Part I - Getting the Right Help for Your Child

When a child suffers a Traumatic Brain Injury, (TBI) the implications can be serious. Parents are extremely worried about the health and future well-being of their injured child, regardless of how severe the injury appears at the moment.

The legal system also takes children TBIs very seriously. That’s why when a child suffers a head injury, there are a different set of guidelines and steps that must be followed that are designed to safeguard the child’s well being, development and future recovery. This article, the first in a series derived from our free Pediatric Brain Injury Guide, is designed to inform caregivers about how best to care for your loved one.

The Importance of Getting the Right Diagnosis, TBI in Children

A TBI is defined as an insult to the brain from an external force that leads to temporary or permanent impairment of cognitive, physical, or psychosocial function. A failure to diagnose the effects of a mild TBI (often called the “invisible injury”) until obvious developmental, cognitive or behavioural impairments are recognized can lead to significant challenges in terms of treatment and can compromise a child’s potential for recovery. It is imperative that you monitor your child closely if you have any reason to suspect brain injury has occurred. The injury can be confirmed by a neuropsychology evaluation, even though it does not show up on an MRI.

TBIs, and particularly mild TBIs, can be difficult to identify in the case of a child, the younger, the more difficult. This difficulty relates to the tools we use to establish brain impairment, and the age and developmental stage of the child. Ordinarily, paramedics will apply a short test known as the Glasgow Coma Scale (GCS) to people that may have sustained a TBI. The test relies on the victim’s ability to respond to verbal commands, which makes it useless for evaluating very young children. Similarly, it is impossible to test for post-traumatic amnesia until a child reaches an age where memory can be described to an assessor.

Unless there has been an Intracranial Injury (ICI), there is no definitive imaging evidence that can identify a mild TBI which can occur in a low-speed collision, without loss of consciousness or even direct head trauma. For example, in many “whiplash” type injuries, the head snaps back and forth, causing the brain to strike the rigid inner surface of the skull. 

Several diagnostic tools are available including: Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Single Proton Emission Computed Tomography (SPECT), Diffuse Tensor Imaging and others. However, recent Guidelines published by the US Centers for Disease Control and Prevention (CDC) do not recommend routine use for children in the absence of ICI. There are risks associated with these tools (including sedation and exposure to radiation), and a lack of evidence that they can effectively diagnose a mild TBI.

Instead, the CDC recommends that physicians use Clinical Decision Rules for children with low risk of ICI. A decision rule is defined as a decision-making tool that incorporates three or more variables from the history, physical examination or simple tests of the patient. Essentially, the physician examines the available evidence and exercises professional judgement based on experience and training.

Paediatric Brain Injury & Legal Recourse

Many TBIs are suffered after a direct or indirect trauma to the head or brain from a car accident, slip and fall or other accident. In these situations, you may have the opportunity to claim compensation for your child’s injuries through a lawsuit against an at-fault driver, property owner or other negligent party. If the trauma happened in a car accident, your child will also have access to “no-fault” accident benefits through your insurance company, or the other driver’s if you are not insured. The amount of medical rehabilitation benefits that a no-fault insurer will pay depends on the severity of the injury.

TBIs are classified according to the severity of the initial trauma, ranging from Mild (Concussion) to Severe. This does not refer to the severity of the outcome for the child. Under Ontario’s current Accident Benefits Regulation (called the SABS), if a child under the age of 18 is admitted to a hospital or neurological rehabilitation facility with a brain injury that can be identified through diagnostic imaging (CT Scan, MRI, etc.), the child will automatically be designated as Catastrophically Impaired (CAT) and have up to $1,000,000 available for medical rehabilitation and attendant care. A CAT designation provides access to greatly increased funding for treatment, home care and other benefits that the child requires.

Parents Are the Child’s Most Important Advocate

While many of the challenges that arise when our children suffer traumatic brain injuries (TBIs) are also encountered by adults, there are additional concerns that you and your child will face.  There are often difficulties detecting and diagnosing impairment in a child’s developing brain and the resulting delays in treatment, and the additional strain it places on your entire family as you attempt to accommodate your child’s rehabilitation and care needs, potentially oversee and participate in a lawsuit on your child’s behalf and maintain your household.

Remember that you are your child’s best advocate, and often the best or only witness of the injury. If you believe there is a risk of brain injury, do not be afraid to seek a second medical opinion regarding a CT Scan.

Contact Campisi for a free, no obligation legal assessment of your case.  We care for our clients, and deliver great results. Those who know personal injury law and insurance, trust Campisi. Ask around.