Report of Early Childhood Traumatic Injury Observations & Symptoms: Preliminary Validation of an Observational Measure of Postconcussive Symptoms

Abstract

Objective: To report preliminary empirical data on a novel, developmentally appropriate, observational postconcussive symptoms inventory for infants, toddlers, and preschoolers. Setting: Emergency departments of 2 tertiary, urban pediatric hospitals. Participants: Ninety-eight children (0-8 years of age; mean age at injury = 33.00, SD = 24.7 months) with mild traumatic brain injury (concussion) divided into younger (0-2 years) and older (3-8 years) age groups. Design: Observational study. Main Measure: The Report of Early Childhood Traumatic Injury Observations & Symptoms (REACTIONS) documents 17 postconcussive symptoms representing observable manifestations thereof and was completed by parents in the acute (24-48 hours; n = 65), subacute (7-14 days; n = 78), and/or persistent phase (25-35 days; n = 72) post-mild traumatic brain injury. Results: Different patterns of postconcussive symptoms were reported by age group, with behavioral manifestations particularly salient in younger children. More children younger than 2 years had sleep and comfort-seeking symptoms at each of the 3 postinjury time points. Conclusion: Postconcussive symptoms may manifest differently after mild traumatic brain injury sustained during early childhood. To fully understand and address their presence and evolution, developmentally sound measures such as the REACTIONS inventory are required.

Postconcussive Symptoms After Early Childhood Concussion

“…Several behavioral manifestations of comfort-seeking (eg, wants to be held, gets upset if separated from parent) and poor mood and motivation (eg, cries a lot, is withdrawn and isolated), which are not included in other PCS questionnaires, were also reported. These findings strengthen the evidence from smaller or retrospective studies showing that early childhood concussion is associated with behavioral manifestations unique to this developmental period, including more fussiness, wanting to be cuddled more, increased crying, and poor feeding . Given their limited verbal and cognitive abilities, behavioral manifestations, such as regression, comfort-seeking, or excessive crying, may be the only ways a young child can convey that they feel unwell after injury.…”

“…These findings strengthen the evidence from smaller or retrospective studies showing that early childhood concussion is associated with behavioral manifestations unique to this developmental period, including more fussiness, wanting to be cuddled more, increased crying, and poor feeding. 11,[17][18][19] Given their limited verbal and cognitive abilities, behavioral manifestations, such as regression, comfort-seeking, or excessive crying, may be the only ways a young child can convey that they feel unwell after injury. Documenting these behavioral JAMA Network Open | Pediatrics manifestations through direct observation could be the key to tracking PCS and facilitating concussion diagnosis in young children.…”

“…In a study of 98 participants, children aged 0 to 2 years had different patterns of PCS using the REACTIONS inventory compared with those aged 3 to 8 years. 19 Behavioral manifestations (irritability, crying, comfort-seeking) were especially salient in the acute phase for the younger age group, while physical manifestations (headache, nausea) were prominent for the older group. However, the nature and evolution of early childhood PCS remains poorly characterized due to retrospective designs, small samples, the inclusion of school-aged children that may confound the findings, and lack of comparison groups to confirm whether symptoms are concussion-specific, general responses to traumatic injury, or expected behavioral variations typical of early childhood.…”

“…In response to the need for a more developmentally appropriate approach, the Report of Early Childhood Traumatic Injury Observations & Symptoms (REACTIONS) inventory provides examples of observable manifestations and behaviors related to PCS. In a study of 98 participants, children aged 0 to 2 years had different patterns of PCS using the REACTIONS inventory compared with those aged 3 to 8 years . Behavioral manifestations (irritability, crying, comfort-seeking) were especially salient in the acute phase for the younger age group, while physical manifestations (headache, nausea) were prominent for the older group.…”

Factor structure and measurement invariance of post-concussion symptom ratings on the Health and Behaviour Inventory across time, raters, and groups: An A-CAP study

“…A factor consisting of emotional symptoms has sometimes been identified in past factor analytic studies of concussion symptom ratings, but this emerged only for parent ratings in the original derivation study of the HBI, and not for child ratings; validated rating scales of emotional symptoms may be included as a supplement to the HBI for specific research or clinical purposes. Similarly, ratings of behavioral difficulties did not cohere in the derivation of the HBI but may be relevant for younger children (Dupont et al, 2021). Future research also should continue to examine the relative contributions of injury and non-injury factors as predictors of the general and subfactors, or the two correlated factors (cognitive and somatic), of the HBI (O'Neill et al, 2021).…”