Understanding Pediatric Traumatic Brain Injury Symptoms

0:00:08 - Kiley Como
Alright. So if you were with us last week, we were talking about some symptoms, and it's a long list, and so we want to kind of pick up where we left off there. So, John, let's get back into that. Let's talk about some of the symptoms we might see with a pediatric traumatic brain injury.

0:00:22 - John Mobley
Yeah, absolutely Kiley. And just to kind of refresh the viewer, we are going through a very long symptom list because we were discussing how, with pediatric TBIs, you know, some of these young clients can't communicate what's going on, can't communicate their injuries. So we have to go to the next best thing, which is to look at what sort of brain injury symptoms have been manifested or appearing in the child. And that gives us the next best thing to know, did a brain injury occur? Is this something that needs to be followed up on? And it's something that the parents or teachers, families, friends can note in the child. One of the other big categories we see is speech. An important thing that all parents of young children monitor is when the child begins talking and, you know, if it's delayed, then it becomes a cause for concern. Well, unfortunately, one of the symptoms of brain injuries can be an impact on speech, which is a delay in speech or inability to hit certain milestones, which is very important for pediatric development. It can also impact the voice as well. Sometimes we see, you know, hoarseness, strained voice, all these things can be correlated to a brain injury. Another category that is of concern to a lot of parents, anyone that has small children who knows this is, you know, feeding, and feeding safely, and the development of just normal chewing, swallowing. These are very, very big milestones for the development of pediatric children.

Unfortunately, brain injuries can impact that. And what happens is, is, you know, it can cause what's termed oral and pharyngeal dysphagia, which can impact the ability to swallow safely, that basic mechanism to get the food down. Another big thing you know, relating back to how we talked to, you know, a brain injury can impact your cognition and cognitive impairment. If you have, you know, poor memory or limited attention as a small child who's had a brain injury or impulsivity, well, you're not going to be as careful when you're eating, right? You're not paying attention to what you're doing because you have an inability to focus on the task at hand. So when you're not focusing on the task at hand, maybe you breathe down the cheerio or the small piece of steak and it presents just a entire childhood of issues and beyond to the parent who at that point is now, you know, burdened is not the right word, but any parent that knows, you know, raising children it now means it adds an extra layer of complexity to
what could otherwise be a normal task, right? Because now you have to cut the food very small, monitor every single feeding. So it's not just the child that is also, you know, that is impacted sometimes by these brain injuries at a young age. It causes stress, inconvenience, and pain and suffering for the entire family who now becomes, you know, a quasi-caretaker. So these are just some of the things with the symptoms that we see that typically follow up on quite a bit or at least bring to our clients who come to our firm's attention to be like, "Hey, that may not be normal" or "here's the checklist so you can keep an eye out for that." Maybe they're making great advancements in the milestones. You know, every time you go into the, your doctor or pediatrcian, they typically give you this chart to show where the baby lands on the development. A lot of times it looks like a U and if you deviate or go too far from it and you stay deviated too long, then you have to get referred to a specialist to see what's
going on. So that chart in that where the baby falls or the young child, we monitor that closely to see if, "Hey, what was the event?" You know your child was doing great, 50th percentile, right where normal babies nationwide are, and then all of a sudden they start falling off in categories, falling off in weight because they're not eating, because they're afraid to eat, because they have issues swallowing. It's really easy to track that, what was the event and when did the fall off occur? I mean, it's sometimes as clear as night and day that we see a young child fall off. So that's just another thing that we add to make sure that we're getting full, fair compensation and justice for the child and for the family.

One of the other categories that is the big one. It's the big one, is cognition. In that cognition category, it encompasses so much. It's basically, you know, how is the brain working? And it impacts so many different areas, things like attention, and you know listeners at home may think well, what's so bad about, you know, having a decrease in attention? Well, if you want to succeed, or you want to go far in your job, or you want to do well in school and get the grades to get the good job later on, well, attention is a pretty darn big thing. Yeah. And it's hard to put a money value on that. So we have to really lean on the life care planner to say well, you know, that, a lifetime reduction in attention, you're more likely to injure yourself, you're more likely to do dumb things, you're more likely to not succeed in job and school. And when you try and put dollar values on this: astronomical. Astronomical! This is why you know, sometimes when people read the news headlines and they say "Why was that big jury verdict given? It just doesn't make sense, they just hit their head." What they don't see in those big headlines about why was there a $10 million plus verdict is because, you know, they don't understand the full amount of things evolved for the future of that person. And all the lifetime of pain and suffering and complexities and medical visits that that person is now gonna have to do. That's why those verdicts are so big, because I'm sure some of those jurors, when they get put and get called to jury duty and they go in there, they may have, you know, their preconceived notions about people getting big settlements until they start seeing the specialist layout exactly what happened here. And the life care plan is saying, here's the future medical treatment that's gonna be needed and here's how much their life and quality of life is gonna be reduced for the next 70 years as a young child. And that's why these verdicts happen. It's not by luck or it's not by you know one jury. It happens nationwide because of these injuries.

