KidsMD Health Topics

Head or Brain Injury

  • As a parent, when you hear that your child might have a head injury, your natural instinct is to conjure up the worst possible scenario. However, while some head injuries do cause serious and lasting damage, it’s important to remember that “head injury” is a broad term describing many different types of trauma—ranging from mild to severe.

    Here are some of the facts about head injuries:

    • Head injuries can be anything from cuts, bumps and bruises to concussions, skull fractures and serious brain injuries.

    • Head injuries are common in children and adolescents of all ages.

    • They occur twice as often in males as in females.

    • Studies indicate that head injuries are more likely to occur in the spring and summer months and on weekends, when children are most active outdoors.

    Another key point is that “head injury” and “brain injury” aren’t necessarily the same thing: Not every head injury will impact the brain. Here are some of the statistics about pediatric brain injury (courtesy of the Brain Injury Association of America):

    • Traumatic brain injury is the leading cause of disability and death in children and adolescents nationwide.

    • The age groups most at risk for brain injury are newborns through age 4 and teens from 15 to 19.

    • Every year, an average of 564,000 children are treated for brain injuries in the Emergency Room, and 62,000 children with brain injuries are hospitalized.

    While treatment options depend on the specifics and severity of the particular injury, you can rest assured that Children’s Hospital Boston has the world-renowned expertise and state-of-the-art tools to give you, your child and your family the care you need.

    How Children’s Hospital Boston approaches head injuries/brain injuries

    Every year, Children’s treats hundreds of patients—from infants and young adults—with the full spectrum of head and brain injuries.

    In addition, we have a dedicated Sports Concussion Clinic for children and teens who have sustained concussions during recreational or competitive athletics.

    Working together, our clinicians will develop a customized treatment plan that meets your child's physical, emotional and social needs—and involves you and your family at every step of the way.

    And Children’s is committed to advocating for more rigorous head and brain injury prevention measures and broader public awareness at the local, regional and national levels, too:

    • We have a specialized Injury Prevention Program that aims to significantly reduce the number of preventable injuries in children through a combination of education and research.
       
    • Children’s has been named the National Lead Center for the Prevention of Pediatric Acquired Brain Injury (PABI) and the Massachusetts Lead Center for PABI by the Sarah Jane Brain Project, a national organization focused on the prevention and treatment of acquired brain injury in children. Read more.

    Led by Brain Injury Center director and neurosurgeon Mark R. Proctor, MD, Children’s successfully advocated for legislation that makes concussion education a requirement for all athletes who participate on Massachusetts public school teams, as well as for parent volunteers, school medical personnel and coaches. 

    Head injury/brain injury: Reviewed by Mark R. Proctor, MD
    © Children’s Hospital Boston; posted in 2011

  • What is a head injury, exactly?

    A head injury is any kind of trauma involving the scalp, skull or brain. Fortunately, the skull and brain covering are both formidable sources of protection, meaning that not all head injuries will have an effect on the brain.

    Types

    What are the different types of head and brain injuries?


    Head injuries

    • Scalp injuries: cuts, scrapes and bumps

    Nearly every child will experience some type of scalp injury in her life—whether it’s from tripping and falling, being struck with an object, bumping into something or otherwise “whacking” her head.

    Because the scalp has so many blood vessels, even a small cut might bleed profusely, and even the mildest impact might produce a scary-looking bump. Thankfully, the vast majority of these injuries are just surface wounds, and will heal within a matter of days.

    However, you should always seek immediate medical attention if your child loses consciousness (even momentarily), vomits or exhibits changes in behavior after a cut, scrape or bump on the head. Learn more in our “Signs and Symptoms” section below.

    • Skull fractures are breaks in any of the bones of the skull. The four major types of skull fractures are:
      • linear fractures, by far the most common type (accounting for nearly 70 percent of all skull fractures). In a linear fracture, the bone sustains a break, but is not moved or jarred out of place. Kids with linear fractures usually need only a brief period of observation in the hospital before resuming their normal activities.
         
      • depressed skull fractures often (but not always) occur alongside a cut in the scalp. They get their name because a part of the skull actually sinks inward, or becomes “depressed.” Surgery is typically necessary to repair the fracture.
         
