Understanding Traumatic Brain Injuries in Children: Symptoms & Implications

0:00:06 - Kiley Como
Hey everybody, welcome back to another episode of Mind Matters: Navigating Head Injuries and Concussions. As part of our concussion and brain group, we've got today one of our attorneys, John Mobley, with us. My name is Kiley Como. I'm sitting in for Shane Smith today. A little bit about me. My background is a registered nurse. I spent many years at the bedside in area hospitals working in neurological intensive care unit settings, so it's a particular interest to me. But let's get going and talk a little bit more about traumatic brain injuries today, John.

0:00:37 - John Mobley
Yeah, absolutely Kiley, thank you so much. So one of the things we want to kind of go over today is exactly what you mentioned how TBIs affect young children differently than adults. And so just to give kind of some background information, we've done a lot of these series on brain injuries but just to refresh anyone watching, is that you know, TBIs are typically acquired injuries that impact the brain, either from penetrating injuries, car crashes, impacts like that, or even birth injuries. We see that as well with pediatric cases. Hypoxic injuries is what they're called, deprivation of oxygen.

The functional impact of brain injuries on children can be a lot more difficult to diagnose and the reason is, is because when we have brain injury patients, clients, victims, we look a lot at who they were before the accident, what were they capable of before the accident, what their symptoms were before the accident, and then we compare it to what they can no longer do after the accident, any sort of deprivations or reductions in their abilities.

We've discussed this on previous podcasts, but you know the brain injuries can impact your memory, can give you dizziness, vertigo, ringing in the ears, cognition reductions, so your ability to focus, be productive, do work. Well, unfortunately, when we have young children, really young children, we have none of that objective before information. Because they're young babies, you know they don't have a nine to five job. They haven't even made it to grade school yet. We don't know, were they getting straight A's in second grade? We don't know because we're before that. You know they're very, very young. So these things present very unique problems to identify just the severity and the tier of the brain injury. Some of the things that help us to determine and classify with adult brain injuries like mild to moderate to severe, here it becomes a little bit more clouded with very young children and that presents a very unique problem and set of difficulties in these cases.

0:03:01 - Kiley Como
That's an interesting introduction. I think you mentioned something that I think is kind of fascinating and just makes it that much more difficult with children. You know, here you and I are having this conversation about some complex stuff. You know we have the vocabulary to do it, but kids they don't have that right? So it's tough to diagnose and truly understand, lLike you know, how do you get a child to talk about ringing in their ears or how they're feeling at night and that sort of thing? So it can present a challenge to really digging into those kind of symptoms. I'm sure as an attorney you probably have to dig a lot deeper with families, guardians, that sort of thing to really understand that, right?

0:03:35 - John Mobley
That's exactly right. And that's a great point is that, you know, when some of these children are pre-verbal, how do you even get them to tell you what their symptoms are? How much stuff goes undiagnosed? And you know, these are some of our most cherished members of society. Anyone that has kids knows this. So it's really something that keeps you up at night and it's something that keeps us attorneys representing these clients up at night too, because we want to make sure that the correct doctors and correct specialists, like any parent would, gets involved in the case, because you have to go to some extra lenghts when you have a brain injured child who can't communicate what's going on. And, as we know with some kids, you know they just tough it out or they don't even know that something's wrong with them because they can't articulate that. They can't communicate that, and it's really heartbreaking.

0:04:26 - Kiley Como
So how frequently do you see this sort of thing then?

0:04:28 - John Mobley
The data on TBIs in car crashes is astonishing. There's some studies that put it as high as 30 to 40 percent of all motor vehicle accidents result in some degree of brain injury. That can range from concussion to post-concussion syndrome, mild TBI, which is a mild traumatic brain injury. And don't be confused, the word mild brain injury is not mild at all, and it means that person has a huge, huge impact and huge difficulties that they're going to be experiencing in the future. To moderate brain injury, which is the more severe, and then a severe brain injury and up to death. So these things are very common. In terms of prevalence, you know, in the United States some studies have that, you know, children in the 0 to 4 year range had the highest annual rates of TBI related emergency room visits, a large number out of every 100,000 reported. And then after that, adolescents aged, you know, 15 to 19 were kind of the next big group or demographic that reported brain injuries.

