Children and Brain Injury: Prevention Strategies - Fact Sheet

Young children are particularly vulnerable to acquiring a brain injury. Their bodies and motor, perceptual and cognitive skills are developing and they are still learning about the dangers of the world.

They are also more delicate than adults, are frequently placed at adult level using high chairs, require size-appropriate seats in cars when very young and don’t have the experience or vocabulary to tell you about how they’re feeling, making it doubly important that parents or carers monitor their health.

Here we look at some common causes of a brain injury in young children, and steps that can be taken to reduce the risk.

Encephalitis and Meningitis

Meningitis and encephalitis are illnesses which may result in serious neurological problems - lasting brain damage.

Meningitis refers to the swelling of the "meninges" which are the protective coverings of the brain and spinal cord. Encephalitis refers to the swelling of the brain itself. When both the brain and the meninges are swollen, the condition is referred to as "meningoencephalitis."

Inflammation (swelling) is one of the body's responses to infection. Swelling of the brain and its coverings is most often caused by bacterial or viral infections which usually enter the body as a result of a respiratory infection. The infecting organism is carried to the brain and meninges by the blood stream. As the meninges become infected, so does the cerebrospinal fluid (CSF) which circulates throughout the central nervous system. Blood vessels supplying the brain can then become infected, as can the brain itself. Swelling and alterations in the blood flow lead to the possibility of brain damage.

These infections are most common in infants and preschool children and are usually caused by specific types of bacteria. However, in the school aged child, viruses are more often the source of the problem. Adults are not immune from meningitis or encephalitis but they do contract these infections far less commonly than children.

The range of possible symptoms and their rate of development vary widely, and can also indicate other illnesses, so specific diagnosis can be difficult.

Encephalitis may begin with a flu-like illness or with a headache. Symptoms indicating that this is a more serious illness follow later and demonstrate a lowered (or altered) consciousness. These may include confusion, drowsiness, seizures (fits) and coma. Other symptoms can be aversion to bright lights, inability to speak or control movement, sensory changes, neck stiffness, uncharacteristic behaviour, and others, depending on the area of the brain under attack. An infant may have very subtle signs. Fever, irritability and poor feeding may be the only signs of a serious infection. For the child less than one year old, fever and significant behaviour changes may be present – both situations indicate the need for immediate medical attention.

It is important to note that all children in whom meningitis or encephalitis is suspected should be admitted to a hospital for appropriate diagnostic and supportive care. Once diagnosed, the treatment of bacterial meningitis or encephalitis with antibiotics will result in almost immediate improvement. Fortunately, most cases of viral-induced infections improve spontaneously with good supportive care.

The most common causes of encephalitis include Herpes simplex, the chickenpox virus (varicella), the measles virus and the glandular fever virus (Epstein-Barr virus). Herpes simplex may attack the brain directly, and the others may bring about an inflammatory reaction in the brain to an infection elsewhere in the body.

Australian Encephalitis is a potentially fatal mosquito borne disease caused by the Australian Encephalitis Virus.

The only preventative measures that can be taken to protect your child from encephalitis are to minimize exposure to mosquitoes and to make sure that your child is fully immunised. This will help to eliminate some of the possible causes.

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Near drowning

Child drownings in Queensland swimming pools account for one quarter of all paediatric injury deaths and is the most common cause of traumatic death for children aged one to four years. Approximately half of all drownings involving children under five years occurred in residential swimming pools. (Between 1992 and 2001, 73 children aged under five years died as a result of drowning in residential swimming pools in Queensland).

For every child drowning, up to 14 children are taken to hospital emergency departments, and four are admitted to hospital.

It is also estimated that for every child taken to hospital emergency departments, there are 10 near misses (i.e. children suffering immersion who are quickly rescued).

For the children admitted to hospital following an immersion incident, there is up to a 20% chance of brain damage due to lack of oxygen.

Young children can drown in only a few inches of water. The following steps will help to protect children:

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Poisoning

Each year in Australia, about 3500 children are hospitalised because of poisoning. This makes poisoning the second most common reason why young children are admitted to hospital.

Poisonous substances include medicines, cleaning, laundry, gardening and car products, insecticides, perfumes, paint, plants, insects and many others.

Toddlers between 1 and 3 years are most at risk of poisoning because:

Strategies to prevent a child ingesting poison include;

If you suspect a poisoning:

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Falls

Falls are consistently the most common cause of traumatic brain injury in the young and the aging. High falls (more than 1 meter) are generally associated with trees, monkey bars and bunk beds. Bunk beds are not considered safe for children under 9 years old.

Baby walkers are dangerous and should NEVER be used. Most walker injuries happen while adults are watching. Parents and other caregivers simply cannot respond quickly enough. A child in a walker can move more than 3 feet in 1 second! Therefore, walkers are never safe to use, even with close adult supervision. Make sure there are no walkers at home or wherever your child is being cared for.

24 % of all children’s falls are from prams. Make sure a harness is fitted whenever you place a child in a pram.

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Motor Vehicle Accidents

Children are particularly vulnerable to head injuries in motor vehicle accidents. Many of these injuries can be avoided with the use of age appropriate, properly fitted child restraints.

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Shaken Baby Syndrome

A parent or carer may shake a baby when they feel frustrated and distressed from trying to settle a crying baby.

All babies cry and this is normal, but constant crying can be very frustrating and confusing.

We know that when a baby is shaken sometimes the crying stops. However shaking a baby can cause permanent brain damage and even death.

When a baby is shaken the head violently rotates back and forth, similar to whiplash.

Babies most at risk are those aged up to two years because a baby's head is relatively heavy compared to their body. Their neck muscles are also too weak to provide full support.

Shaking a baby can cause the brain to bleed and swell by stretching and tearing blood vessels.

Bleeding in the eyes is another severe consequence of shaking.

Shaking a baby can cause:

As mentioned earlier, in the worst situation the baby can die.

If you have shaken a baby or if you believe someone else has shaken a baby it is vital you seek medical help immediately.

Waiting will only cause more damage.

You must take the baby to the nearest doctor, hospital emergency department or community health nurse.

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