The Center for Disease Control (CDC) defines Traumatic Brain Injury as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury” (CDC, 2017). Traumatic Brain Injury, also referred to as TBI, is unlike many other disabilities or disorders, due to the fact that individuals are not born with TBI. Anyone from children to mature adults are at risk for a TBI, as a head injury can happen to anyone at any time. The CDC also states that “the severity of a TBI may range from ‘mild’ (i.e. a brief change in mental status or consciousness) to ‘severe’ (i.e. an extended period of unconsciousness or memory loss after the injury” (CDC, 2017). Traumatic Brain Injuries that are deemed mild can leave individuals with short term effects that only last a few days, but a severe TBI may lead to effects that last an entire lifetime. Traumatic Brain Injuries can result in impaired movement, impaired thinking and/or memory loss, impaired hearing and/or vision, difficulty with physical movement, and a change in emotional functioning (i.e. depression). The most common TBI in the United States is a concussion, which falls into the “mild” category of TBI (CDC, 2017). Traumatic Brain Injuries can be caused by sporting accidents, falls, car accidents, blunt-force to the head, and gunshot wounds.

According to TraumaticBrainInjury.com, there are several subcategories of TBI:

Closed Head Injury – The skull remains intact and has not been penetrated. This type of TBI is usually caused by direct or indirect force. An example of this would be a concussion.

Open Head Injury – The skull is penetrated and there is direct injury to the head.

Diffuse Axonal Injury – There is diffuse cellular injury to the brain, meaning that axons have been torn or damaged due to rapid, rotational movement. This injury commonly occurs from car accidents.

Contusion – Similar to bruising under the skin, there is bleeding within tissue of the brain.

Penetrating Trauma – An object enters the brain, resulting in direct injury to the brain as skull fragments shatter. An example of this would be a bullet shot into the head.

Secondary Injury – The swelling of the brain, accompanied by a release of chemicals that cause inflammation and cell injury. In severe cases, the individual dies due to the brain herniating (pushing out) the base of the skull, leading to respiratory failure. An example of this is brain damage caused by lack of oxygen.

Acquired Brain Injury – This type of brain injury is any brain injury not linked to hereditary, congenital, or birth causes. This type of brain injury is technically not caused by trauma, but symptoms fall into the TBI category.

*(traumaticbraininjury.com, 2004-2006).

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How common is TBI among school-aged children?

Children of ages 0-4 have the highest rates of visiting the Emergency Department of a hospital due to a Traumatic Brain Injury. The age group with the second highest rate of E.R. visits is ages 15-24. The age group with the third highest rate of E.R. visits is children aged 5-14. The Brain Injury Association of America also states that for “. . . children ages 0 to 14, brain injury results in an estimated 2,685 deaths, 37,000 hospitalizations, and 435,000 emergency department visits. In its 2004 Report to Congress, Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths, the Centers for Disease Control and Prevention notes falls are the leading cause of TBI for children age 0-4. Approximately 1,300 U.S. children experience severe or fatal brain trauma from child abuse every year” (Brain Injury Association of American, 2018).

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As stated earlier, TBI falls into 2 major categories: mild and severe. The symptoms for mild TBI are as follows:

• Difficulty thinking clearly

• Headache

• Fuzzy vision

• Sadness, irritability, and/or depression

• Balance problems

• Sensitivity to light and sound

• Trouble falling asleep

• Feelings of anxiety

• Sleeping less than usual, or sleeping more than usual

• Difficulty remembering new information

• Feeling slowed down

• Difficulty concentrating

• Nausea or vomiting

Someone with a mild TBI may experience some or all of these symptoms (CDC, 2017).

The symptoms for a severe TBI are as follows:

• Cognitive Symptoms, including but not limited to: language processing, impulse control, seeking attention, confusion, memory, processing speed, and concentration.

• Speech and Language Symptoms: Receptive Aphasia (not understanding spoken word), Expressive Aphasia (difficulty speaking or expressing thoughts), slurred speech, speaking very fast or speaking very slow, difficulty reading, and difficulty writing.

• Sensory Symptoms: difficulty with sensation of temperature, interpreting touch, movement of limbs, and limb positioning.

• Perceptual Symptoms: difficulty patterning or integrating sensory impressions or experiences into meaningful psychological data.

• Visual Symptoms: partial or total loss of vision, blurred vision, problems judging distance, Nystagmus (involuntary eye movement), Photophobia (intolerance of light), Diplopia (double vision), and weakness of eye muscles.

• Auditory Symptoms: decrease of hearing, total loss of hearing, increased sensitivity to sound, and ringing in the ears (Tinnitus).

• Effects on Other Senses: Anosmia (a diminished or totally lost sense of smell), and diminished or totally lost sense of taste.

• Physical Symptoms: Partial or total paralysis, difficulty with menstruation, chronic pain, difficulty sleeping, loss of control over bowels, loss of stamina, change in appetite, and a difficulty maintaining body temperature.

• Social/Emotional Symptoms: being in a state of denial, lack of awareness, depression, aggression, irritability, loss of motivation, Disinhibition (loss of inhibition, which is the restraint of certain behaviors), and change in emotional ability.

• Other: seizures (convulsions associated with epilepsy).

Someone with a severe TBI may experience some or all of these symptoms (traumaticbraininjury.com, 2004-2006).

Specific symptoms for young children, including infants, with a TBI:

• Change in nursing and/or eating

• More irritable than usual

• Persistent crying

• Inability to be consoled or comforted

• Noticeably decreased attention span

• Loss of interest in favorite toys

• Seizures

• Sadness or depression

• Change in sleeping patterns

• Drowsiness

Children with a TBI may experience some or all of these symptoms (Mayo Clinic, 2018).

• Males, at any age, are more at risk for a TBI related to an accident than females (CDC, 2017)

• TBIs can also be the result of injury in a military combat zone, and can be linked with PTSD (MedlinePlus, 2018)

• In 2013, the leading cause of TBI was a fall. Falls affect both the youngest and the oldest citizens in the United States more than any other age group (CDC, 2017)

• In 2012, nearly 329,290 children in the United States were treated for concussions due to sports-related injury (CDC, 2017)

• No two brain injuries are alike, and the effects of similar brain injuries are different in every individual (traumaticbraininjury.com, 2004-2006)

• Ways to prevent children from experiencing a TBI include: making sure children wear seatbelts while in a car, and air bags are operational; make sure children wear helmets while riding bikes and playing sports (when applicable); make sure stairs at home are free of clutter/objects children may trip over; improve lighting in areas where children are present; install gates at the tops of stairways; use non-slip mats in showers or bathtubs; and make sure children are supervised at all times (Mayo Clinic, 2018).