When a Child is Hurt

Many children who hurt their heads get well and have no long-term problems. Some children have problems that may not be noticed right away. You may see changes in your child over the next several months that concern you. This page lists some common signs that your child may have a mild brain injury. If your child has any of the problems on this list – AND THEY DON’T GO AWAY – see the "What to Do" box on the other side of this page.

These problems don’t happen often.

If your child has any of them, see your doctor right away.

Severe headache that does not go away or get better
Seizures: eyes fluttering, body going stiff, staring into space
Child forgets everything, amnesia
Hands shake, tremors, muscles ge tweak, loss of muscle tone
Nausea or vomiting that returns

Health Problems

Headaches

Headache that keeps coming back
Pain in head muscle
Pain in head bone (skull)
Pain below the ear
Pain in the jaw
Pain in and around the eyes

Balance Problems

Dizziness
Trouble with balance

Sensory Changes

Bothered by smells
Changes in taste or smell
Appetite changes
Ringing in the ears
Hearing loss
Bothered by noises
Can’t handle normal background noise
Feels too hot
Feels too cold
Doesn't feel temperature at all
Blurry vision
Seeing double
Hard to see clearly (hard to focus)
Bothered by light

What to do

If your child has any of the problems on this list, and they don’t go away:

Ask your child’s doctor to have your child seen by a specialist in head injury who can help your child learn skills(rehabilitation)
Ask your child’s doctor to have your child seen by a board-certified Neuropsychologist. This specialist can help you understand and deal with the changes in your child’s behavior and feelings.

Sleep Problems

Can’t sleep through the night
Sleeps too much
Days and nights get mixed up

Pain Problems

Neck and shoulder pain that happens a lot
Other unexplained body pain

Behavior and Feelings

Changes in personality, mood or behavior
Is irritable, anxious, restless
Gets upset or frustrated easily
Overreacts, cries or laughs too easily
Has mood swings
Wants to be alone or away from people
Is afraid of others, blames others
Wants to be taken care of
Does not know how to act with people
Takes risks without thinking first
Is sad, depressed
Doesn’t want to do anything, can’t "get started"
Is tired, drowsy
Is slow to respond
Trips, falls, drops things, is awkward
Eats too little, eats all the time, or eats thing that aren’t food
Has different sexual behavior (older children)
Starts using or has a different reaction to alcohol or drugs
Takes off clothes in public

Thinking Problems

Has trouble remembering things
Has trouble paying attention
Reacts slowly
Thinks slowly
Takes things too literally, doesn’t get jokes
Understands words but not their meaning
Thinks about the same thing over and over
Has trouble learning new things
Has trouble putting things in order (desk, room, papers)
Has trouble making decisions
Has trouble planning, starting, doing and finishing a task
Has trouble remembering to do things on time
Makes poor choices (loss of common sense)

Trouble Communicating

Changes the subject, has trouble staying on topic
Has trouble thinking of the right word
Has trouble listening
Has trouble paying attention, can’t have long conversations
Does not say things clearly
Has trouble reading
Talks too much

Tips for Healing—Children

Parents and caretakers of children who have had a concussion can help them heal by:

Having the child get plenty of rest.
Making sure the child avoids activities that could result in a second blow or jolt to the head, such as riding a bicycle, playing sports or climbing playground equipment until the doctor says the child is well enough to take part in these activities.
Giving the child only those drugs that the doctor has approved.
Talking with the doctor about when the child should return to school and other activities and how to deal with the challenges the child may face.
Sharing information about concussion with teachers, counselors, babysitters, coaches and others who interact with the child so they can understand what has happened and help meet the child’s needs.
Keep the same routines.

The signs of traumatic brain injury (TBI) can be very different depending on where and how severely the brain is injured. Children with TBI may have one or more of the following kinds of difficulties:

Physical disabilities

Individuals with TBI may have problems speaking, seeing, hearing and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body or both sides.

Difficulties with thinking

Because the brain has been injured, it is common that the person’s ability to use the brain changes. For example, children with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.

Social, behavioral or emotional problems

These difficulties may include sudden changes in mood, anxiety and depression. Children with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.

A child with TBI may not have all of the above difficulties

Brain injuries can range from mild to severe and so can the changes that result from the injury. This means that it’s hard to predict how an individual will recover from the injury. Early and ongoing help can make a big difference in how the child recovers. This help can include physical or occupational therapy, counseling and special education.

