Aetiology

The causes of traumatic brain injury are different depending on the age of the child. The incidence is twice as high in males as in females, and children who live in poor psychosocial circumstances are at greater risk. Traumatic brain injury from child abuse occurs in infancy: in the preschool years the most common cause is falls; in early elementary school, it is pedestrian accidents. From 10 to 14 years of age there is an increase in sports and bicycle accidents, but by 15 years motor vehicle accidents and violent assault are the most common. Risk factors include poverty, single-parent homes, congested living arrangements, and a parental history of psychiatry disorder.

A common complication of traumatic brain injury is cerebral oedema, but there are other complications such as infection and haematoma formation both inside and outside the brain. These complications result in neurological deficits that may be extensive. Furthermore, compensatory mechanisms that are involved in recovery from head trauma may alter brain function. A child who has suffered a traumatic brain injury is likely to experience both neurological and psychiatric difficulties depending on the brain regions involved. Multiple mechanisms lead to psychological symptom formation—both psychosocial and physiological factors are involved.

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