The issue inspired a research team at Université de Montréal (UdeM) to develop a unique observational tool, named the REACTIONS inventory, for assessing kids up to age 5 who have had a concussion. Details of the work are published in the Journal of Head Trauma Rehabilitation. “Children below the age of 6 are either preverbal, meaning that they have not yet learned to speak, or if they do speak, they have limited vocabulary and understanding of abstract concepts,” explains the study’s principal author, UdeM neuropsychology professor Miriam Beauchamp, PhD, who conducts research at the UdeM-affiliated CHU Sainte-Justine children’s hospital. This means that young kids can’t accurately explain what they’re feeling and experiencing after a concussion. “Common symptoms like ‘dizziness’ or even ‘headache’ can be impossible or very difficult for a young child to convey to their parent,” Beauchamp says. “An 18-month old simply does not yet have the skills to say to their parent ‘Mom, I feel dizzy and confused today and I need a little extra attention and comfort.’”
Created with Young Kids in Mind
The REACTIONS tool is an inventory of all the post-concussive symptoms known to occur in older children, adolescents, and adults, but they’ve been adapted to reflect a young child’s reality. For example, it includes behaviors typical of early childhood that might indicate a child is not feeling well, such as comfort-seeking and regressive behavior. In addition, rather than just have a one-item example of a symptom that relies on the child reporting something to their parent (e.g., my child says they have a headache), a list of possible manifestations of the symptom are offered. This helps parents and doctors to observe the child and then check off which manifestations they’ve noticed. For example, clues that a toddler has a headache include rubbing their head or holding their head in their hands. After a head injury, doctors look for signs of brain injury including signs of a skull fracture, loss of consciousness, headache, and vomiting. “These sorts of physical symptoms or a high risk injury where the child has fallen a large distance or been hit by a motor vehicle can prompt the need for urgent imaging,” says Kelly Fradin, MD, pediatrician and author of “Parenting in a Pandemic: How to Help Your Family Through COVID-19.” Fradin explains, “Other traumatic brain injuries can be more subtle. Children can experience changes in cognitive function such as inattention, memory loss, or slowed processing and changes in behavioral and emotional functioning such as irritability, fatigue, mood changes, anxiety, and regression.” The inventory can be used multiple times (e.g., at the emergency room, at home one week after the concussion, and three months later) to see how the child’s symptoms are evolving.
A Welcome Development
Natasha Trentacosta, MD, pediatric and adult sports medicine specialist and orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, California, welcomes the new tool. “This has been something that has been missing in pediatric concussion research as the focus has been on older communicative children and using questionnaires for assessment,” she says. “Having a more advanced tool to understand the evolution and status of traumatic brain injuries in young children will enable us to more effectively care for them and their injuries.” Dr. Fradi agrees. “In recent years we have become more aware of the consequences of mTBI (mild traumatic brain injury) and this line of research will help us identify and follow young children who have had concussions,” she says. “Validated scales to identify affected children are crucial steps towards helping these children recover fully.”
