In adults, the effects of a brain injury generally show soon after the event. However, things can be different when a child is injured. Sometimes, it can take months or even years for the impact of a brain injury to become apparent. As parts of the brain continue to develop throughout childhood and into adolescence and young adulthood, it is only once damaged areas are fully developed that the extent of the injury can be fully assessed, and how it disrupts brain function becomes clear.

There are various types and causes of head injuries in children, ranging from falls and sports injuries to car accidents and physical abuse.

Brain injury affects children in similar ways to adults. Physically, the injured child may suffer from tiredness and fatigue, struggle with motor functions and balance, and generally do things at a slower pace. Cognitively, they may find it difficult to concentrate or follow instructions, become easily distracted or forgetful, especially with new information and recent events, or take longer to process information. Their behaviour may change: they may become more aggressive, both physically and verbally, start acting on impulse without thinking through the consequences, become more immature, or behave in a sexually inappropriate way. Emotionally, a brain injury can cause sadness, depression, fear, anxiety, stress and obsessiveness.

Each child affected by brain injury may have some or all of these symptoms, which will affect them and their lives on a daily basis. The potential complications and symptoms of a head injury in children can vary widely, making it crucial to monitor and address each case individually.

Education

It can be easy for teachers to misunderstand the behaviour of a pupil with a brain injury. The effects of the injury on the behaviour may not be obvious, or especially if it occurred long before the child started attending school. Pediatric traumatic brain injury can significantly affect a child's educational performance and behaviour. It is easy to label a child who does not pay attention in class, relate well with peers or is struggling with schoolwork as lazy, badly behaved and lacking in social skills, but it is important to know that fatigue, poor concentration, and social difficulties can all be issues for a child following a brain injury.

Many children perform inconsistently in education, varying between good and poor grades depending on the specific skills needed for each task. A child may struggle to concentrate for long enough to write a story but may perform well in short-answer, interactive tasks such as quizzes. Socially, they may struggle to fit back into the friendship group they had before the injury.

Within the classroom, a child with a brain injury can have difficulties with:

• Concentrating
• Remembering and learning new information
• Thinking of new ideas
• Maintaining conversations
• Behaving appropriately
• Getting on with friends
• Responding to teaching staff
• Following verbal instructions
• Planning and organising their schoolwork

A child may become very frustrated by these difficulties, especially if they performed well at school prior to the injury. To help children affected by brain injury receive the best possible education and enjoy a positive experience in school, it is crucial that everyone within the education system knows about brain injury, regardless of when it happened. Teaching staff may need to be reminded of the likely issues and be given practical information to help deal with any difficulties the child faces at school.

Additional support may be required. Whether it be in the classroom or a tutor at home, a successful compensation claim may be able to fund the cost of any outside help your child needs. A successful case can also fund a case manager who can organise and recruit people to support the injured person.  They can also liaise with the Local Authority and statutory providers to obtain an education, health and care plan.

Independence

The transition into adulthood can be a difficult time for any child, but for someone affected by brain injury this can be particularly challenging. Even a mild traumatic brain injury can impact a child's ability to gain independence. Growing up comes with expectations abount doing more things independently, and it is during this time that a child’s difficulties may become more apparent. Aspects of everyday life, including education, employment, transport and hobbies, may all be subject to change. Providing a safe space and support for a young person to build independence is key. There are a number of further education courses that are designed specifically for young people with special educational needs, and many young adults attend specialist day colleges. Another option for continuing education is attending a residential college, moving away from home and developing further personal, social and practical skills. This can help some children with brain injuries to live as independently as possible.

Supported employment services can be found via the British Association for Supported Employment. A specialist-supported employment service member would spend time getting to know the young person and developing a profile for work, including undertaking various work ‘tasters’ or trials. Once a person’s preferences are established and their strengths identified, the service will work with the job seeker to find employment. One of the main features of this service is that the individual will be supported on the job for as long as necessary and, from day one, will be paid the going rate. A successful claim could fund a case manager who can support the injured person and facilitate their entry into the work force.

