Childhood Brain Injury: More Like a Chronic Disease With Lifetime Repercussions
Children experience brain injuries for many reasons. A traumatic brain injury (TBI) is usually caused by a blow to the brain. Car accidents and falls are leading causes of brain injuries in very young children. Concussions while playing sports are an additional contributor to brain injuries in older children.
More than 5 million Americans of all ages are living with a TBI-related disability. A childhood TBI is, however, more likely to be disabling than an adult TBI. In addition, the full nature of a pediatric TBI does not always become apparent until the child is well into adulthood. Intelligence tests are not a good indicator of the impact a TBI had upon a child because they measure prior learning rather than the ability to learn new things. Only periodic neuropsychological testing can assess the impact of a TBI upon a child's brain over the course of time.
The Recovery Myth
Many people believe that children recover from brain injuries more quickly than adults. At one point, even doctors subscribed to that belief. The evidence does not support the myth that a child's brain is more resilient than an adult's.
A child's brain develops in "spurts" that occur at different times and ages over a period of years. A brain injury that interferes with the development or maturation of a child's brain will often lead to complications that would not appear in a fully developed adult brain that experienced comparable trauma.
The "roller coaster" nature of childhood brain development hampers the assessment of brain injuries in children. For instance, the ability to engage in abstract thinking does not usually begin until age 12 or 13. It is therefore impossible to predict whether a brain injury sustained at the age of 5 will impair abstract thinking until the child reaches his or her early teens. A child who appears to have recovered from a brain injury may not have reached the age at which the injury will become apparent.
Medical experts agree that the long-term impact of a TBI on a child can be far worse than a comparable injury inflicted upon an adult brain. The younger the child, the less likely the child is to make a full recovery. Children between the ages of 2 to 7 who experience a TBI show less recovery than children who are injured at a later age.
Why Neurologists Treat TBI As a Disease
A traumatic brain injury (TBI) occurs suddenly, usually as the result of a blow to the brain. Because its onset is caused by an external event, a TBI differs from damage to the brain caused by birth defects or degenerative diseases. Yet medical science no longer draws a clear distinction between a TBI and a brain disease. As neurologists have gained a better understanding of the evolution of a TBI and its ongoing impact on a patient's life, they have come to regard a TBI as a chronic disease process rather than a single event.
Insurance companies often treat brain injuries as if they were broken bones. Once the bone is repaired, it heals without requiring additional treatment and without having an impact on other organs of the body. A TBI, on the other hand, has the characteristics of a disease. It produces symptoms that change over time, it can affect other bodily organs, and it requires persistent treatment.
A childhood TBI often produces ongoing changes to the brain over the course of time. Those changes can lead to reduced mobility and may affect bodily organs, including the liver and lungs. The immune system of a TBI sufferer may be impaired. Abnormal bone growth (heterotopic ossification), leading to osteoporosis and nerve impingement, is a known result of traumatic brain injuries.
People who have a TBI are more likely than the general population to develop circulatory problems, seizures, septicemia (blood poisoning), and respiratory conditions. Traumatic brain injuries can cause epilepsy, sleep disorders, the loss or impairment of vision, growth hormone deficiency, hypothyroidism, incontinence, and sexual dysfunction. Brain injuries are also suspected of being a risk factor in the development of Alzheimer's.
There is substantial evidence that individuals with a moderate-to-severe TBI have a shorter life expectancy than individuals who have not experienced a brain injury. One study concluded that the life expectancy of individuals who survived a TBI for at least one year was shortened by four years. Individuals with a TBI are 49 times more likely to die of aspiration pneumonia and 22 times more likely to die of a seizure. Another study found that individuals who survived a TBI for at least one year were three times more likely than the general population to die from a circulatory condition.
Disease Management for TBI Victims
Individuals who sustained a serious brain injury and did not die were once considered brain injury survivors. To the extent that the term implies that the injury victims were able to overcome the hardships and life-threatening nature of a TBI, the term is not accurate. Each year in the United States, 125,000 people develop disabilities from a TBI that are likely to worsen over time. The results of a TBI are particularly likely to have a lasting, and potentially life-shortening, impact on children.
Given the evolving impact of a TBI upon a child over the course of time, a TBI must be managed as a disease, not as a single event. A pediatric TBI should be treated as an ongoing process that could require a lifetime of management. The need for ongoing evaluation and treatment must be recognized and funding must be secured whenever insurers are held responsible for paying compensation for the child's injury.