Introduction
Based on the 2019 Canadian Health Survey on Children and Youth, pediatric head injuries had the highest weighted prevalence of reported injuries among children but the lowest prevalence of injuries for which healthcare professionals were consulted. With traumatic brain injuries ("TBI") being a leading cause of death and disability in children between the ages of one and eighteen, parents must know the signs and symptoms to look for and take reasonable safety precautions to prevent head trauma to their children.
Suffering a brain injury during development presents unique challenges and can have serious, long-term consequences on brain development. Pediatric TBI ("PTBI") can alter the course of brain development, leading to cognitive and physical symptoms that persist throughout a child's life. These symptoms may not be visible immediately but become evident as the individual grows and uses more complex thinking and social behaviour.
Pediatric head trauma may be difficult to diagnose because injuries, such as concussions, are diagnosed and treated based on the symptoms the person experiences and describes. However, children cannot always verbalize their symptoms. Therefore, parents need to be able to recognize the common symptoms of head injuries in children and take the appropriate safety measures to prevent them.
Types of Pediatric Head Trauma
TBI are injuries to the brain, such as bleeding or concussions. Some types of pediatric head injuries include the following:
Brain Contusion
A brain contusion is a bruise on the brain that may occur from a blow to the head or a fall. They can be limited to small areas of the brain with mild or no symptoms. Severe brain contusions can lead to memory challenges, difficulty speaking or understanding language or changes in personality.
Concussions
Concussions are a type of brain injury that results from a blow to the head or body, which causes the brain to hit the inside walls of the skull. The impact causes widespread bruising and/or swelling of the brain. It may also result in several brain contusions.
All concussions are bad. If you think your child has suffered a concussion, here are some of the most common post-concussion symptoms to look out for:
- Headaches
- Dizziness
- Ringing in the ears
- Memory loss
- Nausea or vomiting
- Sensitivity to light and/or sounds
- Vision problems
- Drowsiness and fatigue
- Confusion and poor concentration
Second Impact Syndrome ("SIS")
SIS occurs when an individual suffers a second concussion before the symptoms from an earlier concussion have subsided. The secondary concussion causes the brain to swell rapidly. The second impact does not need to be as strong or severe as the first because the brain is still recovering and vulnerable.
Secondary impact syndrome is often fatal or life-altering. Concussions need to be treated seriously. While allowing your child to return to their recreational activities quickly can be tempting, requiring adequate time for the brain to heal is crucial. It is best to proceed cautiously and avoid activities that may lead to further injury.
Diffuse Axonal Injury ("DAI")
DAI results from a blunt injury to the brain. DAI is the shearing or tearing of the brain's long connecting nerve fibers, which occurs when the brain shifts or rotates quickly. The most common cause of DAI is motor vehicle collisions due to the acceleration followed by rapid deceleration.
The severity varies from minor, which may result in brief unconsciousness, to significant, which may result in a coma, permanent and severe injury, or death. If your child has suffered a DAI, medical treatment is required to reduce the swelling in the brain. Though many people who sustain a DAI suffer long-term difficulties, rehabilitation is possible and can improve an injured person's current symptoms as well as their long-term prognosis.
Intracranial Hemorrhage
Intracranial hemorrhaging is an injury that causes bleeding within the brain and can also damage brain cells. Damage to the blood vessels within the brain causes bleeding, which increases brain swelling. Since the brain is not flexible or able to handle the swelling, it causes further injury.
For a more in-depth discussion of the various types of traumatic brain injuries, take a look at this blog written by Salvatore Shaw and Aidan Vining.
Common Causes
While there is no specific setting in which children will sustain a TBI, certain incidents and activities can put your child at a higher risk. Here are a few of the common causes of TBI in children.
Motor Vehicle Collisions
Motor vehicle collisions are one of the leading causes of injuries to children in Canada, despite routine use of car seats and restraint systems.
