A little more than just “a bump to the head”

Children are clumsy - most of us can recall many a time when either ourselves or a younger relative came home from school with scraped knees and bloody elbows, or a bump to the head. Rarely would we think too much of it if this happened with no obvious signs of damage.

However, brain injury in children can occur without it causing concussion or a cut to the face. Sometimes, the parents may not even be aware of their children having hurt themselves at all. Most of the time, a fall causes no serious damage to a child, but where the brain is shaken or scraped against the skull, especially when the frontal lobe of the brain gets damaged, these injuries can have mild to severe effects on the development of the child, and their behavior throughout life.

So, just how prevalent are brain injuries?

In the UK, approximately 1 million people are taken to A&E every year for brain injury (Kay, 2001). Brain injury is the leading cause of death in children, and adults up to the age of 44, ranking above cancer.

How is brain trauma classified?

Trauma to the brain is measured on the Glasgow Coma Scale (GCS), where medical professions ask the patient to follow instructions of actions (motor), react to stimuli (visual), and give spoken responses (verbal) such as their name and date of birth. Better performances of these tasks give responses of 13-15 (where 13 or 14 is mild trauma), whilst anything between 12 and 9 is moderate, and under 8 is severe.

What areas of the brain are typically affected?

It depends on the individual injury. Generally, brain trauma affects three parts of the brain: the frontal lobe (involved in higher order mental functions, such as co-ordinating social behaviour and speech production), the limbic system (associated with emotional responses and pleasure), and the temporal lobe (primarily involved in memory and learning).

Brain injury in children

Initially, it was thought that children were more resilient as they hadn't finished growing or developing and thus could repair themselves, however, research now suggests that although they continue to develop, children with traumatic brain injuries (TBI) develop at a somewhat slower rate. Yet, 5% of children with mild TBI and 50% with moderate or severe TBI develop problems with self-regulation. Teachers, parents, and peers might notice that the child has difficulty socialising. TBI is thought to affect theory of mind (as is autism), meaning that they find it difficult to determine emotions in others, perceiving threat when it's not there and being unable to find appropriate responses to emotional stimuli. This effect is most obvious where the TBI occurs in children between 2 and 6 years of age, so this a period of risk.

So, next time a child gets a little "bump to the head", get them checked out. It's better safe than sorry.