Baltimore's Child Baltimore's Child
The Hearne family was returning home from prekindergarten with their 3-year-old son when the unthinkable happened. A stumble on the sidewalk sent Emmett flying 5 feet from his father’s arms. He landed headfirst on the concrete.
Emmett had always been an active child. He loves to climb on play structures such as swing sets says his mother, Kristin Hearne.
“Your mind always thinks that it’s going to happen somewhere like that,” she says of his fall, but “this was just like a normal day … there was no risk really.”
Stories like these are all too common. According to Stanford Children’s Health, more than 2.2 million children ages 14 and younger are treated for fall-related injuries annually.
March is Brain Injury Awareness Month. Dr. Kalina Hurley, Ph.D, a pediatric neuropsychologist at Mt. Washington Pediatric Hospital, breaks down what parents should know about traumatic brain injuries.
What’s a TBI?
Traumatic brain injury is the umbrella term for any alteration in brain functioning from a head injury, but 80% are mild—commonly referred to as concussions, Hurley says.
Many head injuries are a result of household falls. Children who are not walking yet tend to fall off the bed or changing table. As they get older and more active, they are falling off furniture, jungle gyms and bikes.
Most occur in ages 4 and younger.
“At that point, they’re just less coordinated,” Hurley notes. “They’re a little bit top heavy too—their heads are bigger.”
This ratio changes as they develop and they become more balanced.
Symptoms for mild head injuries can be easy to miss. Some can show up hours or days after a head injury. Keep an eye out for symptoms such as headache, sleepiness, sensitivity to noise and light and irritability.
A good immediate indication is brief amnesia before and after the fall.
“Those are good questions to ask if your child has a head injury: ‘What happened right before you hit your head? What’s the first thing you remember after?’”
A longer loss of consciousness can be indicative of a more severe injury.
When Should I Go to the Hospital?
Not all head injuries warrant ER visits. The signs parents should look for that signal an ER visit is needed are sudden changes in functioning, such as confusion, loss of consciousness or memory, and difficulty with balance, Hurley says.
Emmett’s fall was more dangerous than the Hearnes could have predicted.
As someone who worked in Emergency Medical Services (EMS), David Hearne knew the swelling in Emmett’s head was a concern, but his diagnosis came as a surprise.
With a skull fracture inches from a major blood vessel, the experience left Kristin with her biggest takeaway: “Don’t hesitate with head injuries.”
For milder symptoms of headache or trouble focusing, doctors might recommend a concussion clinic, where children can undergo testing for cognition and balance and expert advice on how to return to school and sports.
Mt. Washington—which celebrates 100 years this year—followed up with Emmett at its clinic as well, since he was also recovering from a concussion.
“He definitely had a lot more sensory symptoms than we expected,” Kristin says, noting difficulty with lights, noises and certain movements for about 6 weeks.
Although he improved every week, “we also were concerned that there could be things we were missing too.”
Despite the commonality of falls at such a young age, data and equipment is best suited for children ages 5 and older, and it can be difficult to find a clinic, Hurley notes.
Road to Recovery
Protocol for concussion treatment has evolved over the years.
“Before we were having kids, (it was) lie in a dark room for the first couple of weeks,” Hurley says.
Now it’s more about paying attention to how your brain reacts to activities. If something is too overstimulating, she says, take it down a notch.
Emmett was allowed to watch TV if it would keep him still. Hurley says it’s very important to minimize second head injuries, especially before the previous one has healed, because that’s when accidental deaths can occur.
No two patients are alike and recovery can vary widely, Hurley says. Explaining differences in behavior to peers or the need for temporary accommodations to teachers can reduce stigma—brain injuries do not always have visible symptoms.
Although falls such as Emmett’s are unavoidable, many household falls can be prevented.
Two parents might not think about preventing falls beyond securing furniture to walls so that pieces cannot fall on children who climb on them and installing window protectors. Many children lean on window screens and do not realize they are not sufficient barriers.
Some falls can happen, but they may not all cause brain damage.
Ultimately, Hurley says, it’s about balancing good judgment with “letting your kid be a kid and have fun.”