When a child suffers a head injury in a motor vehicle collision, you may pursue a personal injury claim for financial compensation against the at-fault party. This compensation may be necessary to pay for the child's care to maximize recovery from injury.
As previously blogged by Joseph Cescon, parents and caregivers can take preventative steps to mitigate the risk of head injury to their child while in a motor vehicle. Some of these steps include:
- Ensuring your child's seatbelt is properly buckled
- Using child seats and booster seats in relation to your child's age, weight, and height.
- Follow installation instructions, set up harness straps, and check expiry date charts for the various car seat manufacturers.
Daycare and Summer Camp Negligence
Pediatric head injuries are common during daycare and summer camp. Parents trust teachers, camp counsellors, and recreation leaders to care for their children. In turn, daycare providers owe a duty to the children in their care to take all reasonable precautions to ensure their safety.
The Occupier's Liability Act states that property owners and those having responsibility for and control over the condition of the property are legally responsible for ensuring their property is reasonably safe for those using it, including children at daycare. Daycare owners and operators must exercise reasonable care in maintaining and inspecting the property.
The Child Care and Early Years Act sets minimum standards that licensed daycares must meet and minimum staff-to-child ratios to ensure adequate supervision. More information about the minimum standards can be found here.
Choosing a daycare that will take care of and protect your child can be overwhelming as a parent. When choosing a daycare for your child, consider the following points:
- Licensing of the daycare
- Adequate supervision
- Childproofing
- Health and sanitization
- Food safety
- First aid and medication
- Emergency planning
For more information on choosing a daycare for your child, see our previous blog for tips and safety information.
Sporting and Recreational Negligence
Physical activity, particularly sports participation, benefits a child's physical and mental health. However, sports are a common mechanism for head injury among children. In 2019, one of the most frequently reported activities at the time of head injury leading to medical consultation was sports, accounting for over 80% of traumatic brain injuries among children in Canada.
To minimize the risk of pediatric head trauma in sporting and recreational activities, consider the following safety precautions before allowing your child to play:
- Ensure your child wears a properly fitted helmet during contact sports such as football, ice hockey, and boxing.
- Ensure your child wears the proper protective equipment for all sports, even if a helmet is not required. This may include padding, eye protection, and mouth guards.
- If your child is playing in an outdoor recreational area, such as a playground, ensure the floor is made of shock-absorbing material, such as mulch or sand.
When pursuing a claim for damages for injuries your child has suffered in a recreational sport, the lawyer you hire must prove that the injury to the child was caused by the negligent act of a participant or the negligent supervision of the activity and was not a result of a normal and accepted risk inherent in the activity. Collecting all available evidence as soon as possible will give you the best chance for success in the case.
Cycling and Pedestrian Accidents
With summer approaching, children are bound to play games such as hide-and-seek, road hockey, skateboarding, or cycling on the street. Unfortunately, pedestrian accidents involving children playing outside are a very real danger, and inattentive motorists driving by at any moment can put your child at risk. In 2019, riding a bike was the leading activity that required medical consultation among children.
In the case, Annapolis County District School Board v. Marshall, the Supreme Court of Canada held that in a school, playground, or built-up residential area, a motorist should drive more slowly and carefully and keep a lookout for the possibility of children running into the street. Motorists have a greater duty of care when operating their vehicles in these areas. When a child suffers a head injury as a result of being struck by a motor vehicle, you may pursue a claim for financial compensation against the at-fault party to obtain compensation for your child's care.
As a parent, you want your child to enjoy outdoor activities safely. Even while taking precautions, a child can still be injured as a result of the negligence of a motorist who is impaired, distracted, speeding, or not keeping a proper lookout. To minimize the risk of pediatric head injury while playing outside, consider the following safety measures:
- Educate your child about the risks associated with drivers
- Monitor the road activity your child is engaging in
- If drivers are driving at a high rate of speed in your neighbourhood, contact your local government and road authorities to try and have measures implemented to reduce speed.