Hormones and Brain Injury

A brain injury can affect a small structure at the base of the brain called the pituitary gland and hypothalamus. A depressed skull fracture can significantly impact these structures, leading to various hormonal imbalances. The pituitary gland produces many of its own hormones and controls hormones produced elsewhere in your body, whilst the hypothalamus regulates the pituitary gland. Fractures to the skull bone can affect brain function and subsequently disrupt hormonal regulation. Different types of skull fractures, such as linear, depressed, diastatic, and basilar skull fractures, can have varying impacts on hormone regulation. Together they are vital in managing:

• Growth
• Hunger
• Thirst
• Weight
• Puberty and sexual maturity
• Sexual functioning and libido
• Energy levels

Depending on the specific site of the brain injury, it may result in a change in the level of hormones a child produces – either less or more. Symptoms of changes in hormone levels can be similar to other symptoms of a brain injury, so they can be difficult to diagnose. Some of the specific conditions caused by a change to hormone levels:

Growth Hormone Deficiency

Made in the pituitary gland, the growth hormone’s main role in childhood is to promote growth of bones and lean body mass. Growth hormone deficiency can particularly impact the growth and development of younger children, leading to them being smaller than average for their age and possibly having increased fat tissue around the waist. A deficient or hyperactive thyroid can also affect a child’s growth, making them larger or smaller than average. High cholesterol is a side-effect of growth hormone deficiency, which may increase the risk of a heart attack or stroke later in life. However, treatment with hormones can correct these effects.

Thyroid Stimulating Hormone Deficiency

Thyroid stimulating hormone ensures a child’s thyroid functions normally. If a child doesn’t have enough of this hormone they may experience:

• Weight gain
• Tiredness
• Low mood
• Muscle aches
• Memory problems
• Dry hair or skin
• Numbness or tingling in hands and feet

Sex Hormone Deficiency

Sex hormones involved in sexual development are produced by the pituitary gland, so levels of these may be reduced following a brain injury. As a result, a child approaching puberty may experience:

• Reduced growth (of bones, lean muscle mass and reproductive organs)
• Reduced body hair
• Irregular periods, loss of periods or failure to start having periods in females
• Improper development of penis and testes, or impotence in males
• Reduced fertility 
• Reduced sex drive

Sex Hormone Excess

Damage to the pituitary gland allows too much hormone to be released, which can lead to early sexual maturity. Girls may start developing breasts and pubic hair and begin to menstruate early. Similarly, boys may develop sexually while still at primary school. 

In cases of sex hormone deficiency or excess, the effects can be difficult to discuss with children as they may be embarrassed by a failure to develop like their peers and reach sexual maturity, or by reaching sexual maturity a long time before their friends do. However, hormone replacement therapy can be used to correct a deficiency in sex hormones, and a paediatric endocrinologist (a doctor with specialist knowledge of hormones) can be helpful in cases of sex hormone excess that may need specific treatment.

Neurogenic Diabetes Insipidus

Neurogenic diabetes insipidus is a disorder where the kidneys are unable to retain water, and instead produce large amounts of urine, making the child feel very thirsty despite drinking normal amounts of water. Severe head injuries can lead to neurogenic diabetes insipidus. This is not caused by a problem with the kidneys; rather a lack of water-retaining hormone called Anti-Diuretic Hormone, which is made by the pituitary gland.

When a child suffers a brain injury, it can be devastating for everyone connected to the child. It can change every aspect of family life: the injured child can feel like their life has been turned upside down, whilst siblings can feel anxious, confused or lonely as the focus centres around the injured child and the relationship with their brother or sister changes. Parents may be forced to take on additional caring responsibilities and become experts in their child’s condition whilst continuing with family responsibilities and coping with their own feelings about what has happened. However, support is available and living well with a brain injury is possible.