Why That Childhood Head Bump Could Cause Permanent Damage

If your child falls and bumps their head while playing, you'd sit up and take notice, wouldn't you? Of course you would. If your child fell from a tree, or the jungle-gym in the Park, you'd whisk them straight to the Hospital. You'd sit by their bedside, wait and worry until the doctor gave you the good news: you could take them home.

And then all your worries would be over, wouldn't they?

Possibly not. New evidence suggests that traumatic brain injury in children as young as two affects the child up to and including adulthood.

Childhood Head Injury

Childhood head injury accounts for 100,000 hospitalisations in the US every year. Children receive head injuries by many means, including: motor injuries, and sadly child abuse. But a very large percentage occurs due to ordinary childhood falls while playing, sporting injuries and bicycle accidents.

It's nearly impossible to determine loss of brain function in a young child. Older children and adults have previous academic attainment and job successes to use as a benchmark, but the younger child does not.

For a long time, it was assumed that the younger the child was when a head injury occurred, the better for the child. It was assumed, although without any real evidence to back it up, that the child's brain would "rewire" over time. Thus, not much research was given to early childhood head trauma.

Research now shows that younger children are even more susceptible to permanent brain damage, even when the force was the same. In very young children, this might be partly due to the softness of the fontanelle, which doesn't fully harden until 19 months in some babies.

READ Help your children grow into a strong and stable person - build their self-esteem

Childhood Head Injury and Lower Childhood Academic Attainment

Very early childhood head injury leads to lower academic attainment. One 2006 study, by Linda Ewing-Cobbs and colleagues, tested 23 children who had sustained a head injury at a mean-age of twenty-one months (between four- and seventy-one months). At a mean-age of eighty-nine months, they were given a series of standardised academic tests in reading, mathematics and language, and their scores compared to 21 children from the community who had not sustained a head injury.

Ewing-Cobbs and colleagues found that the earlier the brain injury had been sustained, the lower the test scores. 48% of the group had test scores below the 10% percentile (meaning that they scored in the lowest 10% of a nationally standardised sample).

Over a 5-year follow-up period, IQ testing revealed that none of the students recovered function. By the time longitudinal monitoring finished, 50% of the head injury group had failed a grade, or had been placed in a contained special education unit.  

Ewing-Cobbs and colleagues (2006) said the odds of poor academic performance were 18 times higher for children who had experienced a head injury, when compared to their peers in the comparison group.

More Long-Term Problems of Childhood Head Injury

Childhood Head Injury and Behavioural Problems

Lezak (1986) described six stages of how parents commonly describe their child's behaviour in the immediate aftermath of head injury:

"a little diffi­cult" (0–1 to 3 months post-injury); "not cooperating, self-centered, and not moti­vated" (1–3 months to 6–9 months post-injury); "self-centered, irresponsible , irritable, lazy" (6–9 months to 9–24 months post-injury); "a different, dif­ficult, childlike person" (9 months and later post-injury; possibly indefinitely); "a difficult, childlike, dependent person" (15 months or later post-injury; unknown duration).

Over time, Lazek reports that caregivers become less optimistic, and begin to become discouraged, before starting to mourn that child they once had.

While mild-to-moderate head injuries are associated with an increased risk of long-term behavioural problems, it appears that the family's response to the child may help allay some behavioural problems.

Louise Crowe, PhD., of the Murdoch Children's Research Institute, says:

"Children from cohesive family environments and children whose parents had lower levels of stress showed better recovery. Why this is so is unclear, but it may be due to a parent spending more time with their children, and children also growing up in a less stressful environment."

Childhood Head Injury and Depression

Children who've had a head injury or a concussion are more likely to suffer depression.

Wylie and colleagues (2013) looked a 2007 study from 82,000 children and teens younger than 18. The results revealed that 2,000 of the minors had experienced a brain injury, and 3,100 experienced depression.

The national rate of depression for minors is 3.7%. In the minors with a history of head injury, Wylie and colleagues (2013) found that it was four times that, approximately 15%.

However, this study is problematic, as concussion and head injury were put together as one question, making it difficult to know if more serious head injuries are more likely to lead to depression.

Head injury and Hypopituitarism

The pituitary gland is situated at the base of your brain. Located behind your nose and between your ears, although it's very small (approximately the same shape and size as a bean) the hormones it emits affect almost every part of your body.

Hypopituitarism (PTHP) can result from any head injury, a concussion, or even a whiplash injury. The symptoms are varied, and frequently dismissed as fibromyalgia or Chronic Fatigue Syndrome (or ME).

Symptoms include:

• Fatigue and/or weakness
• Weight loss or obesity
• Stiffness of the joints
• Stomach pain; nausea/vomiting
• Headache; dizziness
• Decreased sex drive; male impotence
• Sensitivity to cold or difficulty staying warm
• Decreased appetite
• Facial puffiness
• Anemia
• Infertility
• Hormonal changes, including: loss of pubic hair; irregular periods of or amenorrhoea (no menstrual periods); inability to produce breast milk, and hot flashes, frequently mistaken for menopausal symptoms.
• Decreased facial or body hair in men
• Short stature in children

READ Television impact on children's knowledge and behavior

One of Britain’s foremost experts on hypopituitarism, Professor Christopher Thompson, , says:

"The overwhelming evidence from research studies carried out independently in a wide range of places, including the USA, Europe and Turkey, is that hypopituitarism occurs in up to 30 per cent of people who have survived moderate or severe traumatic brain injury. There is no debate. However, the failure to make the right diagnosis after such injury means patients miss out on essential treatment."

If you have these symptoms following a head injury (either in childhood or adulthood), and they are persistent, Chair of the Pituitary Foundation Medical Committee and consultant endocrinologist at the Royal Hallamshire Hospital, Sheffield, Dr. John Newell Price recommends a referral to an endocrinologist. Hypopituitarism can be diagnosed with certainty by a test of the pituitary gland called the Glucagon test. 

What can be done about head injury?

Matthew Wylie, M.D., paediatric emergency medicine, suggests that prevention is better than cure.

To prevent head injury, follow these simple tips:

• Wear a safety helmet for:
  • Baseball and Softball (when batting)
  • Cycling
  • Football
  • Hockey
  • Horseback Riding
  • Powered Recreational Vehicles
  • Skateboards/Scooters
  • Skiing
  • Wrestling
• With young children
  • Supervise them at all times - young babies can suffer very traumatic head injuries by rolling over and falling off a couch.
  • Don't let them go to playgrounds with hard surfaces
  • Don't let them play on equipment unsuitable for their age
• Follow all rules at water parks, swimming pools and beaches
• Don't let your child participate in sport when ill or tired
• Ensure your child always wears a seatbelt
• Remove anything that your child can fall over
  • Secure rugs, and loose extension cords
  • Put away toys

But Keith Yeates, Ph.D., Chief, pediatric psychology and neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, has some comfort to give, reassuring worried parents that, while all childhood head injuries need to be taken seriously, many childhood head injuries are mild concussions and many children fully-recover.