      • diastatic skull fractures are breaks along the bony joints, or sutures, of the skull. Because the skull is still soft and malleable in babies, diastatic fractures are most common in newborns and infants. These breaks cause the suture lines to widen, and are usually treated with surgery.
         
      • basilar skull fractures are the most serious type. These fractures occur at the base of the skull, and frequently cause bruising around the eyes or behind the ears. If part of the brain covering, or dura, is torn, a child with a basilar skull fracture may also have clear fluid draining from his nose or ears. Close observation and intensive medical care is required.

    Brain injuries

    • Hemorrhages are episodes of bleeding in the brain due to some kind of trauma. They may also be referred to as hematomas. The three main types are categorized by where in the brain they occur:
      • subarachnoid involves bleeding between the protective tissues covering the brain and the brain itself. These hemorrhages often occur in car accidents, and but rarely require surgical intervention to stop them.
         
      • epidural describes bleeding between the cranium (outer skull) and the tough outer covering of the brain (called the dura). This type of hemorrhage can be dangerous because it tends to progress silently, not causing any visible symptoms for a period of time (lucent interval) after the actual trauma, but then can lead to severe consequences 1-2 hours later.

        For this reason, prompt medical attention is a must after serious blows to the head, especially if they lead to a loss of consciousness ... even if the child appears to be better for a short time.
         
      • subdural means bleeding between the hard outer lining of the brain (the dura) and the brain itself. This type of hemorrhage typically happens after a powerful blow to the head, such as a fall from a great height, and often accompanies loss of consciousness.

        Subdural hemorrhages require immediate, intensive treatment—sometimes including emergency surgery.
         
    • Traumatic brain injuries (TBIs) are any type of brain injury caused by sudden trauma. Like other head injuries, TBIs can be mild, moderate, or severe, even life-threatening. Specific types include:
      • contusions, also called cerebral contusions, which are bruised and swollen areas in the tissue of the brain. They can be caused by virtually any type of head trauma, and can range in seriousness from very mild—needing only a short period of observation by a doctor—to severe, requiring surgery.
         
      • concussions, which are injuries that happen when the brain is sent into a sudden spinning motion, either because of a direct blow to the head or because of a blow to the torso that snaps the head forward or backward. Learn more about concussions.
         
      • penetrating brain injuries, which occur when the hard outer lining (dura) of the brain is pierced—either by a projectile, such as a bullet or knife, or by fragments of the skull that are forced into the brain by a violent impact (for example, in a car accident). Penetrating brain injuries can be life-threatening and require immediate emergency care.
         
      • diffuse axonal injuries, which happen when the head is forced forward or backward at a rapid speed, shearing the brain’s white matter (which facilitates messages throughout the central nervous system).

        These injuries are particularly devastating because they cause widespread neurological damage, and may lead to coma or death. Children with less severe diffuse axonal injuries may benefit from medication and rehabilitation services like physical therapy. Unfortunately, surgery is not an option for treatment.


    Causes

    What causes head injuries and brain injuries in children?
    Virtually any type of trauma can cause a head injury or brain injury in a child. The most common causes are:

    Signs and symptoms

    What are the symptoms of a head injury/brain injury?
    The following list contains the most common symptoms of a head injury. However, it’s critical to recognize that each child may experience symptoms differently, depending on the exact circumstances and severity of his injury. Be sure to seek professional medical attention to get the right diagnosis and care plan for your child.

    Symptoms of a mild head injury

    • raised, swollen area at the site of the blow
    • small, superficial (shallow) cut in the scalp
    • headache
    • sensitivity to noise and light
    • irritability
    • confusion
    • lightheadedness and/or dizziness
    • problems with balance
    • nausea
    • problems with memory and/or concentration
    • change in sleep patterns (difficulty sleeping, or excessive sleepiness)
    • blurred vision
    • "tired" eyes
    • ringing in the ears (tinnitus)
    • complaining of strange or altered taste
    • fatigue/lethargy

    Symptoms of a moderate to severe head injury

    All of the above, plus:

    • deep cut or laceration in the scalp
    • loss of consciousness
    • severe headache that does not go away
    • repeated nausea and vomiting
    • loss of short-term memory, such as difficulty remembering the events that led right up to and through the trauma
    • slurred speech
    • difficulty standing/walking
    • weakness in one side or area of the body
    • sweating profusely
    • unnaturally pale complexion
    • seizures or convulsions
    • behavior changes, including sudden irritability
    • blood or clear fluid draining from the ears or nose
    • in the case of a brain injury, one pupil (dark area in the center of the eye) appearing larger than the other eye

    Always seek immediate medical treatment if your child displays any of these warning signs.

