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