New tool could make it easier to detect concussions in toddlers
A new tool being developed by researchers at the CHU Sainte-Justine could make it easier to identify concussions in young children, who may not have the words to explain the extent of the pain they are feeling.
"The tool is an inventory of all the different ways a young child could feel pain after suffering a concussion," said neuropsychologist Miriam Beauchamp. "It aims to address the lack of information we currently have to analyze the side effects in young children."
Concussions can cause cognitive symptoms, such as problems with reasoning or concentration; physical symptoms, such as balance or sleep problems; or behavioural symptoms, such as impulsivity, irritability or anxiety.
However, a child under the age of five may not have the vocabulary they need to describe what they are feeling to answer questions from adults.
Beauchamp and her colleagues collaborated with the emergency department at CHU Sainte-Justine, as well as parents and caregivers whose children have suffered a concussion.
"When you think of a child (up to six-years-old), when you talk about symptoms like headaches or loss of balance, you might wonder how he's going to tell you he has a headache," she said. "Even at three or four years old, the concept of having difficulty concentrating or feeling dizzy can be extremely difficult for a child to explain to their parents, to say they are not feeling well. Children of this age will rarely explain it so clearly."
A child who holds his head in his hands or rubs his forehead may have a headache; a child who abandons a drawing or a craft may have difficulty concentrating; a child who has lost weight or refuses dessert may feel nauseous.
"The big challenge in this area of research and clinical practice is that at a young age, there are also some behaviours that are completely normal," Beauchamp said. "A two-year-old who is irritable could be a perfectly healthy child. We have to be able to distinguish between what could be a consequence of the injury and what is not, so the tool will allow us to do that too."
Part of the practice, Beauchamp continues, requires observing the child in his or her environment.
The checklist will not only be for health care personnel who receive the child in the emergency room, but also for parents and daycare staff.
'Documenting these symptoms is the cornerstone of managing and intervening to improve the outcome of concussion at any age," she said. "But if we don't know what the symptoms are in young children, how can we manage them effectively? If we don't know what they're experiencing, we don't know if they're getting better."
Traditionally, it was thought that head injuries in children this young were less damaging, as the plasticity of the brain allowed them to recover quickly.
This is not entirely untrue, says Beauchamp, noting some children who have suffered head injuries have made miraculous recoveries, "but there is no reason to believe that a brain injury at a young age would be any less harmful to a young child than to a school-age child or teenager, for example."
When you disrupt brain function at a young age, she explains, you can also disrupt language learning, motor skills and social skills.
"When the brain reorganizes, it does not necessarily reorganize well," she warns. "We tend to say that brain plasticity is a positive thing, but it can also lead to changes that are a bit out of line with normal development."
Once completed, the tool will be shared with hospitals in Canada and the United States, who will, in turn, share their data with researchers at Sainte-Justine.
This will allow researchers to better understand how concussions in toddlers manifest.
"Eventually, we will be able to better understand the impact of a concussion at a young age," explains Beauchamp. "Is it the same as in older children? Is it worse? Is it less serious? It could be, but without a tool like this, you can't really compare the experience of young children with older children."
The findings have been reported in the medical journal, Journal of Head Trauma Rehabilitation.
-- This report by The Canadian Press was first published in French on June 1, 2021.