Dr. Saad Saad: Traumatic Head Injury in Childhood Increases Mental Health Risks

Football, soccer. Bike, scooter or car accidents. In a split second, a child can suffer a traumatic brain injury. In fact, more than 800,000 children seek treatment for traumatic brain injury every year, according to the CDC’s National Center for Injury Prevention and Control. Not only is the injury stressful for the family when the injury occurs, but there may be lasting effects for the child, reports Dr. Saad Saad, a noted pediatric surgeon.

Research has shown that repeated blows to the head, such as from playing football or heading a soccer ball, can lead to long-term memory loss, dementia and other serious health issues.

Focus on male adolescents, concussions

The risk of head injury is high among adolescents, with males at twice the risk compared to females. Studies show that head injuries are more common in the spring and summer months when children are usually very active in outdoor activities such as riding bicycles, in-line skating, or skateboarding — especially in the late afternoon, early evening, and on weekends.

Concussions during youth sports have also received considerable attention from concerned parents. In fact, the CDC recently issued the first guidelines to outline treatment for children with concussions, providing parents, coaches, and doctors with the tools they need to ensure the best outcomes for young people with mild traumatic brain injury, Dr. Saad Saad reports.

What exactly is a concussion?

A concussion is caused by a bump, jolt, or blow to the head, explains Dr. Saad Saad. The injury can also be caused by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around – or twist in the skull – which creates chemical changes in the brain. In some cases, the brain is stretched, which damages brain cells.

Concussions are serious, says Dr. Saad. Doctors may describe a concussion as a “mild” brain injury because it is usually not life-threatening. However, there may be serious effects from a concussion.

Symptoms of concussion/traumatic brain injury

  • One pupil larger than the other
  • Drowsiness or inability to wake up
  • Headache gets worse and won’t go away
  • Slurred speech, weakness, numbness, or decreased coordination
  • Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
  • Unusual behavior, restlessness, increased confusion, or agitation
  • Loss of consciousness

Children and teens who show – or report – any of these symptoms may have a concussion, explains Dr. Saad Saad. If they say they just “don’t feel right” after a bump, blow, or jolt to the head or body, they may have a concussion or more serious brain injury.

Some symptoms may not show up until several hours or days later. A child or teen might be confused or dazed at first, then an hour later might not remember getting hurt. If any concussion signs get worse, you should take the child to the emergency department right away.

With early intervention, it is possible to diminish or avoid any long-term effects from the injury, explains Dr. Saad Saad. Recovery must involve a strict protocol of rest from any activity, including school. The child can gradually return to relaxing activities at home, then moderate activities, as they start feeling better. If concussion symptoms worsen, it’s important to take more breaks from activity.

Lifelong considerations for a child with a head injury

Child with head injury
Mild brain injury may affect the brain temporarily with no lasting effects, says Dr. Saad Saad. However, traumatic brain injury can have wide-ranging physical and psychological effects. Symptoms may appear immediately after the traumatic event, while others may appear days or weeks later.

Children who suffer a severe brain injury may lose muscle, speech, vision, hearing, or taste depending on the area of brain damage, Dr. Saad explains. Long- or short-term changes in behavior or personality can occur. Those children with the most serious injuries may require lifelong medical care and rehabilitation including physical, occupational, or speech therapy.

A severe brain injury is serious as it can affect all aspects of life, including relationships, ability to work, driving, and other everyday activities.

Danish study: Link with football injuries and mental health

The focus on adolescent football is warranted, as there is strong evidence regarding the effect of head injuries on mental illness, says Dr. Saad Saad. A paper in the American Journal of Psychiatry, the largest study yet to investigate the link, revealed that even a single head injury increases the risk of later mental illness — especially if the injury occurs during adolescence.

Researchers used Danish medical registries, studying 113,906 people who had been hospitalized for head injuries over a 23-year period. They found that in addition to cognitive symptoms caused by structural damage to the brain (such as delirium), these people were more likely to develop several psychiatric illnesses.

They found a 65% increased risk for schizophrenia and 59% higher risk for depression. This risk was highest in the first year following the injury — but remained significantly high during the next 15 years.

This risk was evident even when researchers took into account family history of psychiatric problems. Head trauma injury between ages 11 and 15 was the strongest predictor for later onset of schizophrenia, depression and bipolar disorder.

Because the exact mechanisms that lead from head injury to mental illness are still unknown, it is not clear whether there are specific ways to reduce the risk of mental illness after such an injury.

