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Injuries often occur in childhood. Usually, these injuries heal with time and do not cause lasting problems. However, some injuries to the brain may alter a child’s thinking and behaviour.

Health professionals and educators can help families of a child with an acquired brain injury. There are also support groups and specialist agencies who understand the effects of acquired brain injury.

Alert!

If a child has a hard blow to the head, seems dazed or loses consciousness (even briefly), see your doctor. Also consult your doctor if your child seems unwell or begins to vomit after a hard blow to the head. Call an ambulance if your child is unconscious and do not leave the child alone.

What is an acquired brain injury?

• An acquired brain injury refers to injury to the brain that is caused by something that happens to a person at birth, after birth or during their lifetime.
• This injury is permanent and changes the way the person acts, thinks or behaves.
• An acquired brain injury is not present before birth but can be caused by the birth process.
• It is not caused by developmental delay or disabilities that affect development of the mind but certain types of acquired brain injury may cause intellectual disability and/or physical disability.
• Acquired brain injury can also cause communication problems and mood changes.
• Sometimes, acquired brain injury is called traumatic brain injury when the injury is caused by some type of ‘accident’.

Causes of acquired brain injury

There are a number of causes of acquired brain injury. These include:

Trauma

• Trauma means that an injury to the brain has been caused by a blow to the head, such as falling, motor vehicle accident, bicycle accident or being hit on the head, or by being shaken hard.
• Trauma to the head is the most common cause of acquired brain injury.
• Children may be unconscious for a short time, or if the injury is more severe they may be in a coma for hours, or days, or longer.
• The type and amount of brain injury will depend upon the severity and location of the blow.

Tumour

• Tumours (including cancers) that grow in the brain are another cause of acquired brain injury.
• The type of injury to the brain depends on the size of the tumour, what part of the brain is affected, the age of the child and the treatment needed.
• Treatment for brain tumours such as chemotherapy, radiotherapy or surgery, can also cause brain injury.

Treatment

• Treatment needed for problems in other parts of the body (such as for cancers) may injure the brain.

Neurological events

Neurological events (things that happen to the brain) include:

• stroke
• cerebral haemorrhage (bleeding in the brain)
• hydrocephalus (pressure from too much fluid around the brain)
• aneurysms (dilation of the wall of a blood vessel)
• epilepsy.

Anoxic injuries

• Anoxic injuries happen when the brain does not get enough oxygen.
• This can happen as a result of near-drowning, suffocation, electrocution or heart failure.
• Having a block in important blood vessels can also cause anoxic injuries.

Other causes

• Brain injury may happen as a result of infections (such as meningitis and encephalitis) or from severe drug abuse or poisoning (such as lead poisoning).

Effects of acquired brain injury

An acquired brain injury may affect a child’s normal development.

• The effects of acquired brain injury will depend on how bad the injury was and the part of the brain that has been affected.
• Brain injuries can be mild, moderate or severe.
• The recovery time will vary for each person, but a child may not recover fully.
• In some cases, acquired brain injuries will have a small (subtle) effect on your child’s learning and behaviour. In others, the effects will be more wide ranging and there may be a physical disability.

The age of the child at the time of the injury will affect their future development. There are important factors to consider for any child who has a brain injury.

Younger children

• A brain injury in children under two years may permanently affect the development of speech, language and control of movement (eg causing cerebral palsy).
• A brain injury in young children may affect the development of other important processes that are part of thinking, learning and social skills.
• Problems with the development of important foundation skills (skills that are needed before a child can learn other skills) may lead to general and specific learning difficulties later in life.

Older children

• Older children often lose skills in some areas but not all areas (eg they may lose the control of one leg or arm but not all limbs as in cerebral palsy in a younger child).
• Older children will be more aware of the effects of their injury and will know that they have ‘lost’ skills. Social and emotional problems may happen because of this and because of the length of time spent in hospital away from their friends.
• In children between the ages of nine and fifteen, brain injury may interrupt the development of complex thinking. This may make it difficult for these children to learn to organise and plan ahead or to understand how ideas relate to each other.
• Older children may be more willing to do whatever is necessary to help their recovery.

Changes to thinking and behaviour

Changes to a child’s thinking and behaviour may be evident in many ways. Often parents and teachers will notice changes in a child’s:

• memory (there may be gaps or lapses)
• ability to plan and complete tasks (concentration is poor)
• judgement (working things out)
• ability to think in complex ways
• balance and ability to move skilfully
• sense of time
• self-confidence
• ability to think clearly
• personality (including mood swings, depression and anxiety)
• understanding of speech and language
• health (including the onset of epilepsy and changes to weight or growth rates).

The effects of some brain injuries may not be obvious at first, and they vary from child to child. This means parents, families and teachers will need to think about what changes have happened to each individual child. They may also need to change their expectations of the child because of the brain injury.

Can it be cured?

• Acquired brain injury may have long term effects on what your child can do and how he behaves and feels.
• Recovery from this type of injury can be uncertain and may take a long time.
• Some skills may not come back. This will depend on the severity of the injury, the part of the brain affected and the age of the child at the time of the injury.
• For some children, recovery of individual cognitive (thinking) skills will be patchy and uneven. This may happen to your child’s physical, communication, emotional or social skills as well.

What you can do

You will feel many different emotions as a result of your child’s brain injury. Many parents feel shock and disbelief, anger, self-blame, despair, frustration and sorrow. It is quite normal to have any and all of these reactions and they may last for many years.

There are many things that you can do at different stages of your child’s recovery. However, it is always important to take care of yourself as well as to look after the needs of your child, family and friends.

During hospitalisation

• Some families find it helpful to keep a diary of what happens during their child’s recovery period. Older children with a brain injury can find it useful to read about their recovery at a later time.
• Your child may seem quite different after a brain injury. You may wish to speak to health professionals or other parents about your feelings about this.
• Often you will be asked to provide support and comfort to your recovering child, other children in the family and to friends. This may be at the same time that you are dealing with strong feelings of your own. Ask for help from health professionals. It is part of their job to support parents in your situation.
• Your child may spend a long time in hospital. You can help by bringing familiar toys and posters from home.
• Try to develop a routine between home time and hospital visits.
• Ask hospital staff for information about rehabilitation (the ongoing management of injuries and disabilities after the accident) and support services once your child leaves hospital.
• Be involved in the decisions made about your child.
• Remember that the pattern of recovery is different for each child. Professionals may not be able to give exact answers to all of your questions.
• Keep asking questions.
• Encourage friends to visit. However, in the early stages of your child’s recovery, visits may need to be kept short. Visitors should be asked to follow some predictable routines and should avoid giving your child too much ‘new’ information to deal with.

Once your child is home

• Try to keep in regular contact with friends and family.
• Organise a roster with family members for hospital or therapy appointments.
• Look after your own health and well-being.
• Contact and join support organisations. A number of helpful support groups and specialist agencies in Australia and in South Australia have been listed at the end of this article.
• Remember that your child’s recovery will take time.

Preschool and school

• Preschools and schools should make every effort to meet your child’s support needs.
• Staff can be more helpful if you give them information about the injury and any other relevant medical information.
• Remember to give new teachers this information.
• Update the information every year or when there are important changes to your child’s condition.
• The children in your child’s class may need information about brain injury in order to understand what is happening.