What About the Little Ones? Assessment and Outcomes of Early Childhood TBI


Isabelle Gagnon and Miriam Beauchamp


Isabelle Gagnon
Miriam Beauchamp
Shari Wade
Audrey McKinlay


Pediatric traumatic brain injury (TBI) has drawn considerable attention over the last decade, with recognition that children and adolescents cannot be managed as “little adults”. Unfortunately, this focus does not often extend to the youngest, and possibly most vulnerable developmental group: preschool children with TBI (i.e. <6 years), even though birth cohort and Emergency Department registry data indicate that children between 0 and 5 years constitute an extremely high-risk group, with a yearly TBI rate of 1.85 per 100 children (compared to 1.17 in older children). Thus, there is little evidence available for clinicians to make decisions regarding the detection, assessment and management of TBI in this young population. In an attempt to fill this gap, the objective of this symposium will be to introduce theoretical concepts and recent evidence related to TBI in the preschool population (0-5 years).

Consensus-based recommendations for the use of Common Data Elements have been proposed for the general pediatric TBI population, including infants and young children. Although designed to guide the assessment of TBI of all severities, very little work has been done to validate those choices, especially for mild TBI/concussion. The Canadian Pediatric mTBI Common Data Elements study (PedCDE) was designed to adopt an evidence-based, biopsychosocial approach to propose developmentally appropriate and sensitive measures for use with children of all ages. Dr Isabelle Gagnon will present initial findings regarding the definition of mTBI/concussion in the 0-5 age group, as well as regarding the choice of relevant outcome measures.

A central aspect of evaluation after mild TBI/concussion lies in the documentation of post-concussion symptoms (PCS). However, in infants and very young children, this poses a challenge because typical PCS are difficult to detect directly and young children are unable to self-report. In an effort to address these methodological challenges, work on the development and initial validation of a new PCS questionnaire for preschool children (REACTIONS) will be presented by Dr Miriam Beauchamp.

Finally, outcome from TBI sustained in early childhood continues to generate controversy as it relates to the “plasticity vs vulnerability” paradigm. Results from selected international cohort studies on short and long term outcome from preschool TBI will be presented by Drs Shari Wade and Audrey McKinlay with particular focus on the developmental impact of the injury on the child’s and family’s functioning, as well as on the influence of parental education and social environment on long-term cognitive, social and functional outcomes.

To conclude the symposium, Dr Keith Yeates will offer discussion points relating to methodological considerations when designing research projects with this group, and pertaining to the detection, diagnosis, assessment and long-term outcome of preschool children who sustain TBI.


Learning Objectives:

  1. Describe the key components of TBI (including concussion) recognition and diagnosis in the infant, toddler and preschool population.
  2. Identify important elements to consider in choosing or creating developmentally appropriate assessment tools to use with young children.
  3. Detail some factors influencing cognitive, social and functional consequences of sustaining TBI before the age of six years.