However, Dr. Saad Saad and other doctors advise following established post-injury guidelines, such as getting plenty of rest and avoiding physically and mentally demanding activities for a specified period depending on the severity of the injury.

They also advise that early detection can help improve the prognosis for mental illness, so Dr. Saad recommends seeing a doctor as soon as any symptoms appear.

Swedish study reinforces the link

Childhood brain injuries, including concussions, are associated with an increased risk of subsequent mental illness, poor school attainment and premature death, reports a research team based in the UK, US and Sweden. They analyzed data from more than a million Swedes born between 1973 and 1985 to examine the long-term impact of having a traumatic brain injury before the age of 25.

Researchers found that a childhood brain injury increased the chances of all these things. More serious brain injuries and repeated brain injuries increased the risk even more.

In this study, 77% had mild head injury (or concussions) and the others had more severe injuries. They were compared with non-injured people in their same age group, and also to their brothers and sisters who had not been injured.

Comparisons with siblings allowed researchers to rule out factors in the person’s upbringing that could have a bearing on their later life.

People who had experienced a single mild, moderate or severe brain injury during childhood were at twice the risk of being admitted to hospital as a mental health inpatient. They were 50% more likely to use a mental health service.

Also, they were 80% more likely to receive disability benefits and 70% more likely to die before the age of 41. There were 60% more likely to have done poorly at school or to receive welfare benefits.

People who had experienced repeated mild, moderate or severe brain injury were over 2.5 times more likely to receive disability benefits than those who had a single-episode injury.

This was the largest study to date of the long-term effects of head injuries in young people, says Dr. Saad Saad. This study reinforces what we know — that prevention is very important, he adds.

Many, many children don’t get admitted for concussions, says Dr. Saad, and yet just one concussion can have a lasting impact on their mental health. Early intervention (after the injury) can prevent a drift into unemployment and mental illness, he adds.

How head injury changes the brain

Researchers have honed in on the multiple changes that occur in the brain when a traumatic injury occurs. They have discovered an increased permeability of the blood-brain barrier. Normally, the membrane called the “barrier” protects the brain from potentially harmful substances in the bloodstream. However, when inflammation occurs due to an injury, these substances may have access to the brain. In some cases, this might trigger a process that damages the brain.

Oxygen deficiency caused by the injury may lead to free radical and release of damaging neurotransmitters that can damage brain neurons. The injury may disrupt brain circuits and dramatically disrupt neurotransmitter systems such as serotonin, dopamine, norepinephrine, and acetylcholine — which directly affect mood.

Also, a traumatic brain injury may affect brain regions involved in mood, especially the temporal lobes and frontal cortex.

Long-term effects of brain trauma

Major depression, bipolar affective disorder, and anxiety disorders (including PTSD and panic disorder) are very common after a traumatic brain injury, according to a study in The Journal of Pediatrics. Substance abuse was also fairly common, at 22%, while psychosis was uncommon at less than 1%.

In fact, a brain injury may result in difficulty adjusting to new situations, disruptive behavior, eating disorders, learning disorders, and sleep disorders.

Researchers found that children hospitalized for an injury had on average a 63% increase in mental health diagnoses and a 155% increase in medications prescribed to treat a mental illness.

Children under four years old with burns — and children of all ages with head injuries — were at greatest risk for new mental health diagnoses after injury.

Suicide risk is higher

In fact, suicide risk is higher among children and youth under 18 years old who had a serious traumatic head injury, according to a study in CMAJ (Canadian Medical Association Journal). They were also much more likely to be admitted for a mental health issue in the years following their injury. This was especially true for males living in rural areas.

Five years after the injury, those who had sustained major trauma had a 40% increased rate of hospital admission for one or more mental health diagnoses — alcohol abuse, drug abuse disorders and major depressive disorders.

It’s clear that there are often serious mental health concerns after children go home, says Dr. Saad Saad. Healthcare providers must do a better job assessing children for mental health needs, identifying high-risk children, and referring them to mental health providers before sending them home.

Parents also need to be vigilant after their child sustains an injury. If your child is behaving differently – not sleeping well, mood or behavior changes, or difficulty focusing in school – talk to your pediatrician or seek help from a behavioral health specialist, says Dr. Saad.

Steps to recovery from head injury

Child resting
Dr. Saad Saad explains that most kids and teens will only need a little help as they recover from a concussion. However, when there are ongoing symptoms, a variety of formal support services may be necessary. These support services may vary widely among states and school districts.

