Traumatic Brain Injury: Recovery Tips for Children

• Have the child get plenty of rest. Keep a regular sleep schedule, including no late nights and no sleepovers.
• Make sure the child avoids high-risk/high-speed activities such as riding a bicycle, playing sports, climbing playground equipment, or high speed amusement park rides that could result in another bump, blow, or jolt to the head or body. Children should not return to these types of activities until their health care professional says they are well enough.
• Give the child only those drugs that are approved by the pediatrician or family physician.
• Talk with his/her health care professional about when the child should return to school and other activities and how the parent or caregiver can help the child deal with the challenges that the child may face. For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
• Share information about concussion with parents, siblings, teachers, counselors, babysitters, coaches, and others who interact with the child to help them understand what has happened and how to meet the child's needs.

Returning to School

After a brain injury a student's successful return to school academics and sports often depends upon having good support from parents, the school and his/her physician(s). The positive news is that more than 80% of concussions, a type of brain injury, resolve successfully if managed well within the first three weeks post injury.¹ For information on how students may best be supported after a brain injury and return most successfully to academic and sports activities see the following resources.

• Upstate Medical University provides information for parents and educators about concussion and a student's subsequent return to classroom academic work after sustaining a brain injury.
• The Brain Injury Association of New York State provides a step by step guide for parents, teachers, health professionals and youth about how to implement a good concussion management plan after a student sustains a concussion.

Helping Children Cope with Brain Injuries

Having a family member with a brain injury may be frightening for a child. The person with the injury may no longer act the same as he or she did before the injury. As a result, the child may be confused and upset about what is going on. It is important to recognize that the child is grieving just as you are. He/she may withdraw from social activities with peers, have mood swings, become withdrawn or disruptive, do poorly in school and show other behavioral problems. Children need time and space to be kids. Make sure any tasks that your child takes on-household chores for example - are suitable for his/her age. Strive as much as possible to find other adults to help you, rather than relying on your children to play a major role.

You can help your child by explaining brain injuries in a way that he/she can understand. Ask a health care professional to talk with him/her as well. Create new family routines and keep an eye out for signs that your child is not coping well. If risky behaviors exist, seek professional help.

The following table lists tips for explaining brain injuries to children in accordance with their age and stage of development.

Tips to Help Children Cope with Brain Injuries
Age & Stage of Development	Communication Techniques
Age 2-3 Can differentiate expressions of anger, sorrow and joy.	Use simple words in talking Use picture books Create simple books with pictures of family, and things the child can understand (hospital, doctor, bed, rest) Offer dolls to play with so he/she can recreate what is happening at home or the doctor's office
Age 4-5 More self secure, can play well with others, tests the rules, "magical thinking".	Select books with stories that mirror families like yours to help your child relate Familiarize your child with pictures of objects related to medical care and health (hospital gown, doctors, flowers, bed, coming home from hospital) Incorporate play with a child's doctor kit to familiarize your child with what is happening
Ages 6-7 Capable of following rules, enjoys having responsibility. Uncertain of the relationship between cause and effect.	Use interactive communication - reading books and creating stories with your child Help child create his/her own "this is our family" album and talk about the photos and memorabilia Watch movies with story lines similar to what your family is experiencing
Ages 8-11 Has a little better understanding of logic and cause and effect, less centered on self, able to understand others' feelings, to empathize.	Listen to your child's thoughts and opinions Ask questions that go beyond yes and n Depending on the child's level of development/understanding, speak with direct, reality based explanations that include facts Include the sequence of events involved and what to expect
Ages 12-17 Experiences puberty and physiological changes, seek freedom and independence, acceptance by peers is extremely important, develop more intimate relationships, more thoughtful and caring.	Talk with your children not to them Give facts: what is expected to happen, including the diagnosis, prognosis, treatments and expected outcomes Check in and offer time to discuss concerns frequently Listen attentively Ask questions that go beyond yes and no Stay alert for risky behaviors or acting out. Also be aware if they seem withdrawn If risky behaviors exist, seek professional help

• ¹  Collins, MW. Lovell, MR, Iverson, GI, Ide,T, Maroon, J. Examining concussion rates and return to play in high school football players wearing newer helmet technology: A three year prospective cohort study. Neurology 2006,58:275-286