It’s also important to know that, as the child grows and develops, parents and teachers may notice new problems. This is because, as students grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for the student to learn new skills that come with getting older. Sometimes parents and educators may not even realize that the student’s difficulty
comes from the earlier injury.

Susan's Story

Susan was five years old when she was hit by a car while riding her bike. She broke her arm and leg. She also hit her head very hard. The doctors say she sustained a traumatic brain injury. When she came home from the hospital, she needed lots of help, but now she looks fine. In fact, that’s part of the problem, especially at school. Her friends and teachers think her brain has healed because her broken bones have. But there are changes in Susan that are hard to understand. It takes Susan longer to do things. She has trouble remembering things. She can’t always find the words she wants to use. Reading is hard for her now. It’s going to take time before people really understand the changes they see in her.

What About School?

Although TBI is very common, many medical and education professionals may not realize that some difficulties can be caused by a childhood brain injury. Often, students with TBI are thought to have a learning disability, emotional disturbance, or mental retardation. As a result, they don’t receive the type of educational help and support they really need.

When children with TBI return to school, their educational and emotional needs are often very different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes. The child’s family, friends, and teachers also recall what the child was like before the injury. These other people in the child’s life may have trouble changing or adjusting their expectations of the child.

Therefore, it is extremely important to plan carefully for the child’s return to school. Parents will want to find out ahead of time about special education services at the school. This information is usually available from the school’s principal or special education teacher. The school will need to evaluate the child thoroughly. This evaluation will let the school and parents know what the student’s educational needs are. The school and parents will then develop an Individualized Education Program (IEP) that addresses those educational needs. It’s important to remember that the IEP is a flexible plan. It can be changed as the parents, the school and the student learn more about what the student needs at school.

Tips for Parents

Learn about TBI. The more you know, the more you can help yourself and your child.
Work with the medical team to understand your child’s injury and treatment plan. Don’t be shy about asking questions. Tell them what you know or think. Make suggestions.
Keep track of your child’s treatment. A three-ring binder or a box can help you store this history. As your child recovers, you may meet with many doctors, nurses, and others. Write down what they say. Put any paperwork they give you in the notebook or throw it in the box. You can’t remember all this. Also, if you need to share any of this paperwork with someone else, make a copy. Don’t give away your original.
Talk to other parents whose children have TBI. There are parent groups all over the U.S. Parents can share practical advice and emotional support. Call NICHCY (1-800-695-0285) to locate parent groups near you.
If your child was in school before the injury, plan for his or her return to school. Get in touch with the school. Ask the principal about special education services. Have the medical team share information with the school.
When your child returns to school, ask the school to test your child as soon as possible to identify his or her special education needs. Meet with the school and help develop a plan for your child called an Individualized Education Program (IEP).
Keep in touch with your child’s teacher. Tell the teacher about how your child is doing at home. Ask how your child is doing in school.
Give your child’s teacher the tips for teachers’ fact sheet.

Tips for Teachers: When Your Student has a Traumatic Brain Injury

Find out as much as you can about the child’s injury and his or her present needs. Learn more about Traumatic Brain Injury (TBI) from the many resources that exist.
Give the student more time to finish schoolwork and tests.
Give directions one step at a time. For tasks with many steps, it helps to give the student written directions.
Show the student how to perform new tasks. Give examples to go with new ideas and concepts.
Have consistent routines. This helps the student know what to expect. If the routine is going to change, let the student know ahead of time.
Check to make sure that the student has actually learned the new skill. Give the student lots of opportunities to practice the new skill.
Show the student how to use an assignment book and a daily schedule. This helps the student get organized.
Realize that the student may get tired quickly. Let the student rest as needed.
Reduce distractions.
Keep in touch with the student’s parents. Share information about how the student is doing at home and at school.
Be flexible about expectations. Be patient. Maximize the student’s chances for success.

For more information on traumatic brain injury, visit:

Brain Injury: A Guide for Families About School - http://www.bianj.org/pdf/BI_guideFamilies_forSchool.pdf

TBI Resources for Teachers & Parents

TBI in School Children - http://www.mssm.edu/tbinet/alt/TA/techa2.html

Brain Injury: A Guide for School Nurses - http://www.bianj.org/pdf/BI_guideSchoolNurses.pdf