skills. "Frontal lobe functions" develop in adolescence and adulthood. These functions include high-level reasoning and control of social interactions and interpersonal skills, particularly inhibiting behaviors that aren't acceptable in society. If a child's frontal lobe is injured, it may not be apparent until the related skills are expected to be present.

Periodic re-evaluation will be necessary during the school years. Acting early if problems are observed is key to limiting complications and improving your child's functioning. Different services are available for children depending upon the child's age. See Early Services, 0-5 Years, From Preschool to Kindergarten/Elementary School, and Special Education Supports and Services.