Concussion and Traumatic Brain Injury (TBI) have been previously discussed in the pediatric age group. There is special consideration that must be given to infants and toddlers (age 0-3 years). This is an extremely vulnerable population. Falls, automobile accidents and child abuse are major causes of head injury in young children.
Young children with head injuries almost always require immediate CT scans. Bleeding in the brain and skull fractures are common. Young children usually require admission to a pediatric neurosurgical ICU. The care of these patients is very specific to their young age. Neurosurgery is frequently needed, unlike adults with TBI.
Examination of young children is much more difficult than in adults and older children. Young children cannot provide a history and their behavior is difficult to assess. Infants and toddlers simply do not engage in as many behaviors as adults. Subtle disruptions in feeding patterns, restlessness, and altered sleep can be important clues.
The external signs of trauma may be present with bruising and bleeding. Seizures are common in young children. Pupils must always be checked.
There is also an entity termed “Shaken Baby Syndrome” which is a profound form of child abuse. Caretakers and parents can become frustrated with a crying baby and begin shaking the baby from arms and legs like a doll. The neck and shoulder muscles of young children are poorly developed and the head is heavy. Thus, the brain undergoes rapid torsions and acceleration causing bleeding. There are often no outward signs of external trauma as the brain and head have been injured indirectly.
The ophthalmologist can often play a useful role in diagnosing “Shaken Baby Syndrome” as the babies eyes can have multiple retinal hemorrhages which can be seen on retinal evaluation. Unfortunately, extensive retinal hemorrhages can lead to blindness. Appropriate law enforcement agencies and social services must be contacted if child abuse is suspected.
Traumatic brain injury in young children often becomes a chronic disease. The brain is rapidly growing in young children. Any disruption in normal development can have devastating consequences on future behavior. These deficiencies may not become evident until adolescence and early adulthood. All forms of written and verbal expression can be compromised.
The infant and toddler are the most vulnerable victims of head injury. They simply have no defense and are helpless victims. Emergency room staff must always be extremely diligent in detecting even subtle signs of trauma or abuse. The ophthalmologist can be very helpful in making a diagnosis. The eyes and vision centers of the brain are frequently damaged in TBI in this young age group. Older children are simply not the same- infants and toddlers have some of the worst outcomes from serious head injury.
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Steven H. Rauchman, M.D. is an eye physician and surgeon who has been in private practice for 30 years. He has served as a Traumatic Brain Injury (TBI) medical/legal expert for the last 6 years specializing in the area of personal injury and related traumatic brain injuries.