And you know, you- all these numbers you have to take with a grain of salt because they are vastly underreported, vastly underreported. And that is widely, widely accepted in the medical community that some people just don't understand that they've sustained a brain injury and that's why you know, really, us kind of sometimes doing these podcasts and just getting the information out there is so crucial so that people can really identify the injury and know that, hey, it's not that just something's all of a sudden not wrong with your body, it's that you had trauma to your head and now you know you are a different person or you are- these symptoms you're experiencing have a root cause, which is the brain being injured.

0:06:20 - Kiley Como
Yeah, amen, it's a complicated landscape, for sure, traumatic brain injury. Sometimes you don't even see it right away, right? I mean these things creep up on us after weeks, days, weeks, even months sometimes. So it's really a waiting game with some of that, I'm sure.

0:06:33 - John Mobley
That's exactly right. And you know that's a key point to brain injury and just having a better understanding of it, is that it is not a one and done event. It's not like you bumped your head or that car rear ended you and you hit the steering wheel and then hit your head and then you know that was the injury, like you know if you broke your arm. It is actually a chronic and progressive disease. That's a better way to kind of understand brain injuries and that you hit your head and now, as testing and in medical studies and knowledge have really evolved in the past few decades, we see that having a brain injury just affects all sorts of things. Hormonal changes, changes in, that we didn't previously understand, in brain chemistry, changes in, in what we talked about before, some of the symptoms. And these things, if they last beyond six months, it's unfortunate, but the studies also show that that can be permanent changes. So we're talking about a lifetime of difficulty. And to bring it full circle to what
we're talking about here today about pediatric TBIs is these are young folks that just started life.

Yeah right, it's, it's, and that's the heartbreaking nature of it, is that they just started life and we don't even know what was, what they could have been, or what was taken away from them. Right? And then we find out that you know they may have to, if they lived to the, you know, government-predicted age of mid-80s or you know, high 70s, then they're gonna have 70 to 80 more years dealing with, you know, the potential symptoms or the reduction of who they could have been. And it, it's- this is why, when we get these cases, they're are some of the most serious cases we take on as a firm, because, and, and jurors resonate with this as well, and it's just, they're very tough cases. So we take them very seriously here at the firm.

0:08:35 - Kiley Como
Alright, so now let's kind of dig down into the meat and potatoes of, let's talk about some signs and symptoms of traumatic brain injury, especially with with pediatrics. So what might we see?

0:08:44 - John Mobley
There's a long list of pediatric symptoms that we kind of use to decode if the injury has occurred. Now, this is typically paired with testing that can be done and we've spoken about that on previous podcast, about just some of the amazing, amazing technological advancements in the medical community that we've made in recent years through diffusion tensor imaging, which is very, very high-powered imaging that can literally trace the flow of water through the brain, where we can identify exactly which portion of the brain was injured. There's huge advancements being made in blood tests, or we might be able to see if there's, as we previously spoke about, there's hormonal changes that occur when the brain is injured and that can be reflected in the blood. So those are some of the tests too, in addition to like a CT scan, which is only going to pick up really bad brain injuries and then it'll be clear anyways. So if the test is not available for whatever reason, or it's not ordered, then we go to the next best
thing, which is looking at the symptoms, okay? Because when you injure your brain, typically it manifests in the body in other ways.

So you know, we will see with children commonly a large list of things. They could experience changes in their bowel and bladder function, changes in their level of consciousness, ranging from, you know, a brief loss of consciousness to a full coma or worse, dizziness. So if anyone's ever had a very small child, sometimes- I personally have a small child as well, they may appear dizzy, so it's hard to really identify that symptom, but there are special tests that are done that can identify levels of dizziness, balance and things of that nature. A little bit harder in a small child, though. Another thing that we see is, that can impact it, is fatigue, so if the child had previously high energy levels and now seems kind of withdrawn out of it, disassociated, these are all things that really a good support structure and parent can identify so that they can report back to the medical professional. And that goes for any of the symptoms we'll discuss here today is, you know, we always encourage our brain injury
clients or their support staff, so that's a spouse, parent, cousin, even a good friend or significant other that you're living with, to help us by, and help the client, by keeping a journal of these things and identifying symptoms and seeing what the person is like on the day-to-day basis, especially if they knew them before the accident. In the context of speaking with small children, of course the parent's going to know the child best. So really they're the first line of being the great historian to communicate that information both to us, the lawyer, and to the doctor. And what that means is that we can just get the best possible care and identify all that stuff.