     
    FAQ

    Q: Will my child be OK?
    A: The severity of a head injury can vary widely, depending on:

    • the type of injury
    • whether the brain is involved
    • the child’s age
    • whether she sustained any other injuries at the same time
    • the symptoms she is experiencing

    The most important thing you can do for your child is to seek prompt medical attention from a qualified professional. The earlier a head injury is diagnosed and treated, the better the general outlook.

    Q: How common are pediatric brain injuries?
    A: The Brain Injury Association of America reports that nearly 650,000 children sustain brain injuries each year.

    Q: Can head injuries/brain injuries be prevented?
    A:
    Unfortunately, there is no way to completely prevent a head or brain injury: There is no type of headgear or rollbar that offers 100-percent protection.

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

    Q: What do the terms “open head injury” and “closed head injury” mean?
    A:
    An open head injury means that the scalp has been penetrated. A closed head injury involves a hard blow that does not pierce the scalp.

    Q: What do I need to look out for once my child has been diagnosed with a head injury?
    A:
    Parents of children diagnosed with a head injury should always be watchful for changes in their child’s:

    • balance/coordination
    • speech
    • pupil size
    • sleep patterns
    • behavior

    Q: Is there a cure for a head or brain injury?
    A: The answer hinges on the type of injury sustained. Mild to moderate head and brain injuries can resolve completely, or with minimal complications, with time, rest and proper medical care. Unfortunately, severe brain injuries may cause permanent damage. Learn more in our “Lifelong considerations” section


  • How is a head injury/brain injury diagnosed?

    In many cases, the full extent of a child’s head injury isn’t obvious right away. That’s why it’s key that you obtain a diagnosis from a qualified medical professional as soon as possible.

    Here at Children’s, our trauma specialists will perform a comprehensive physical exam on your child and ask for a full medical history, as well as a detailed account of how and where the injury occurred.

    Next, doctors may also order any or all of the following:

    • blood tests

    • X-rays, which use small doses of radiation to take pictures of a part of the body

    • magnetic resonance imaging (MRI), a combination of electromagnets, radio frequency waves and computers that takes two-dimensional and three-dimensional images of the brain and other body structures

    • computed tomography (CT) scans, a non-invasive procedure that uses x-ray equipment and powerful computers to create detailed images of the head, brain and other body parts

    • electroencephalogram (EEG), a procedure that records the brain's continuous electrical activity through electrodes attached to the scalp

  • Boston Children's Hospital 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:

    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.


    Helpful links

    Please note that neither Boston Children's Hospital, 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.

  • At Children’s Hospital Boston, our care is informed by our research, and our discoveries in the laboratory strengthen the care we provide at each child's bedside. Children’s scientific research program is one of the largest and most active of any pediatric hospital in the world.

    In particular, our neurology, neurosurgery, sports medicine and emergency medicine researchers are making new inroads in understanding the causes and progression of head and brain injuries, paving ground for new treatments. Our research projects with promise for treating these injuries include:

    Study finds CT scans are frequently unnecessary after head injury
    Overall, roughly half of U.S. children taken to hospital emergency departments (EDs) for a head injury receive a head CT scan, often to ease worried parents’ concerns. Yet true traumatic brain injury is uncommon. A multi-center study of more than 40,000 children with minor blunt head trauma, co-led by Children’s Hospital Boston, shows that allowing a period of observation can reduce the use of head CT by as much as half without compromising care – and without exposing children to ionizing radiation. Read more

    Kids who receive neuropsychological testing after concussions are sidelined longer
    When computerized neuropsychological testing is used, high school athletes suffering from a sports-related concussion are less likely to be returned to play within one week of their injury, according to a study in The American Journal of Sports Medicine co-authored by Children’s clinicians William Meehan and Pierre d'Hemecourt, MD. Read more

    A link between head injuries and epilepsy?
    As doctors re-examine many of the basic assumptions and long-held understandings about concussions, research by Children’s neurologist Alexander Rotenberg, is shedding light on what happens on a molecular level during brain injuries. Learn more.

