Picture this: It’s a typical day of running errands with your toddler. Your last stop is the grocery store. You place your toddler in the shopping cart. As you lean over to grab a bunch of bananas, your little one stretches a bit too far across the aisle to reach for an apple. She falls from the cart onto the floor, grazing her head on a shelf on the way down. There’s quite a bit of crying, but no bleeding. You see a slight bump on the back of her head, but she seems physically okay otherwise—just a little scared. She stops crying after a few minutes. You quickly finish your shopping trip and head home, a bit rattled but relieved that she’s not seriously injured. 

Scenarios such as these are not uncommon in young children. Bumps to the head, falls, and other accidents happen frequently as infants and toddlers start to walk (and run!) on their own, climb on furniture (and out of their cribs), ride scooters and bikes, and play on the playground. Many of these injuries won’t have lasting effects, but it isn’t always easy to tell which ones are more serious. Young children who experience falls or other bumps to the head can be at risk for damage to their brains. This is called traumatic brain injury (TBI). Concussions are one type of TBI. 

But how do you know if your toddler has a brain injury? This can be a tough question to answer without professional help. Some symptoms of TBI, such as problems communicating, thinking, or learning, may not appear until hours, days, or even years later. This is especially true for infants and toddlers, whose brains are still developing. It’s important for parents and caregivers to be aware of signs and symptoms of TBI in young children, to watch for them after any injury to their head, and to contact their child’s doctor if they have any concerns. If a child is exhibiting signs such as nausea/vomiting, dilated pupils, unusual clumsiness, or dizziness/balance problems after a head injury, it’s always best to take them to the emergency room right away. 

Spotting TBI in Infants and Toddlers

Recognizing signs and symptoms of TBI in young children can be tricky. Unlike older children and adults, infants and toddlers can’t clearly communicate how they feel after a fall or injury. Also, signs that appear soon after an injury may be confused with behaviors that are typical for young children, such as crying, clinginess, or changes in eating or sleeping patterns. More worrisome physical, behavioral, and emotional changes might only occur days later or even longer. These may include:

• Seizures

• Extreme fussiness

• Sensitivity to light

• Changes in bathroom habits

• Loss of newly developed skills (for example, less babbling or talking)

It may be many years later when the effects of a brain injury show up for the first time, such as when the child starts school. For example, a child who experiences a TBI at 2 years old may not show any major symptoms until kindergarten, when they start to fall behind in new areas of learning (such as reading, writing, and math), social skills/interactions, or communication and problem-solving.

Supporting Infants and Toddlers With TBI

Young children who experience TBI need to be monitored closely over time. Be sure a child has routine check-ups with their pediatrician after an injury to their head. Parents with concerns about their child’s communication, thinking, or any other developmental skills should contact their local early intervention (EI) program. EI services can help improve the child’s long-term success in school and social situations. A list of EI programs by state with contact information is available here. EI programs provide free or low-cost care to children birth to three.

In EI, children are evaluated by one or more child development professionals who will look at all their skills and their medical history to determine if they qualify for services. A family’s income does not have anything to do with qualifying for services. Audiologists and speech-language pathologists are among the early intervention providers who evaluate and treat infants and toddlers with TBI. They can help parents track changes (even subtle ones) in a child’s abilities and typical behaviors, and review the skills that a child is expected to meet by their age. 

Long-term, it’s important to continue to monitor any attention, memory, thinking, communication, hearing, and/or behavioral changes in a child with a history of TBI as they grow. If a family has concerns about their child’s development beyond age three, they should talk to their pediatrician and consider contacting their local school district to schedule an evaluation. Parents should mention any prior injuries to their child’s head at this time. It’s also important to remember this injury as part of the child’s education and medical history whenever a child changes schools or moves. 

To find an audiologist or speech-language pathologist in your area who can screen, evaluate, or treat children with TBI, search ASHA ProFind.

More information:

• American Speech-Language-Hearing Association: https://www.asha.org/public/speech/disorders/traumatic-brain-injury/ 
• Brain Injury Association of America: https://www.biausa.org/brain-injury/about-brain-injury/basics 
• Centers for Disease Control and Prevention:  https://www.cdc.gov/TraumaticBrainInjury/get_the_facts.html 

Adapted from ASHA Leader Live blog post, How TBI Presents Differently in Children Under Age 4.

Adena Dacy, M.S., CCC-SLP, is Associate Director, Health Care Services in Speech-Language Pathology, for the American Speech-Language-Hearing Association (ASHA). 
 

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