You know, another thing to point out is that some of these children may not present with immediate effects of the TBI, and that's the big kind of scary thing here is that it may show up later and you see the challenges that this child would not otherwise had.

And it doesn't show up until later development. And particularly we see where maybe that brain injury is causing issues years down the road, once they reach some of the more rigorous demands made by, in the academic setting. So like school. Maybe they seemed okay as a small child when they were just around the house doing baby things or young child things, but then once they have to start doing reading, comprehension, math, then that lack of cognition really starts to show itself and we don't see it until years later. So a lot of times with our very young pediatric clients, if we have any sort of academic history, that's a great way to see who they were before and who they are after. And if they're too young to even be in an academic setting, then we just don't have that and we have to really look at other things in order to know the severity of the brain injury.

Some of the other difficulties, Kiley, that also will present themselves is, you know they'll see issues, and we spoke about educational issues, but also vocational, it'll, the brain injury young will also affect their vocational outcome later on in life. It will have social issues, like you know, their ability to make and maintain friendships, participation in, you know, home, school and community overall. So it really, we will see a huge reduction in all the things that what we would deem the quality of life. And that's why these are some of the biggest verdicts out there. The biggest settlements that a lot of firms do is brain injuries, but even more so pediatric brain injuries, because a lot of times when we're valuing a case we're not looking at just hey, what sort of you know bills, and medical bills and costs and expenses has the client incurred to date, but we would also be presenting to a jury future damages, future needs. Depending on the severity of brain injury, I've had life care planners with
some of my clients say, "This brain injury is so bad, they're eventually going to need an in-home assistant." $80,000, $100,000 a year. A YEAR. So, and that's just one portion of it. And then you know, additional follow-ups, your hearing and vision can go if you have a brain injury. So you think about a young child who then has, you know, potentially over a hundred lifetime visits to an audiologist or an eye doctor, and we've got to include all those things. So we really, really, really lean heavily on certified life care planners in these types of cases and situations to fully map that out. And you know, this is just one of those things where you have to be so thorough and document everything and make sure that the right medical treatment is occurring, because anything missed could, you know, really be leaving something on the table for, you know, the potential recovery for the young child. And these are all decisions that parents have to make. To get back to some of the symptoms, we also see impaired
movements, impaired balance, impaired coordination. And that might not sound like much on paper, but you talk about being what they deem a fall risk. Think about it. I mean, how much does it cost if you fall and break your hip? A lot, and if you now have bad balance for the rest of your life, bad movement, can participate in sports? Are you going to fall down more than if you had not? These are very, you know, hard things to make seem tangible to people. So it's our job as the attorneys to explain just what that means on a day in, day out basis for someone, both from a future pain and suffering standpoint to a potential medical risk. These are scary things when you actually start thinking about the day to day implication of it.

Another thing that we see sometimes in pediatric TBIs is nausea. You know a lot of our clients, when they get into a motor vehicle accident they will sometimes vomit or be nauseous on the scene, literally vomit, and they don't know what's happening. Well, that is a clear sign that you hit your head and had some sort of brain injury. A very, very common thing. It means you not only sustained a brain injury but a somewhat serious one, so that's a great way to tell. We hear a lot of some of our pediatric clients involved in accidents that they, you know, were nauseous or threw up and that might be the only symptom we have. But that's an immediate red alert that we need to make sure that they get screened for a brain injury.

Pain is another one. Headaches is one of the most common things, and that's a hard thing for a young child to explain, they have a headache. In a very young pediatric victim or client it might just present as crying. You know, we don't know. They can't communicate that they have a headache. It can also- some of the other physical symptoms we've seen are seizures in very serious cases.

Another category that gets impacted is what's called the sensory perceptual category. And that can be things like dizziness, vertigo, imbalance, hypersensitivity to sounds or light. One of the classic brain injury symptoms is hypersensitivity to light. We see a young client squinting or having trouble adjusting. We know that that may be a symptom that needs to be recorded by the parent or whoever is taking care of the victim and then immediately communicated to the specialist, which is typically a neurologist, but it can vary.