- Ensure your child wears a helmet while biking, skateboarding, rollerblading or engaging in other pedestrian activities.
- Make sure your child's helmet is fitted correctly.
- Ensuring the breaks on your child's bike work
- Install reflectors on your child's bike to increase their visibility
- Educate your child on the importance of being aware of their surroundings
- For further safety measures, look at this blog by Dale Orlando.
Falls
The summer months are a perfect time for kids to use municipal playgrounds. However, playground elements can be dangerous, and games, including tag, can result in unnecessary falls. Children under the age of 5 are at even greater risk due to their higher propensity for falls while learning to walk and develop ambulatory skills.
To minimize the risk of unnecessary falls and head injury, consider the following precautions:
- Ensure your child is adequately supervised
- Only allow your child to use playground equipment the way it's designed to be used
- Do not allow your child to climb on areas that are not meant to be reached
Under the Occupiers' Liability Act, a municipality owes a duty of care to children using municipal playgrounds by ensuring the playground equipment is appropriately maintained and reasonably safe. If your child is injured on a municipal playground due to the municipality's negligence, you may be entitled to compensation.
If you notice faulty or damaged playground equipment, such as a broken chain on a swing or a sharp edge on a ladder, contact your local municipality to have it repaired. For more information on avoiding common summertime accidents, see Patrick Brown's blog.
Know the Signs and Symptoms of PTBI
When a child suffers head trauma, there is the danger that without the early intervention of a qualified medical and rehabilitation team, symptoms related to pediatric head trauma may be overlooked or credited to be "normal" childlike behaviour. This is why parents must be aware of the symptoms of head injuries and ensure they are addressed as early as possible.
While parental observation may provide some insight into a child's functioning before the injury, it is crucial to have your child assessed by a qualified medical professional with experience in pediatric brain injuries as early as possible. Early intervention and progress monitoring provide a greater chance of differentiating PTBI symptoms from normal childlike behaviour, providing a more objective baseline for measuring your child's recovery.
The Role of a Personal Injury Lawyer
Having a knowledgeable and experienced personal injury lawyer on your child's side is crucial in achieving the best possible outcome for their case. A personal injury lawyer should ensure the child recovers to the fullest extent possible, obtains fair compensation for their injury, and leads an optimal life.
In Ontario, complex requirements and restrictions apply to litigation in which children are plaintiffs. These complexities are why it is so important to ensure you have the right personal injury lawyer on your side.
Children under 18 are considered to be a party under disability and, therefore, must be represented by a litigation guardian in a civil proceeding. The adult who will act as the litigation guardian must agree to act in the child's best interests and swear that they have no adverse interest to the child. Once appointed, the litigation guardian instructs the lawyer representing the child. The general limitation period is two years; however, this does not apply to children. The time limit begins when a child turns eighteen or a litigation guardian has been appointed.
Additionally, a court is required to ensure that the settlement is made in the best interests of the child involved. Any settlement of a minor's claim is not binding until it has been approved by a judge, who must determine if the settlement is adequate in the circumstances and serves the best interests of the child.
Proving the damages your child has suffered as a result of their injury can be challenging. Generally, the initial recovery period for TBI is 18-24 months. In many instances, children will have ongoing symptomology even after the two-year mark. It is often helpful to obtain an opinion from an expert who can provide a prognosis for the future concerning the impact that the injury will likely have on a person's ability to function in home and work settings and provides an opinion regarding the cost of care associated with injury. However, with pediatric brain injury, a doctor may not be able to give a prognosis until the child progresses through developmental milestones.
This blog, by Dale Orlando, outlines the characteristics to look for when finding the right personal injury lawyer.
Conclusion
Head injuries in children are serious and have the potential to affect a child throughout their life. Parents should learn the signs and symptoms of TBI and consult a medical professional if they suspect their child has suffered a head injury. It is essential for parents to take reasonable preventative steps to minimize the risk of head injury to their child.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.