To get back to some of the cognition symptoms is, you know, we see certain deficits with task completion, conversational engagement, that's a big thing for lifetime success. Just an overall reduction in attention span, which can be a huge hurdle for being successful long-term in life. If you can't focus on getting something done, it's gonna impact your relationship with others, your spouse and family and friends. We also, there's another category, which is kind of executive functioning, where, you know, your brain has certain aspects of it that are responsible for, you know, goal setting, judgment, planning, organization, reasoning. These are all things that make a person who they are. And that's why when we see clients that have, you know, impairments, what we call deficits to their executive functioning portion of the brain, these are sometimes the biggest brain injury cases of all. Because while physical impairments can be dealt with with the right specialist care, or therapy, physical things like we
talked about on the last episode, it's much harder to treat cognition and executive functioning problems. It's just, it's who you are now. And that's unfortunate and that's sad for some of these victims is that there's nothing that's gonna potentially cure your inability to not be impulsive, to not make terrible decisions in judgment, because that portion of your brain has sustained permanent damage.

You are just a different person after that, and that is so hard for people to grasp. And we see it with some of our family members of victims that come to us. They're like, I feel like I'm in my house with a stranger, or, I feel like I've got a new person, a new child here now. Completely different. And it gives you kind of cold chills when you think about it. And it gives jurors cold chills too. And that's why we see these large awards, because imagine the person you love most and they're now a different person. Yeah, that's fascinating.

Some of the other symptoms we see too is information processing and just long-term and short-term memory. The memory one is especially difficult for a lot of families to adjust to when they have young children that either have short-term or long-term memory issues, because our memories make us who we are as individuals. You are the total aggregation of your memories that makes who you are as a person. And when you can no longer remember stuff that happened to you as a child because of your brain injury, or if you're already a small child and you just have no short-term memory, then sometimes it can be as simple as, I don't know where I put my keys. Did I put my toys away? Where did I put this? You constantly feel lost when you have severe memory issues, and so those are sometimes some of the really saddest cases. We see it, unfortunately, quite a bit.

0:09:53 - Kiley Como
It's got to be trying on victims, the families. I can't even imagine. I've seen it, but to experience it, it's just got to be terrible. Okay, so we've talked a lot about the signs and symptoms of a traumatic brain injury. Talk to me a little bit about the causes, like how would one sustain a traumatic brain injury?

0:10:13 - John Mobley
So, Kiley, some of the data that we have that tracks nationwide incidences of pediatric TBIs and TBIs in young people-- luckily we have access to this data-- it gives us a great breakdown of what sort of are the causes for young children ages 0 to 14, and what are the causes of those TBIs. The number one cause for brain injuries in young children is going to be falls. And this really comes as no surprise to people that have children, because children are in a constant state of falling down, getting bumps and bruises, getting out in the world and just doing life with no regard to their bodies. So we see a lot of that being falls. And some of that comes to us, some of it doesn't. If there was negligence based, if it was negligence from the bad actions of someone else that caused the fall, then it may come to us, but a lot of those are just falls occurring in sports activities. Beyond that, though, you know, the head injuries are going to be occurring primarily because of being struck, actually events that occur or things like motor vehicle accidents. And then the bottom are going to be assaults and other unknown reasons. So a lot of it is going to be motor vehicle accidents, where we have children and unfortunately even being restrained in a car seat is not always enough to prevent the brain injury. They're going to be better suited to be snug in that car seat but the physics and the whiplash features that cause that forward back, what's called a "contrecoup" forces exerted on the body, it's still going to present issues for that young child. All that energy of 40 miles per hour, cars hitting against each other. That energy has to go somewhere and unfortunately gets transferred to the people that are inside the vehicle and it causes these injuries.

In terms of other big causes, like with falls and assaults, we see just generally that in the age range of very young, shaken baby syndrome is a big thing. When we have, you know, it's a common name for when parents shake the baby, it causes head injuries. We also see young people receiving brain injuries at birth with hypoxic or anoxic injuries when they have some sort of deprivation or complication at birth. That typically is more in the realm of medical malpractice with the claims that we see come to us. We also see injuries a lot that occur with bicycle, motor vehicle accidents, and sports injuries. These occur more often in elementary school children and adolescents.

0:12:57 - Kiley Como
All right, so talking about some causes there. So once we have a traumatic brain injury, who might we meet in our path to taking care of that injury?