The child or teen may feel emotional if they cannot return to school or hang out with friends right away. Frustration, sadness and even anger are common. Talk with your child or teen about this. Be as supportive and encouraging as possible.

Recommended care after a head injury

Changing your child’s daily activities in the short term will help them get back more quickly to a regular routine. As your child starts to feel better, you can slowly remove the restrictions.

If your child’s symptoms do not worsen during an activity, then the activity is OK for them, advises Dr. Saad Saad. If symptoms worsen, the child should cut back on that activity. Each concussion and each child is unique, so the child’s recovery should be customized based on symptoms.

  1. Rest

The first few days after injury, your child should simply take it easy.

Physical activities should be limited to avoid any symptoms getting worse.

Activities that involve thinking should be very limited.

Prohibit activities that are risky for your child’s head and brain.

Help your child get a good night’s sleep; encourage naps during the day.

  1. Light Activity

When the child starts feeling better, gradually return to relaxing activities at home.

Avoid any risky activities.

Return to school gradually.

If any activity does not cause symptoms to worsen, then it’s OK.

If symptoms worsen, cut back on the activity until it is tolerated.

Get maximum sleep at night. Don’t allow loud music or screen time before bed. Keep the room dark. Keep bedtime and wake up on a fixed schedule.

Reduce daytime naps. Or return to a nap schedule appropriate for the child’s age.

  1. Moderate Activity

When symptoms are nearly gone, most regular activities are fine.

Breaks are important if concussion symptoms worsen.

Return to the regular school schedule.

  1. Back to Regular Activity

Recovery from a concussion is evident when your child can participate in all regular activities without any symptoms.

Dr. Saad Saad also notes:

Make a follow-up appointment with your child’s doctor or nurse.

Ask about safe over-the-counter or prescription medications to help with symptoms. Ibuprofen or acetaminophen are typically advised for headache, but ask your doctor or nurse to clarify.

Limit soft drinks or caffeinated items (tea, chocolate) during recovery so your child will rest.

Returning to sports and activities

An athlete who has had a concussion should only return to sports/practices when the healthcare provider has approved, advises Dr. Saad Saad. Parents should work closely with the team’s certified athletic trainer.

The return to sports should be a gradual process. Parents and coaches should watch for concussion symptoms after each day’s activity.

The athlete should only move to the next step when they have no new symptoms, Dr. Saad explains. If symptoms return or if new symptoms develop, the athlete is pushing too hard. The athlete should stop these activities and the doctor should be contacted. When the athlete has rested and has no more concussion symptoms, the athlete can resume activity.

Prevention & Helmet Safety

children on bikes wearing helmets
The key is to promote a safe playing environment for children and to prevent head injuries from occurring. The use of seat belts when riding in the car and helmets (when worn properly) for activities, such as bicycle riding, in-line skating, and skateboarding may protect the head from sustaining severe injuries.

Dr. Saad Saad advises you can help prevent head and brain injuries with a properly fitted helmet:

  • Age-appropriate size
  • Worn consistently
  • Worn correctly (latched under the chin)
  • Appropriately certified for use

No helmet is concussion-proof, but a properly fitted helmet is the best assurance your child is protected from a serious brain or head injury, advises Dr. Saad. It is also important to educate your child or teen on avoiding hits to the head.

About Dr. Saad Saad, Pediatric Surgeon

Dr. Saad Saad has performed thousands of complex pediatric surgeries on children of all ages, from infants to teenagers during his 40-year medical career. Dr. Saad has served as the Surgeon-in-Chief and the Co-Medical Director of K. Hovnanian Children Hospital at Hackensack Meridian Health Care System in New Jersey. During the 1980s, Dr. Saad was invited to serve as pediatric surgeon for the Saudi Royal family. Over the years, he has participated in eight Medical Missions to Jerusalem to perform free complex surgeries on poor children.

Read our previous post featuring Dr. Saad Saad: http://medicaldailytimes.com/medical-inventions/life-saving-medical-inventions-dr-saad-saad/3570/






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About the Author: BJ Hetherington

BJ is the lead editor of Meical Daily Times. Fluent in French and proficient in Spanish and Arabic, he focuses on diseases and conditions. BJ is a graduate of York University In Toronto. When BJ isn't busy writing his next piece, he can often be found running the streets of the GTA.

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