ABI – The life-changing effects of child brain injuries

It is possible for a child to suffer an acquired brain injury at any age, including during pregnancy, during birth and immediately following birth.

ABI during pregnancy

An ABI sustained by a baby during pregnancy is most often due to either a partial or complete occlusion of oxygen. Oxygen starvation of the baby, also known as birth asphyxia or perinatal asphyxia, can happen for several reasons:

• Trauma to the mother may threaten the blood supply to the baby

• If the placenta separates too early from the uterus, known as placental abruption

• The umbilical cord may prolapse prior to or during birth

• Preeclampsia

The nature of the ABI sustained by the baby will depend on whether the oxygen starvation is partial and complete, and at what stage of development the starvation occurred. Different areas of the brain will be affected based on both of these factors, which will have different ramifications on a child’s physical, psychological and behavioural development.

When examining the MRI of a child with an ABI, a paediatric neuroradiologist should be able to assess at what stage of development the oxygen starvation occurred, how long the baby was without oxygen, and whether this was due to a complete cut off of oxygen, or an ongoing, chronic lack of oxygen.

This information can be crucial to determining if the oxygen deprivation was overlooked by healthcare professionals during monitoring, which could make them liable to a birth injury claim.

ABI during birth

An ABI can also be sustained as a result of birth trauma. For example, if an obstetric emergency such as shoulder dystocia occurs, this can cut off a baby’s oxygen supply while they are stuck in the birth canal. Depending on how long the baby is oxygen-deprived, this can cause substantial injury to the baby’s brain.

Similarly, the umbilical cord can become wrapped around the baby’s neck during birth, limiting its ability to breathe. Again, this can result in an extended period of oxygen starvation.

For more on the impact of oxygen starvation before and during birth, you can read more in this helpful article.

ABI after birth

It is possible that in the immediate period following birth, a healthcare professional could fail to recognise the symptoms of conditions such as hypoglycaemia or a pneumothorax. Certain metabolic disorders also only become apparent after birth.

If these conditions are not identified by a healthcare professional, they have the potential to cause brain damage to the affected baby. In these circumstances, it is possible that the injuries sustained would be due to medical negligence.

Brain injury effects can be difficult to predict in the long term, as injuries will impact different children in different ways. Due to the vast number of functions that the brain is responsible for, the location and nature of the injury can have one of many diverse outcomes, ranging from mild difficulties to profound challenges.

Physical effects

An acquired brain injury can lead to a range of physical complications, at varying degrees of intensity. While each situation is unique, common physical consequences include:

• Physical and mental fatigue

• Vision and hearing difficulties

• Lack of balance and coordination

• Limited mobility

• Loss of bladder and bowel control

• Restricted growth

• Children suffering from seizures or epilepsy

A brain injury prior to or during birth can also lead to a child developing a condition like Cerebral Palsy. Depending on the extent of the injury, this can range from the injured person having mild coordination and mobility problems, to being completely confined to a wheelchair and having difficulties breathing and swallowing.

Depending on the extent of the physical limitations, a child may require several aids, adaptations and therapies to live as comfortable and fulfilling a life as possible, such as:

• Wheelchairs, rollators, scooters and other forms of mobility aids

• Assistive technologies

• Home adaptations, such as wet rooms, hoists, stairlifts, expanded living areas, covered garages, storage space, sensory rooms and therapy rooms

• Physiotherapy, hydrotherapy, speech and language therapy, occupational therapy, etc.

• Ongoing treatments and surgeries

Intellectual effects

An ABI can also affect a child’s cognitive and learning abilities to varying degrees. Common intellectual and educational consequences can include:

• Reduced speed of processing information

• Reduced attention and concentration

• Limited memory

• Reduced speaking and communication skills

• Difficulties organising and planning

A child affected by an ABI may also have a global developmental delay (GDD), meaning that they fail to meet certain development milestones compared to other children their age.

Psychological effects

When a child suffers a brain injury, it is possible that it only affects their body physically and not mentally. However, it is possible that their condition, and their feelings toward their condition, will have a psychological impact on them as they grow older and realise the limitations that they have.

For example, as they become more aware of their limitations, and their inability to do things that their peers can, this can lead to feelings of depression and anxiety, as well as struggles with their own self-image. This often becomes more apparent as they enter adolescence.

Furthermore, there is the risk that they will be subject to ridicule by their peers, or excluded from activities and social gatherings due to their disabilities. Again, this can greatly affect their mood and overall wellbeing.

Behavioural and emotional effects

The potentially profound and life-lasting changes that can occur even in mild cases of ABI can have a substantial impact on a child’s behaviour and emotional development:

• They may not develop a sense of danger, making them more impulsive and reckless

• They may not learn to regulate their emotions effectively, resulting in frequent outbursts of temper or frustration

• They may have a lack of empathy towards others

• They may experience rapid and intense mood swings

• They may consistently repeat certain words, phrases and gestures

• They may ignore acceptable social and moral conventions

These not only impact the affected child, but also have ramifications on their parents, siblings and other family members. They may find it difficult to go out in public with their child, in case they do something that causes a scene.

Furthermore, if the child recognises their differences to their peers, this can create a great deal of bitterness and resentment, and they might use their family as an outlet for this. Again, this can place a significant emotional strain on the child’s parents and siblings.