Spinal cord injury

How is a spinal cord injury defined?
A spinal cord injury is any damage to the spinal cord that is caused by trauma, rather than a birth defect or medical condition that involves the spinal cord (such as a spinal cord tumor or tethered cord syndrome).

What are the different types of spinal cord injuries?
Spinal cord injuries can vary in severity—from slight bruising to complete tears—as well as location. Serious injuries are classified according to the degree of lost movement and sensation they cause:

• quadriplegic/tetraplegic (“quad” derives from the Latin word for “four” and ‘tetra’ derives from the word for five, implying loss of control of the trunk muscles) SCIs cause loss of movement and sensation in both arms and both legs. They also affect the muscles of the chest, meaning that a child with this type of injury may require mechanical support for breathing.
   
• paraplegic (“para” comes from the Greek term for “half”) SCIs cause loss of motion and sensation in the lower half of the body, including the legs.

Causes

What causes spinal cord injuries in children?
Virtually any type of trauma can result in a SCI. Some of the most common traumatic situations children experience are:

• falls
• motor vehicle accidents (either with the child riding as a passenger or struck as a pedestrian)
• sports injuries
• child abuse or other incidences of violence
   

Signs and symptoms

What are the symptoms of a spinal cord injury?
The exact symptoms your child experiences will depend on the degree of severity and particular location of her SCI.

Right after the trauma, she may go through spinal shock—a pronounced loss of feeling, muscle movement and reflexes below the level of her injury. This is caused by swelling. In the case of minor SCIs (such as bruises), spinal shock can subside over the next couple of days as the swelling goes down, and some or all sensation and functions may gradually return.

When a SCI is more severe, however, other symptoms will start to emerge. These can include any or all of the following, depending on the location of the injury:

• muscle weakness
• partial or complete loss of muscle movement in the chest, arms or legs
• breathing difficulty
• partial or complete loss of feeling in the chest, arms or legs
• loss of bowel and bladder function

In general, the higher in the back or neck the injury is located, the more extensive the symptoms will be. For example, if your child’s injury is in the lower portion of her spinal column, she may have reduced or absent feelings in (and impaired control of) her legs, bladder and bowels. If her SCI is in the upper neck region, she may be unable to move her arms or legs or to breathe on her own.

SCIs can be severe and potentially life-threatening injuries. You should always seek immediate help for your child from trained, qualified emergency medical responders.           

FAQ

Q: Will my child be OK?
A: The prognosis for a child with a spinal cord injury hinges on his exact injury—where in the spine it occurs, how serious it is and the specific symptoms it causes.

As a general rule of thumb, if a child shows rapid progress after a SCI, he has a better chance of making a more complete recovery.

Your child’s doctor is the best source of information about his situation and long-term outlook. The most important thing you can do for your child is to seek prompt medical attention from a qualified professional.

Q: How common are spinal cord injuries in children?
A: They are relatively rare, accounting for only 1 to 10 percent of all SCIs.

Q: Can spinal cord injuries be prevented?
A: Unfortunately, there is no way to completely prevent a spinal cord injury: There is no equipment, device or safety gear that offers 100% protection.

However, there are several steps you can take to reduce the likelihood of your child suffering a spinal cord injury:

• Promote a safe playing environment, both in general play and recreation and in competitive sports.
• Always ensure that your child is wearing a seat belt, or properly secured in a car seat, whenever he is in the car.

Q: Do I need to keep my child immobilized on the scene of his injury until help arrives?
A: Yes—this is very important.

It can be incredibly difficult for anyone witnessing a traumatic incident involving a child to resist the natural urge to intervene—either by picking up and cradling the child, or by otherwise moving him. However, keeping the injured child’s head and neck immobilized until medical help arrives is critical to avoid worsening the damage to his spinal cord.

Q: Is there any hope that my child will regain any degree of lost function over time?
A: The answer really depends on how badly your child’s spinal cord is injured and where in her neck or back the injury occurs. Some children with more moderate SCIs do regain feeling and function as the spinal cord heals.

Q: Is there a cure for spinal cord injuries?
A:Unfortunately, there is no cure at this time. However, Children’s researchers are hard at work in an effort to better understand the biological mechanisms involved in SCIs—and to discover how they might be reversed in the future, restoring partial or complete nerve and muscle functions. Learn more in our “Research and Innovation” section. 
 

Questions to ask your doctor

You and your family play an essential role in your child’s treatment for a spinal cord injury. It’s important that you share your observations and ideas with your child’s treating physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.

You’ve probably thought of many questions to ask about your child’s injury and outlook. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you’ll have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you.

Some questions to ask your doctor might include:

• Where in my child’s spine is the injury located?
• Is the injury quadriplegic or paraplegic? Complete or incomplete?
• Is there any chance that he will regain lost sensation/function?
• Is surgery necessary?
• What medications will he need?
• Will he require a wheelchair or ventilator?
• What is the long-term prognosis for my child?
• How should I explain my child’s SCI to him? To friends, classmates and family members?
• How will the injury affect my child’s home and school life?
• What changes do I need to make to my child’s daily routines?
• How can physical therapy, occupational therapy and counseling help my child and family?
• What other resources can you point me to for more information?