Post-concussion Symptoms following Mild Traumatic Brain Injury in Young Children

Mild traumatic brain injury (mTBI), or concussion, is extremely common during childhood with notable peaks of incidence in pre-school children. Despite this, few studies have examined the nature and frequency of post-concussive symptoms (PCS) in children younger than eight. There are additional challenges of PCS assessment in younger children which are yet to be fully considered. In order to address these gaps, the current research adopted a semi-structured interview approach to PCS assessment with the aims of 1) identifying which PCS differentiated children with mTBI from trauma controls in the acute stages of recovery, and whether these differed among pre-school and school-aged children, 2) examining the frequency and nature of PCS and behavioural outcomes, across a three month post-injury period; and 3) investigating the relative influence of child, family, and injury factors on both acute and persistent PCS. Participants were 101 parents of children aged 2 – 12 who presented to a hospital Emergency Department between November 2012 and February 2015, with either mTBI (n = 46) or superficial injury to the body (trauma control (TC), n = 55)).
   Adopting a prospective longitudinal design, PCS were assessed in the acute stage post-injury (<72 hours) and re-assessed at one week, one month, two months, and three months post-injury. Children’s behaviour, sleep, and levels of parental stress were also examined at baseline and re-assessed across the post-injury period. PCS burden peaked in the acute stages post-injury, where children presented with a different profile of PCS following mTBI from that evident in children with superficial bodily injuries. In most children, PCS reduced significantly from 1 week to 1 month post-injury, but persisted in a greater percentage of children with mTBI (18%) than trauma controls (5%) up to 3 months post-injury. These were characterised mostly by behavioural and sleep-related symptoms. Injury characteristics remained the strongest predictors of PCS across the post-injury period, but their association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Early intervention which addresses family stress, in addition to providing education and recommendations for cognitive/physical rest, may minimise longer-term complications in this population. Study findings suggested that the method of assessment may influence reporting of PCS by parents; thus future studies could systematically compare methods of eliciting PCS in children following mTBI.