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Traumatic Brain Injury

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

What is traumatic brain injury and what causes it?

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.

What are the symptoms?

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

How is it diagnosed?

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.

What is the expected outcome?

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.

Will anyone else in the family get a TBI?

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

What is the treatment?

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.

How will my family’s life be changed?

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.

Our child's doctors told us that it would be years before we would know how our toddler would recover from his fall. Why can't they tell us now?

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.

Resources

Information & Support

Related Portal Content
Traumatic Brain Injury
Assessment and management information for the primary care clinician caring for the child with traumatic brain injury (TBI).
Care Notebook
Medical information in one place with fillable templates to help both families and providers. Choose only the pages needed to keep track of the current health care summary, care team, care plan, health coverage, expenses, scheduling, and legal documents. Available in English and Spanish.

For Parents and Patients

TBI Resource Guide (CSN)
Comprehensive list of national, informational, educational, and organizational resources related to traumatic brain injury; Children's Safety Network.

Traumatic Brain Injury (CDC)
Facts, statistics, clinical guidelines, publications, reports, videos, and resources for parents and clinicians responding to TBI. Also includes tools to assist with prevention of TBI, recognizing and responding to a concussion and other serious brain injuries, and how to safely return to school and sports; Centers for Disease Control and Prevention.

Traumatic Brain Injury (NINDS)
Overview and links to publications and relevant organizations - not pediatric-specific; National Institute of Neurological Disorders and Stroke.

Traumatic Brain Injury (Center for Parent Information & Resources)
Parent-focused page about TBI, includes information about education.

National Resource Center for Traumatic Brain Injury
Practical information for professionals, persons with brain injury, and family members.

Family Functioning Following Pediatric Traumatic Brain Injury (Word Document 80 KB)
Information about family adaption after TBI and characteristics of healthy families, re-entry into community and school, role of the pediatrician, and family functioning research; Brain Injury Association of Washington.

Pediatric Neuropsychology: A Guide for Parents (PDF Document 456 KB)
Describes pediatric neuropsychology, how it differs from a school psychological assessment, reasons for referral, what is assessed, what it will tell you about your child, and how to prepare for the test.

Types of Memory (PDF Document 59 KB)
A five-page handout developed by Dr. Glen Johnson, Clinical Neuropsychologist, that describes the types of memory, things that affect memory, and tips for improving memory.

Fatigue (PDF Document 41 KB)
Courtesy of Dr. Glen Johnson, Clinical Neuropsychologist, this handout describes fatigue and ways to adjust to the fatigue factor.

Traumatic Brain Injury (MedlinePlus)
Information for families that includes description, frequency, causes, inheritance, other names, and additional resources; from the National Library of Medicine.

Brainline Kids – Helping Kids with Brain Injury
BrainLine Kids, a feature of Brainline.org, provides information about children ages birth through 22 years who are affected by Traumatic Brain Injury.

Abusive Head Trauma / Shaken Baby Syndrome (Nemours)
Signs, symptoms, outcomes, and prevention of abusive head trauma/shaken baby syndrome; KidsHealth.

Easterseals
Nonprofit organization offering services for individuals with disabilities and their families. Primary services include medical rehabilitation, early intervention, physical and occupational therapy, speech and hearing therapy, child care, recreation, and transition.

When your Child is in the Hospital
Information about TBI specific to the Boston area. Good tools/resources for families in any state; Brain Injury Center at Children’s Hospital, Boston.

Pressure Ulcer Resource Guide
Information for families and caregivers about pressure ulcer types, causes, treatments, preventions, and remedies.

Brain Injury: The ABC Years (PDF Document 90 KB)
According to the Centers for Disease Control and Prevention (CDC), an estimated 5.3 million Americans currently live with disabilities resulting from brain injuries. A publication of the Brain Injury Association of America.

Infant Head Injury
Any kind of head injury can be scary, but when the injured is a young child or baby, it becomes even harder to assess the damage.

Traumatic Brain Injury, Susan's Story
Explanation of traumatic brain injury, tips for parents and teachers, and a listing of resources and organizations; National Dissemination Center for Children with Disabilities.

The Road to Rehabilitation Series (BIAUSA) (PDF Document 758 KB)
Eight articles (total 80 pages) for TBI patients and families about dealing with pain, headaches, cognition and memory, behavior changes, speech and language, drug therapy, spasticity, and concussion/mild brain injury; Brain Injury Association of America.

Services for Patients & Families Nationwide (NW)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Brain Injuries in Children (ClinicalTrials.gov)
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.

Authors & Reviewers

Initial publication: October 2012; last update/revision: January 2021
Current Authors and Reviewers:
Author: Lynne M. Kerr, MD, PhD
Reviewer: Marybeth Barkocy, PT, DPT
Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.