Synapse - reconnecting lives

Young children are particularly vulnerable to brain injuries as their bodies and brains are still developing. 

Children often aren't aware of certain dangers, and they are also more delicate than adults but placed at adult level using high chairs, require size-appropriate seats in cars when very young, and may not be able to tell you how they are feeling if sick. 

Here we look at some common causes of a brain injury in young children, and steps that can be taken to reduce the risk.

Encephalitis & meningitis

These are illnesses which may result in serious neurological problems - lasting brain damage. Meningitis refers to the swelling of the "meninges" which are the protective coverings of the brain and spinal cord. 

Encephalitis refers to the swelling of the brain itself. When both the brain and the meninges are swollen, the condition is referred to as "meningoencephalitis."

Swelling of the brain and its coverings is most often caused by bacterial or viral infections which usually enter the body as a result of a respiratory infection. As the meninges become infected, so does the cerebrospinal fluid which circulates throughout the central nervous system. Blood vessels supplying the brain can then become infected, as can the brain itself. Swelling and alterations in the blood flow lead to the possibility of brain injury.

Encephalitis  may begin with a flu-like illness or with a headache. Symptoms indicating that this is a more serious illness follow later and demonstrate a lowered (or altered) consciousness. These may include confusion, drowsiness, seizures (fits) and coma. It is important to note that all children in whom meningitis or encephalitis is suspected should be admitted to a hospital for appropriate diagnostic and supportive care. 

The only preventative measures that can be taken to protect your child from encephalitis are to minimize exposure to mosquitoes and to make sure that your child is fully immunized. This will help to eliminate some of the possible causes.

Near drowning

Swimming pools account for a large number of pediatric injury and deaths among children aged one to four years. Young children can drown in only a few inches of water. These steps will help to protect children in baths:

• Never leave young children alone, and empty the bath tub after use
• Never leave a baby alone in a bath seat (bath cradle)
• Do not leave nappy buckets or any other containers with water in reach
• Cover garden ponds and water features with mesh or fence them
• Empty paddle pools after use
• Check your garden after rain to ensure water hasn't collected anywhere
• Ensure your spa securely covered and out of reach
• Ensure your pool is securely fenced, and gates  always closed
• Make sure pool fences cannot be climbed over
• Clear of toys and floating items out of an unused pool
• Always supervise young children near a pool
• Take the child with you if leaving the pool or bath tub
• Ensure dams, irrigation channels and underground tanks are securely fenced in rural areas
• Establish pool rules e.g. no running, never swim alone
• Keep a resuscitation guide for children near your pool
• Learn first aid skills - they save lives
• Teaching young children to swim but remember they won't learn fully until at least five years old
• Always supervise young children even if they can swim.

Poisoning

In many countries poisoning is the second most common reason for young children admitted to hospital. Poisonous substances include medicines, insecticides, perfumes, paint, plants, insects, and cleaning, laundry, gardening and car products.  Toddlers between one and three years are most at risk of poisoning because:

• they are extremely curious and active
• they tend to put everything in their mouths
• their taste buds and sense of smell aren't developed to warn them that a substance is dangerous because it tastes or smells awful.

Strategies to prevent a child ingesting poison include:

• Store medicines and chemicals out of sight and reach, at least 1.5metres off the ground and in a locked child-resistant container.
• Use medicines and chemicals safely and return them to safe storage immediately after use
• Buy products in child-resistant containers and use child-resistant locks on cupboards or cabinets that store poisons
• Ensure all products are stored in original containers and are clearly labeled
• Regularly dispose of unwanted and out-of-date medicines by taking them to your nearest pharmacy for safe disposal
• Don't call medicines 'sweets'
• Check that the plants in your garden are not poisonous.

If you suspect a poisoning:

• Don't wait for your child to look or feel sick
• Remain calm as not all poisonings require medical treatment
• Keep the number for your Poisons Information Centre handy
• Where possible take the suspected poison to the phone
• Do not give anything by mouth unless advised.

Falls & Traumatic Brain Injury

Falls are consistently the most common cause of traumatic brain injury (TBI) in the young and the aged. High falls (more than one meter) are generally associated with trees, monkey bars and bunk beds. Bunk beds are not considered safe for children under nine years old.

Baby walkers are dangerous and should never be used. Most traumatic brain injuries involving walkers  happen while adults are watching - parents simply cannot respond quickly enough. A quarter of all children's falls are from prams. Make sure a harness is fitted whenever you place a child in a pram to avoid a traumatic brain injury occurring.

Motor vehicle accidents & TBIs

Children are particularly vulnerable to traumatic brain injuries  in motor vehicle accidents. Many of these injuries can be avoided with the use of age appropriate, properly fitted child restraints.

Shaken baby syndrome

A parent or carer may shake a baby when they feel frustrated and distressed from trying to settle a crying baby. All babies cry and this is normal, but constant crying can be very frustrating and confusing.

We know that when a baby is shaken sometimes the crying stops. However shaking a baby can cause a permanent traumatic brain injury  and even death. When a baby is shaken the head violently rotates back and forth, similar to whiplash.

Babies most at risk are those aged up to two years because a baby's head is relatively heavy compared to their body. Their neck muscles are also too weak to provide full support. Shaking a baby can cause the brain to bleed and swell by stretching and tearing blood vessels. Bleeding in the eyes is another severe consequence of shaking.

Shaking a baby can cause:

• blindness
• brain injury
• cerebral palsy
• seizures and epilepsy
• hearing loss
• learning difficulties
• behaviour problems.

In the worst situation the baby can die. If you have shaken a baby or if you believe someone else has shaken a baby it is vital you seek medical help immediately - waiting will only worsen the traumatic brain injury. You must take the baby to the nearest doctor, hospital emergency department or community health nurse.