New Children's center aids in treatment of brain injuries
Evaluation clinic focuses on follow-up of children with minor brain injuries

These kids know that wearing helmets makes for a safe and fun summer of bike riding.

Summer is the long-awaited time of year when children head outdoors to play, and adults fling open windows to let sunshine and fresh air in. But it is also the most dangerous time of year for these very reasons. According to Carole Atkinson, MS, RN-C, trauma nurse coordinator in the Children's Hospital Boston Trauma Program, almost half of all injury-related childhood deaths occur from May through August. Many of these are due to brain injuries that can be caused when children fall from playground equipment or open windows, or have bicycle crashes.

Following a brain injury, children might be seen in an Emergency Department or evaluated by their primary care provider and sent home. In some cases they may not be seen by a health care provider at all because the injury does not seem significant. But days, weeks or months after a mild or moderate brain injury, pain, headaches, trouble sleeping or behavior problems can occur.

To help clinicians and parents deal with the effects of minor head injuries, Children's is opening a new comprehensive screening and evaluation clinic called the Central Nervous System Injury Center. It offers patients evaluation in either a single or multidisciplinary assessment by medical experts in Neurosurgery, Neurology, Physiatry, Neuropsychology, Physical Therapy, Occupational Therapy and Speech/Communication.

The center will also address the needs of children with spinal cord injuries and severe brain-injuries, but has started with a focus on follow-up of children with minor brain injuries, who constitute a much larger population. While Children's cares for only about 20 to 25 children with severe brain or spinal cord injuries each year, Atkinson says there are approximately 300 children with mild-to-moderate brain injuries admitted each year.

"When we started looking at those patients we saw that there wasn't always a coordinated follow-up plan," says Atkinson. "Although they only have minor brain injuries, these kids could have learning disabilities or focusing issues later on. We wouldn't find any particular injury when we did their CT, but through long-term follow-up we would find that they did have some problems."

In addition to opening the new clinic, the center has developed expanded discharge instructions for parents that advise them to look not only at acute problems like vomiting, dizziness, or lethargy, but also to be aware if the child's behaviors have changed: Have they had more outbursts? Did they used to be outgoing and now are withdrawn?

"We're trying to instruct families, not worry them," says Atkinson. "We want to make them more attentive to symptoms like headaches, sleeping trouble, behavior changes, or poor decision making."

Head Injury: Guidelines to Share with Parents

Clinicians, pediatricians and healthcare professionals should also be aware of the possibility of long-term effects so they can alert parents to watch their children for these symptoms. The center advises physicians to tell parents that their children need extra rest and time to recover from a brain injury, even if there's not a clear lesion on the CT scan.

Clinicians can refer patients to Children's Central Nervous System Injury Center clinic for any ongoing issues, such as if symptoms remain or occur a month or more after the injury. Even if it's a year later, a child may have vague complaints that the parents or physician don't recognize as a result of the brain injury. The clinic screens for problems that a child might be having, for instance, with gross motor control, word recovery, coordination, attention span, or proper sequencing. Based on the test outcomes, a management and treatment plan will be developed by the appropriate specialists.

The center also offers anticipatory guidance. For example, "Think First" is an injury prevention program presented in elementary and middle schools to educate kids in safety practices so they understand why they need to follow safety recommendations such as wearing helmets.

	For more information or to refer patients, contact the Children's Hospital Boston Trauma Program at (617) 355-5400.