    Understanding the genetics behind concussions
    NFL Charities, the charitable foundation of the NFL owners, has awarded Children’s Hospital Boston a grant to support sports-related medical research on concussions, specifically examining how genetics may influence a person’s health after repeated concussions. Learn more.

    “Rewiring” the brain?
    Researchers have long sought a factor that can switch on the brain's ability to learn. Now, research led by Takao Hensch, PhD, of Children's FM Kirby Neurobiology Center and the Department of Neurology, has identified such a trigger. Called Otx2, it signals certain cells in the cortex to mature and initiate a critical period—a time window when the brain can readily rewire itself. Learn more.

    Stimulating regrowth of damaged nerve fibers
    Because injured neurons in the brain or spinal cord can't grow back, damage from spinal cord injury, stroke or other forms of brain injury can't be repaired. But researchers led by Children’s neurologist Zhigang He, PhD, BM, have found a way to overcome natural inhibitory mechanisms that suppress regeneration, causing nerve fibers to re-grow vigorously. Learn more.

    An easier, quicker, portable way to measure intracranial pressure
    Children’s neurosurgeon Joseph Madsen, MD, is creating a system to noninvasively measure pressure inside the skulls of patients with head injury, hydrocephalus, subarachnoid hemorrhage and other conditions. His goal is to create a portable device for use by emergency technicians or in battlefield situations. Learn more.

    Children’s is known for pioneering some of the most effective diagnostic tools, therapies and preventive approaches in pediatric medicine. A significant part of our success comes from our commitment to research—and to advancing the frontiers of mental health care by conducting clinical trials.

    Children’s coordinates hundreds of clinical trials at any given time. Clinical trials are studies that may involve:

    • evaluating the effectiveness of a new drug therapy
    • testing a new diagnostic procedure or device
    • examining a new treatment method for a particular condition
    • taking a closer look at the causes and progression of specific diseases

    While children must meet strict criteria in order to be eligible for a clinical trial, your child may be eligible to take part in a study. Before considering this option, you should be sure to:

    • consult with your child’s treating physician and treatment team
    • gather as much information as possible about the specific course of action outlined in the trial
    • do your own research about the latest breakthroughs relating to your child’s condition

    If your physician recommends that your child participate in a clinical trial, you can feel confident that the plan detailed for that study represents the best and most innovative care available. Taking part in a clinical trial at Children’s is entirely voluntary. Our team will be sure to fully address any questions you may have, and you may remove your child from the medical study at any time.

  • Kate’s story

    “I call William my spirited child. Like many 3 year-olds, he loves to run and jump, and does it without the slightest sense of fear. His boundless energy has always been one of his most endearing features, but in a split second, it also almost took him from us forever.

    A few days before Christmas, my husband Mark and I had some last minute holiday chores to do so we decided to beat the rush by heading out early in the morning. As we walked out the front door William and I were standing side by side, just inches from each other. Suddenly, he turned to go back towards the door and somehow lost his footing. He fell backwards off the steps and hit the back of his head on the brick walkway as he landed.”

    Read more.

    One patient’s story: my toddler’s head injury

    I call William my spirited child. Like many 3 year-olds, he loves to run and jump, and does it without the slightest sense of fear. His boundless energy has always been one of his most endearing features, but in a split second, it also almost took him from us forever. Read more about William's head injury.

     

     

     

     

    Hard Knocks: Maggie's story

    On a Friday afternoon last October, 15-year-old Maggie Hickey was getting ready to go to a high school football game when she started feeling queasy. The next thing she knew, she was lying on a couch with a whopping headache, a gash over her left eye and only the fuzziest idea about what had happened. “I felt so disoriented and started crying,” Maggie remembers.

    It turned out that Maggie had fainted, smashing her forehead on a doorknob as she crashed to the floor. Eight stitches later, Maggie and her parents left the emergency room thinking that the mysterious incident was over. “It hurt a lot but I was mostly embarrassed,” she says. “I was more worried about what people were going to think of my stitches than anything else.” So, despite a dull headache that wasn’t quelled by Motrin, Maggie returned to school and varsity rowing practice that Monday. But the pressure in her head didn’t go away. Instead, the pain intensified—especially when she exercised, studied or, strangely enough, when she entered brightly-lit areas, like a room with fluorescent lights or the sunny outdoors. Each day ushered in more peculiar maladies: Just sitting still in class caused crippling headaches and Maggie became anxious, fatigued and forgetful. Soon, she couldn’t eat because of constant nausea, and couldn’t sleep because of the incessant pain.

