The following articles were prepared by the International Paediatric Brain Injury Society; professionals from around the world who promote the needs of children and their families following paediatric brain impairment. Traumatic brain injury (TBI) is recognised as one of the most common forms of injury and disability across the life span. As outlined in the first article in this special edition, incidence rates for TBI are particularly high during early childhood, and again during adolescence. While incidence rates for TBI vary between counties and depend on the definitions used, the high vulnerability of children is a consistent finding, and most likely a result of early exploratory play and their inability to anticipate cause and effect in risky situations. As such, children are overly represented in TBI statistics. It is important that these injuries are well managed to ensure that children obtain optimal levels of recovery post injury. However, while the research regarding appropriate interventions and return to work plans are well formulated for adults, there is less understanding of the needs of children post injury. These needs include support for the family system and reintegration into the education system, and recognition that children are developing and any intervention/rehabilitation plan will not only need to take into account injury severity, but also the developmental age of the child.
Post injury interventions for children are complicated by the fact that children are part of a family system. As the second article in this series points out, research has shown that family plays a crucial role in the recovery process and long term care of the injured child. However, for a variety of reasons, the family unit itself may be ill prepared for a serious injury to one of its members. Support to caregivers is essential to reduce stress and social isolation. The differing guidelines that have been developed vary on a regional and international basis are also sumarised in this article.
Children are in a rapid period of cognitive and physical change, and in most developed nations are required to attend formal schooling. However, following TBI there will be a disruption to schooling as the physical aspects of the injury recover, and ongoing impairments in cognition are common. Assessment of deficits and the return to the classroom environment requires considerable planning and the provision of continuing and appropriate support for the child to ensure that educational input is successful. The third and fourth articles in this series examine the level of knowledge and understanding of educators, a fundamental aspect of the return to school process, and how reintegration is managed in different areas of the world.
The last manuscript examines one of the most overlooked areas for childhood TBI, the issues associated with the preschool child. Children in this age group do not always receive the attention required as there is often a delay between when the injury occurs and when any formal assessment may take place. Because of this delay deficits may be attributed to other issues unrelated to the injury event. Further, even if assessment is considered necessary at the time of injury, this may be difficult depending on the age of the child and the availability of appropriate assessment materials.
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