Head/brain injury

Children’s Hospital Boston has been a worldwide innovator in diagnosing and treating pediatric head and brain injuries for decades.  Learn more about how we care for children who have sustained traumatic injuries.

Treatment options

Like the injuries themselves, the treatment options for head and brain injuries are widespread and very specific to the individual child. Your child's treatment team will develop a customized care plan according to:

• the type of head injury your child has sustained
• the extent of the injury
• whether the brain is affected
• the extent of complications your child is experiencing
• your child's age, overall health and medical history
• your child's tolerance for specific medications, procedures or therapies
• your family’s preferences for treatment

Depending on the severity of the injury, treatment may include any or all of the following:

For mild to moderate injuries

• ice applied to the injured area
• rest (both physical and mental)
• topical antibiotic ointment
• bandaging
• medical observation, either as an inpatient or outpatient

For moderate to severe injuries

• emergency medical attention
• stitches
• hospitalization for observation
• surgery

Another key aspect of treatment: Monitoring intracranial pressure (ICP)

The space within your child’s skull is limited. That means that some head injuries can cause a buildup of pressure inside the skull—known as intracranial pressure.

If left untreated, excessive ICP can lead to brain damage. For this reason, your child’s treatment team will begin monitoring his ICP immediately if he is deemed to be at risk for this complication.

How is ICP monitored?

Intracranial pressure is measured by either:

• placing a small, hollow tube (called a catheter) into the fluid-filled space in the brain (called a ventricle) or
   
• placing a small, hollow device (called a bolt) through the skull into the space just between the skull and the brain.
  
  The bolt or catheter will be inserted either in the operating room (OR) or in the intensive care unit (ICU). Next, it will be hooked up to a monitor that gives a constant reading of the pressure inside your child’s skull. If the pressure goes up, the device can be used to withdraw the excess fluid.
  
  While the bolt or catheter is in place, your child will be given medicine to help keep her comfortable. When the swelling has gone down and there is little chance of further swelling, the device will be removed.
   

Lifelong considerations for children with brain injuries

Children who suffer a serious brain injury may lose some or all of their movement, speech, vision, hearing or taste abilities, depending on the area where the damage occurred and the extent of its impact.

In addition, brain injuries can cause short-term or permanent changes to a child’s personality and behavior. As a result, some children will need lifelong medical and rehabilitative support, including:

• psychosocial care and counseling
• physical therapy
• occupational therapy
• speech therapy
• vision support
• hearing support

Regardless of the severity of your child’s brain injury, it’s crucial to focus on maximizing his capabilities at home, at school and in the community. Positive reinforcement from you and other family members, combined with professional support services, will help your child strengthen his self-esteem and gain the greatest possible level of independence.

Coping and support

When your child has a head or brain injury, your family is grappling with many concerns and questions. Not only are you focused on meeting all of your child’s medical needs; you are also facing a significant emotional and psychological toll that can affect every member of the family.

In addition to the clinical information offered on this page, Children’s has several other resources designed to give your family comfort, support and guidance:

Patient and family resources at Children’s

Children’s Behavioral Medicine Clinic helps children who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:

• being sick
• facing uncomfortable procedures
• handling pain
• taking medication
• preparing for surgery
• changes in friendships and family relationships
• managing school while dealing with an illness
• grief and loss
   

Children’s Psychiatry Consultation Service is comprised of expert and compassionate pediatric psychologists, psychiatrists, social workers and other mental health professionals who understand the unique circumstances of hospitalized children and their families. The team provides several services, including:

• short-term therapy for children admitted to one of our inpatient units
• parent and sibling consultations
• teaching healthy coping skills for the whole family
• educating members of the medical treatment team about the relationship between physical illness and psychological distress
   

The Experience Journal was designed byChildren’s psychiatrist-in-chief David DeMaso, MD and members of his team. This online collection features thoughts, reflections and advice from kids and caregivers about living with medical conditions and going through treatment.
 

Children’s Department of Psychiatry publishes a free booklet, “Helping Your Child with Medical Experiences: A Practical Parent Guide”(.pdf file). Topics in the booklet include:

• talking to your child about her condition
• preparing for surgery and hospitalization
• supporting siblings
• taking care of yourself during your child’s illness
• adjusting to life after treatment
   

Children’s Center for Families is dedicated to helping families locate the information and resources they need to better understand their child’s particular condition and take part in their care. All patients, families and health professionals are welcome to use the Center’s services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.
 

The Children’s chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members—representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions—who will listen to you, pray with you and help you observe your own faith practices during your child’s treatment.
 

Children's International Center isa dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu.

Helpful links

Please note that neither Children’s Hospital Boston, the Brain Injury Center nor the Trauma Center at Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

• Brain Injury Association of America
• Brain Injury Family Resources
• Brain Injury Support Forums (MDJunction.com)
• Brain Injury Support Group (DailyStrength.org)
• Brain Trauma Foundation
• Child Brain Injury Trust (UK)
• Head Injury Association
• International Brain Injury Association
• Pediatric Brain Injury Foundation
• The Sarah Jane Brain Project
• ThinkFirst National Injury Prevention Association