Children cheerful and smiling in diversity. A GUIDE TO POSSIBLE CHANGES AFTER BRAIN INJURY FOR YOUNG CHILDREN AGES 7 AND UNDER This guide was designed to help parents and caregivers watch for changes that may follow a brain injury in young children. Changes after brain injury may happen even years after a child’s treatment ends, whether they completed rehabilitation, stayed at the hospital, etc. This guide addresses changes and gives tips for keeping your child’s brain healthy throughout their life. Keep this guide handy in case there are questions or concerns. You may never need this, but it will be helpful if your child does develop challenges. OUTCOMES AFTER BRAIN INJURY REHAB ARE DIFFERENT FOR EVERYONE THEY WILL DEPEND ON MANY THINGS INCLUDING: Girls Hug while sitting in the park in the grass and sunshine. Injury severity/Types of changes Support from family Mental health (depression, anxiety) Age at the time of injury Complications (infections, seizures, other injuries, etc.) Funding for rehab/Length of rehab/Willingness or ability to participate in rehab Assistance with transitioning from hospital to home and childcare/school As they get older: Motivation to improve, ability to adapt to changes and support from friends There is no cut-off date for brain injury recovery. Improvement happens quickly for some children and more slowly for others. Some children may have negative changes over time as they develop. The choices you make for your child today can prevent some of those. Positive changes can continue throughout life. THINGS TO WATCH FOR IN YOUNG CHILDREN - First weeks or months after injury Expect the best, plan for the best...but be armed with knowledge. Once your child comes home, their physical injuries may heal quickly, but they may continue to struggle in other areas like remembering and learning. Changes in these other areas can be hard to see if you don’t know what to look for. Your young child can’t tell you areas where they need help. Watch for changes in thinking, behavior and slower development. Consider whether the following types of problems may be related to the injury. Be sure to tell your child’s doctor if they have any of these symptoms: Changes Watch for these Changes Since Injury Specialist Emotions/Feelings Irritable/fussy, crying or tantrums, sad/depressed, more nervous, change from happy to tantrum quickly, have trouble calming themselves, upset and you can’t tell why, hard to adjust to new situations, feeling overwhelmed or alone Counselor, Psychologist Sleep Sleeps more or less than usual, tired during day, trouble falling asleep, wakes often at night, wets the bed, nightmares Pediatrician, Neurologist Appetite/Food Eats more or less since injury, stomachaches Pediatrician Cognitive/Thinking Thinks slowly and reacts slowly, has trouble putting things in order, harder to concentrate, forgetting Neuropsychologist, Speech Language Pathologist, Occupational Therapist Development/Progress Struggling to learn new skills, needs to relearn skills like: using a spoon, tying a shoe, potty training, counting, handwriting, typing Occupational Therapist, Physical Therapist, Neuropsychologist Play Less interested in toys or books, can’t stay on task playing, struggles with how to use/play with toys, doesn’t pretend play like other children their age Speech Language Pathologist, Occupational Therapist Social/Friends/Behavior More hitting, pushing, taking toys, less sharing, harder to make friends, withdrawn, clingy Speech Language Pathologist, Counselor, Behavior Specialist Flexibility/Changes Upset by changed routine, schedule or people Behavior Specialist, Neuropsychologist Language/Talking Difficultly naming objects, understanding directions, telling stories. Using shorter sentences than before injury. Speech Language Pathologist Physical Headaches, dizziness, head or neck pain, tightness, weakness, balance, visual problems, reduced stamina, fatigue, sensitive to lights and sounds, seizures Pediatrician, Physical Therapist, Neurologist, Chiropractor, Neuro-Ophthalmologist THINGS TO WATCH FOR AS THEY GROW Watch for any problems as your child grows and goes through preschool, elementary, middle school and high school. Of course, all children have difficulties at some point. Not all will be caused by the injury. In adults, it can be easy to see changes, but it can be harder to notice problems in a child because they are still changing and developing. Brain injury can affect new learning and skills during brain development. It is still important to remind the child’s school and doctor about the injury every time a problem arises and to be aware that the injury may be causing what you see. If your child has special services at school, include him/her in the process as their age allows. Ask them what they need, what could help and encourage them to speak for themselves in planning adjustments. You can learn more from Support and Training for Exceptional Parents: https://tnstep.info. Academic (School) Problems: Falling behind in class, difficulty learning new information, putting off schoolwork, forgetting homework, leaving items behind at school, trouble saying or writing what they mean. Social Problems: Losing friends, difficulty making new friends, not knowing how to act or speak in different situations, not understanding facial cues or social skills (like knowing it is time to end a conversation or that they are making someone uncomfortable), acting younger than their friends, laughing or crying too easily. Portrait of three children making glasses with their hands while sitting on the floor. Behavior Problems: Not acting like themselves, getting into fights, acting without thinking, making poor decisions, making inappropriate sexual comments, using abusive words or tone, letting friends talk them into doing the wrong things, letting others mistreat or abuse them, alcohol or drug problems, taking risks, trouble with the law. Physical Problems: Pain, a physical change from the injury that gets worse, sleep changes, coordination changes like: trouble learning to tie shoes, handwriting, riding a bike or kicking a ball. Mental Health Problems: Becoming depressed or anxious, difficulty coping with change or handling stress, worrying and not sleeping, pushing friends and family away, spending too much time alone, doing things to hurt themself, feeling stuck or unmotivated, developing addictive behaviors like: overeating, overexercising, fasting, drugs or alcohol. Suicide is the second leading cause of death for ages 10-34. Subtle Warning Signs of Suicide in Children: https://www.healthcentral.com/condition/depression/children-and-suicide?legacy=psycom General Suicide Warning Signs, TN Dept of Health: https://bit.ly/3TwVB8U Facts About Suicide, CDC: https://www.cdc.gov/suicide/facts/index.html How to Recognize Signs