Another thing that we see is tinnitus. Tinnitus, tinnitus. Pronunciation is up for dispute in the medical world, but it's a big word that basically means ringing in the ear and what it can do is impact your ability to pick up sounds. So people, a lot of people that have worked, we see it a lot with some of our older clients actually, who have spent long careers, you know, on the railroad or loud sounds, or construction, and or you know some of, unfortunately, some of our military veterans will have reduced hearing in tinnitus. And what it does is that, you know, if you've ever had someone you know that is afflicted by this, they have trouble picking up small nuances and conversations when they're out in a noisy restaurant. It just, they can't pick up certain sounds.

It also impacts your sleep. And they say is- leads to depression, because when you have the constant ringing that's described as this just nonstop, incessant cicada sound in your ear, or ringing that it's- it really can impact your quality of life. And luckily there's, there are now some objective tests for that, which is just wonderful for small pediatric clients who have sustained a brain injury, because you know, of course, they couldn't communicate or even understand what ringing in the ears is. So to be able to test it is a very exciting advancement in our ability to diagnose TBI symptoms in young clients. Because you know, until they can become verbal and communicate what's happening to them, you know they may not be able to explain that, hey, I'm having this tinnitus or tinnitus. Another category that we see impacting our young clients is the visual category. What that means is that some clients, when they sustain brain injuries of a certain degree, will have changes in their vision, or what we call
disruptions, and what that can mean is, is that you may see double vision in very bad cases.

And anyone's ever had double vision, know that that is enough enough to make you impaired or get an impairment rating that can impact your ability to do anything, let alone just live. Another thing would be blurred vision, or seeing spots. What they say sometimes, when you have a, what's deemed an abnormal nystagmus, is basically you know you can see fluttering or your ability to focus on an object, tt's impacted. This is a very hard thing to identify in young, very young clients, pediatric clients.

So what we typically do, a doctor that we like to have quote, quote, quarterback, a pediatric case is there's not only ophthalmologists, but also neuro-ophthalmologists, which is a doctor that specializes in, you know, vision issues after you sustain a brain injury. And getting to the right doctor is imperative. Sometimes you know we'll have clients that come to us late in the game and you know they will have been seen just a normal eye doctor because they're, like my vision's messed up. And sometimes they even forget to tell that they're in a motor vehicle accident and we're like, unfortunately, these vision symptoms started after your accident and that really needs to be what needs to be focused in on. And you might not even be at the right type of eye doctor.

You might need to be at a neuro-ophthalmologist, which is someone, like we mentioned, specializes in, you know, vision changes after a brain injury. So this is the type of doctor that can be included on a pediatric brain injury as well.

0:21:32 - Kiley Como
And that's a lot to look for. I think you know, in my experience as a bedside clinical nurse in the neuro setting, one of the things that always struck me over the years was how brain injuries are so insidious in that you don't see it a lot of times. If it's an open head injury, obviously, but those closed head injuries, you just don't see it. They can, a patient or a client can be sitting right in front of you and you'd never know they had a massive brain injury. And like you've been saying, with children, even more complicated. So it's just being acutely aware and alert all the time. You mentioned having, you know the parents, guardians, you know teachers, you know just everybody on the lookout and just be bold and not let anything slide. I loved your idea about the journal, great idea to keep those little thoughts in because there may be many, and they last, for you know, like you said, months, years potentially. So what a complex landscape that is.

0:22:24 - John Mobley
So you made a great point there and the key takeaway just to build on that a little bit, is that it really takes a village to identify these symptoms, the potential for the injury, and, to you know, get the child the appropriate care they need, because you know you're going to need everyone looking out for some of these symptoms. It's a huge list, and it's one of the things that we really urge clients, if they're on the fence about getting an attorney or not, there's no question. In a pediatric TBI case, you need to consult attorney because the landscape is just so complex, so in depth, that we want to make sure we're not missing anything.

And the parents not missing anything, because no one wants their child to, you know, be beginning life starting off on a wrong foot or difficult in, in these TBIs that impact them can cause that to happen. But they can be mitigated and they can be improved upon, and with the right treatment and therapy, the symptoms can decrease, hopefully. So getting in sooner rather than later is always the name of the game.

0:23:29 - Kiley Como
All right, John, thanks so much. That's all the time we have for this episode. There is so much more we want to talk about, so make sure you come back for our next one when we dig in a little bit deeper on pediatric traumatic brain injury. So if you just wouldn't mind, hit like, subscribe to our channel, come back next time and just remember: if you're in pain, call Shane, 980-999-9999.

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