    Until her accident, Maggie sailed through school, earning straight As, despite her heavy sophomore year workload. But she started bringing home Cs—partly as a result of losing her homework and forgetting to bring books to class, but mostly because her concentration was shot. As Maggie’s grades plummeted, her social life also screeched to a halt. She stopped going out with friends, preferring to lie down in her dark bedroom, which soothed her symptoms. “It was frightening,” says her mom, Judy, who watched her daughter transform from an athlete bursting with energy to a sluggish girl with sunken, dark eyes. “After three weeks, she didn’t look like herself anymore.” Maggie’s personality changed too, as her confusion and frustration spiraled. “My whole life was falling apart,” Maggie says. “I thought, ‘This just can’t be normal.’”

    An invisible epidemic?
    Maggie was referred to Children’s Hospital Boston, where the Hickeys were startled to learn that Maggie’s problems were due to the after-effects of a severe concussion. William Meehan, MD, director of Children’s Sports Concussion Clinic in the Division of Sports Medicine, made the diagnosis after assessing Maggie’s brain function through computerized neuropsychological testing, an advanced diagnostic technique that measured her reaction time and verbal and visual memory—the faculties most often affected by concussions. While Maggie was relieved to have an explanation for her symptoms, she found the test itself extremely irksome. “It wasn’t hard, but I couldn’t do it,” she says. “I couldn’t think. My 9-year-old sister could have done better.” Her self-assessment wasn’t far off: Her dismal test scores placed her below the first percentile. “I thought I must have gotten really dumb,” she says. “I just couldn’t imagine a concussion could cause this many problems.”

    Meehan understood Maggie’s incredulity. “Only recently has it been recognized that concussions involve any kind of brain dysfunction,” he says. “There’s been a lot of attention paid to them in the past decade, but before that, they were thought to be short-lived and fully recoverable, so people didn’t pay them much notice.” Now, as doctors standardize diagnostic tests and treatment plans for concussions, they’re re-examining many of the long-held basic assumptions about them. Gone is the idea that someone needs to be knocked unconscious to get one; even a mild blow can impact brain function. And gone is the notion that someone needs to be hit in the head in order to be concussed—a blow to the chest can also do the trick.

    The “shake it off” approach to concussions is certainly changing—from doctors’ offices to the 20-yard line—thanks, in part, to a surge in media attention. News reports are revealing that some retired NFL players’ devastating mid-life mental problems, including dementia and suicidal depression, may be the result of years of repetitive brain injuries. Media accounts are also illuminating the rare but catastrophic condition called second impact syndrome. For reasons doctors don’t fully understand, people who have sustained a concussion are three times more likely to suffer another one. And the second blow can cause major long-term neurological impairment or, in the worst-case scenario, deadly brain swelling. And while the media spotlight has focused on professional athletes, attention is turning to the potential hazards that younger players face in games and even during practices.

    Exactly how many teenagers are affected by concussions—and to what extent—are two of the many unanswered questions about the condition. Children’s Sports Concussion Clinic alone sees about 40 patients a week with concussions—and that’s not counting the patients with more severe head injuries who are treated in Children’s Brain Injury Center. National statistics estimate the number of high school athletes who suffer concussions at 10 percent. But it’s probably much higher, since studies show that almost half of these athletes don’t report their injuries, either because they don’t recognize their symptoms as signs of a serious injury or because they don’t want to get relegated to the sidelines. “If you ask players anonymously at the end of the season if they ever sustained a blow to the head and then had nausea, vomiting or a loss of consciousness, the numbers are much higher,” Meehan says.

    The under-diagnosis problem is so widespread that experts describe it as an epidemic. “It’s at a level where it’s happening so often and is so under-reported and under-treated that we don’t understand all the implications,” says Meehan. “What are the cumulative effects? How does memory loss affect children’s school lives? Down the road, how does that loss affect the workforce? We can’t even imagine the ramifications.”

    Possible long-term effects are especially hard to study since the traditional laissez-faire approach to concussions has resulted in scattershot recordkeeping. “We have ideas about what happens to kids who are admitted to hospitals with brain injuries, but we don’t know what happens when they’re treated in emergency rooms and go home,” says Robert Tasker, MD, a world authority on head trauma and Children’s new director of Neurocritical Care. One of his goals is to help track the outcomes of brain injuries months, years and decades down the road.