of Mental Health Problems and Teen Suicides, Kidcentral: https://bit.ly/3KT0ZOcMentalHealthTeenSuicide CDC Relationships: Struggling to keep healthy relationships with family or friends; being very needy; being verbally, physically, emotionally, or sexually abusive in a relationship; being a victim of an abusive relationship. WHAT TO DO IF YOU SEE CHANGES IN YOUR CHILD What you do depends on what you see happening. Teach A Skill: The child may just need to learn or relearn how to do the things that are difficult (tying a shoe, starting or stopping a conversation, learning how to do a type of math problem or learning how to use a computer or device). They may need extra time to learn, repetition of directions or to be shown how to do it. Teach A Strategy: A strategy is a way to do something that is hard in a different way. For example: using a thick crayon to help coloring, using a brace to help with pain or weakness, sing a song to remember new information. Use All Senses (multisensory): A child may need to learn using more than one sense (like including vision or touch) to help them do a task. Use a schedule made with pictures, a timer, or picture cues (for example, place pictures for all of the steps to brushing teeth above the bathroom sink). Talk To The Daycare Provider: They should share what works with elementary school teachers and support people (counselor, school nurse). They may have faced the issue your child is having before and they may have suggestions to help. Talk To The Teacher: The teacher can help figure out what to try in the classroom or next steps within the school. Options might be extra help, a tutor, a 504 Plan or an IEP (Individualized Education Program). If your child does not qualify for services now, it does not mean that they won’t in the future. You can also get help privately if your child does not qualify for services in school. If your child uses or does something at home that helps, share that with the teacher. Seek Symptom-Specific Treatment: Get treatment for your child’s specific symptoms. Treatment can be helpful even years after an injury. Demands in your child’s life can change. These changes can make it a good time to get a “tune-up” and find a new specialist that fits their symptoms. If you are not sure who to go to, you can ask your child’s doctor. Talk about the injury and changes since it occurred. Ask to see a specialist (see chart on previous page). It is best to see someone who understands brain injury. Stay Positive: As your child grows, always help them understand their strengths and weaknesses. When pointing out a weakness, include something positive or show them a way around it. For instance, “I like that you made your bed. I notice that sometimes you forget to put things away, but when you use the check-off list, you do a great job!” Happy children in a classroom Check adjustments often to see if they are still working or if they need to be changed. COMMUNITY SUPPORT Get Support: It is important to find support for your child, their siblings and yourself. Start with people who understand brain injury like the school or hospital social worker, school counselor, local counselors and psychologists, and your child’s neuropsychologist. They can help you get resources for you and your family. Find options for support at Kidcentral TN: https://bit.ly/33TgDIUChildwithDisability Disability information and resources at Tennessee Disability Pathfinder: https://www.tnpathfinder.org/ For brain injury support groups in Tennessee: https://www.tn.gov/health/health-program-areas/fhw/tbi/contact.html There are also in-person and virtual support groups for specific symptoms like seizures, decreased balance and migraines. It may help to think outside of the box, like looking for a support group for similar types of symptoms or experiences to connect with other children, siblings and parents. Children having a playdate and playing with colored blocks. Keeping supportive people in your family’s life is very important. • Schedule play dates. • Stay connected to friends in person, by phone or computer apps. • Meet and connect with other people through church, scouts, classes, lessons, volunteering. • You can also find private Facebook or social media groups that focus on brain injury or specific symptoms. KEEP YOUR CHILD’S BRAIN HEALTHY Keeping our brains healthy is important for everyone, and it is extra important for people who have had a brain injury. A bowl of colorful berries • Eat healthy foods • Get exercise • Get enough sleep • Do not smoke, vape, drink alcohol or use drugs • Be social • Keep learning • Take care of mental health • Avoid another injury - see below. Be a good role model with your food choices, exercise and relationships. To take control of your brain health, visit https://www.tndisability.org/brain-health. PREVENTION Preventing another injury is very important. Brain injury survivors have a higher risk for another injury. Talk to their doctor to plan a safe return to the classroom, playing, physical education, and sports. Make good decisions about social interactions and safety. Avoid rough sports and activities. With any activity, think first about how to avoid another injury. Children should always wear a helmet when needed and always wear a seatbelt. FREE RESOURCES Tennessee Resources Tennessee Traumatic Brain Injury Service Coordination Program: https://www.tn.gov/health/health-program-areas/fhw/tbi/support-groups.html help with referrals, insurance issues and more Dial 988 for the Suicide & Crisis Lifeline or you can text to 988; 988lifeline.org to chat with someone. Concussion and Brain Injury in Students: Who needs to know? https://bit.ly/3ZzX4io Brain Links: https://www.tndisability.org/brain Family Voices of Tennessee: https://www.tndisability.org/family-voices-tennessee families supporting families of children with special healthcare needs, chronic illnesses or disabilities Kidcentral TN: https://www.kidcentraltn.com find parenting tips, track child milestones and more School and Work Resources Tennessee Early Intervention Services (TEIS): https://bit.ly/44mvojv provides services to children birth to age three who have disabilities or other developmental delays Support and Training for Exceptional Parents: https://tnstep.info helps parents with support and training for a child’s educational needs Center on Brain Injury Research and Training (CBIRT): https://cbirt.org/ helpful school resources for families and educators National Resources Brainline: https://www.brainline.org/ information on living with brain injury Brain Injury Association of America: https://www.biausa.org/ national resource on brain injury Psychology Today: https://www.psychologytoday.com/us/therapists/traumatic-brain-injury find a local counselor/therapist 6/2025 REV Originally Published 2/2022