0:13:08 - John Mobley
Right. So, unlike adult brain injury victims or clients that come to us, the amount of doctors that you need on your team is gonna be larger with pediatric victims and in young children that sustain TBIs. And the reason for that is because, since they can't tell us their symptoms, like we previously discussed, we need specialists that specialize in the certain areas of the symptom to kind of step in and see if they can't help move along the treatment and identify issues. So that can range from a speech language pathologist, doctors that specialize in speech. If you know, all of a sudden the child's speech milestones have been delayed due to the accident, or they've been able to speak, but then all of a sudden seeing some sort of delay or drop off or new inability to speak, then obviously we now need the, a speech doctor involved. An audiologist as well. So doctors that specialize in hearing are crucial, because the child can't always communicate that their hearing has been reduced or all of a sudden they
can't hear mom or dad or don't respond to the, you know, the nanny or the babysitter's commands like they used to. That's a great reason for us to, you know, get the audiologist involved so maybe further up testing can be done.

Some other specialists that we see very commonly are physicians, the treating podiatrists, where if hopefully they're doing everything that they need to do, they're kind of playing quarterback for the team of doctors and doing good follow up to get those referrals out to the correct doctors, to get them involved sooner rather than later.

Because since the, you know the brain injury is a progressive disease, we want to get those baseline numbers by the specialists early so that if it progresses or gets worse, then you know we can monitor that, that progression of things getting worse. That's why coming soon to us or soon to a doctor to identify this stuff and getting good specialists involved is absolutely crucial. Some other doctors that we see commonly on our pediatric TBI cases are physical therapists, occupational therapists, any sort of rehab, brain injury rehab doctors. These are all people that get involved early and often after the baby has seen, or the child has seen, the neurologist or the brain doctor, because once they identify that brain injury has occurred then they need to get them to the doctor and actually begin therapy, whether that's cognitive rehab, balance rehab, it basically it changes based off what the symptoms the child is experiencing. But luckily there is rehabilitation out there for some of these symptoms.

0:15:52 - Kiley Como
And it's, you mentioned several key points. I think you know oftentimes when we go to our doctor, we think this is our doctor or our pediatrician for our child and they kind of, you said quarterback everything. But in a situation like a traumatic brain injury, that that's a whole different ballgame. I mean, I know we tend to lean a lot on our primary care or pediatricians to take care of that, but we really need to trust them and get those, like you said, those specialists in there, because that's what they- they're highly trained and skilled professionals that know that body part, whether it's the brain or a knee or whatever it is. inside and out that a pediatrician or a primary care physician just isn't trained to do. And so you're absolutely right. I think being able to encourage our clients and to give them that information, to say, this is probably your best course of action to make sure you get the best care and make the best informed decision. I think that's super important.

0:16:39 - John Mobley
Absolutely. We have the utmost respect for our family doctors and pediatricians, but I was, however, at a recent brain injury conference and one of the renowned brain doctors, neurologist specialists said the best primary care physician or pediatric doctor is the one that sends the referral out to the specialist the soonest. So true. And that really is a, you know, that's an important point to make, which is that when we have some of these specialist issues, you want the absolute best doctor on the case, and that is typically the specialist. And then one of the other categories that we see that has a big impact on these cases is the long-term outlook in challenges that are faced by young, our young clients that get diagnosed with these unfortunate injuries.

I know we've gone over attention and executive function. Beyond that, there's also emotional impairments and other challenges that really amount to issues with schooling failures, schooling difficulties and a long-term job outlooks, which are, you know it's way down the road, but we have to look down the road. The reason that these long-term outlooks get jeopardized is because you're playing down a level right. You now have issues and challenges that you didn't have before, and life just gets harder. That's the best way to describe it. Now I've seen some specialists describe it as that life just generally gets a little bit harder because you have deficits that you didn't have previously.

0:18:16 - Kiley Como
I know since my time here with the firm in working with you and other attorneys and the team, what we see so often is treatment fatigue, and that can be extremely dangerous. You're talking especially with a child, and you're talking decades down the road. I mean we could be potentially talking about decades' worth of treatment, right? And so it really is a long haul kind of game and so you need to really get familiar with and comfortable with working with those professionals, I'm sure, as a patient or a victim. Like I'd be really patient. That's something I'm sure you really try to coach up your clients on, to kind of prepare them for that.

0:18:49 - John Mobley
So true. And you know, one of the issues that we run into with that fatigue too is that when someone has a very bad brain injury and they're having all those issues that we talked about organization, impulse control, follow-up, they don't necessarily make great medical treaters. Like, they don't follow up with the care a lot. They miss appointments. And all these challenges and disruptions to their treatment path occur because they don't make the appointments. Yeah. So it's great sometimes when we have parents that are really on board, when we have young children having to go through this long haul of treatment, that they're committed to the process of getting better. It's the best thing you can do as a parent.

0:19:31 - Kiley Como
All right. Well, this is the conclusion of our two-part series. Thanks so much, John. That was fascinating, full of information. And so, everybody, if you wouldn't mind giving us a like, please subscribe to our channel, come back for more great content. And remember, if you're in pain, call Shane. Give us a call at 980-999-9999.