    Sleep it off
    Meehan prohibits his patients from returning to sports until they’re free of symptoms and their brain function has returned to normal. While this usually happens within a few weeks, he errs on the side of caution, since research indicates that younger players recover more slowly from concussions than college or professional athletes, possibly because their brains and nervous systems are still maturing. But in drastic cases like Maggie’s, he recommends doing absolutely nothing. That is, he prescribes complete physical and cognitive rest.

    Nobody knows why—or, truly, whether—a hiatus from both physical and mental exertion boosts the brain’s recovery process. But experts often recommend it simply because it seems to break the cycle of symptoms. (Children’s is conducting a major study to find out why.) So, Meehan essentially benched Maggie, banning her from school, homework, reading and exercise. Her short list of permissible activities consisted of resting, watching TV (strictly the mindless variety), listening to music and light text messaging. While many people would see a doctor-ordered stint as a couch potato as a dream come true, for Maggie it was a nightmare. “It really killed me to not do anything,” she says. “I watched One Tree Hill over and over and only got up to get something to eat. I couldn’t read or work out or go to school. It added up, and I felt like I had lost everything.”

    Specialists also occasionally treat patients with medications traditionally used to treat other conditions, but their efficacy is as unclear as the efficacy of the cognitive/physical rest approach. In the winter, Maggie started taking daily doses of amantadine, an anti-viral medication that has revealed some improvements in children with mild brain injuries, but is not yet a tried-and-true therapy. Meehan is testing medications on concussed mice and finding encouraging results. He’s even been able to identify a particular molecule in the brain that may play a key role in determining post-concussive symptoms; if he gives mice a drug targeting this molecule within 15 minutes of getting a concussion, their motor and cognitive function are preserved.

    Lessons learned
    For Maggie, the drug did seem to help. But she still fought an uphill battle against her unrelenting symptoms. She sat out the rowing season and when she gradually returned to school as a part-time student, the smallest amount of homework set her back physically. “I couldn’t read two pages a night, let alone three chapters,” she says. “I couldn’t remember anything, so I’d take lots of notes, but it was still so hard to keep things straight.” For Maggie, the hardest part was having to justify her frequent absences and doctor-sanctioned light workload to teachers and students who didn’t understand her condition. As the months wore on, classmates accused her of playing up her symptoms. “Even my friends started to think I was milking this concussion thing,” she says. “They didn’t realize I was dragging myself to classes and it wasn’t that sweet of a deal.”

    To Meehan, Maggie’s hardship at school is telling, and highlights yet another aspect of concussions that’s waiting to be explored. “Nobody ever recognized that if someone’s brain isn’t functioning properly because of a concussion, his grades are inevitably going to be affected,” he says. “A lot of ‘dumb jocks’ were probably just kids hugely affected by many concussions. But nobody knew it and nobody helped them.” Meehan sees a disconnect between academic and physical expectations: “Kids wouldn’t fail gym if they couldn’t do 10 push-ups with a broken arm. But with concussions, it’s a different story.”

    Maggie finally started feeling better in April, six months after hitting her head. Eventually, a whole day went by when she didn’t have a headache, and eventually, several days in a row passed symptom-free. The day Meehan gave her the green light to exercise, she was so excited she went out and ran three miles. “I hadn’t moved in six months, and the fact that I could was so awesome,” Maggie says. She resumed rowing with a vengeance and, with help from a tutor, caught up in school. “Things turned right around and she got her drive back,” says Judy. “She’s her engaging and charming self again.” During Maggie’s final neuropsychological assessment, she scored in the 97th percentile.

    Maggie’s full recovery didn’t surprise Meehan. “If a child’s concussion is managed properly, she’ll do just as well at sports and school as she always did,” he says. “The key is making sure these kids get diagnosed and treated while getting the chance to completely recover.” And while Maggie essentially lost half a year of her life, she feels she learned some lessons she couldn’t have picked up in a classroom. “I’m grateful now just to be able to go for a run,” she says. “When you go through something like this, you realize how much you can do when you don’t have a debilitating injury. I feel much more privileged about everything I’m able to do. I never thought like that before.”

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
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