Child brain injury is a potentially catastrophic event for the child involved, their family and for wider society. This book is about how child neuropsychology can help.

Traumatic brain injury (TBI) in children has received increasing attention in recent years among parents, educators, clinicians and service providers, researchers and policymakers owing to the incidence and financial burden associated with injury during infancy, childhood or adolescence. Understanding the ways in which the immature brain may exhibit specific vulnerabilities to injury, how injury at a young age may interact with subsequent development, and anticipating the likely cognitive and functional consequences of child TBI is critical in detection of injury, monitoring recovery, and designing and evaluating rehabilitation strategies that may enhance recovery.

Incidence rates for children with TBI vary by global region and the methodology used for inclusion of cases (e.g. emergency department presentation vs. hospital admission vs. general practitioner visits, whether deceased individuals were included, the specific age range that was selected, variation in the definition of TBI used), but estimates suggest a range of 280–1373/100,000 based on review of research published over the last decade where rates of TBI for children can be extracted (McKinlay and Hawley, 2013). Epidemiological studies in the USA and other developed countries indicate that the rates of hospital admissions and emergency department visits for head injury in children surpass that of the general adult population, particularly among children under five years of age and in older adolescents (Hawley et al., 2003; Langlois et al., 2005; Rutland-Brown et al., 2006; McKinlay et al., 2008; Wu et al., 2008; Faul et al., 2010; Koepsell et al., 2011; Kim et al., 2012; de Kloet et al., 2013). Generally, across locations where data on mechanism of injury are recorded, falls remain the leading cause of TBI in younger children (under 14 years), and road traffic accidents are a more common mode of injury for older children (McKinlay and Hawley, 2013).

Several features related to differences between child and adult patients in anatomy and tissue characteristics, the biomechanics of injury, and biochemical or physiological processes have been cited as factors that may increase vulnerability to injury in children. First, in terms of anatomy and tissue characteristics, the relatively thin and less rigid skull of an infant or very young child may increase the potential for diffuse injury (Margulies and Thibault, 2000; Case, 2008). Additionally, the disproportionately large and heavy head and weak neck muscles may increase the young child’s susceptibility to rotational and shearing forces during an insult (Hahn et al., 1988; Margulies and Thibault, 2000). Differences in water content of the brain and incomplete myelination have also been considered important factors related to the potential vulnerability of the brain to certain forms of trauma-related injury in children. Mass lesions, subdural haematomas and tearing of the subcortical frontal white matter have been reported to occur more often after TBI in young children compared with older children (Hahn et al., 1988). Analysis of the distribution of findings on admission of computed tomography imaging indicate that child patients with TBI were more likely to have skull fractures and epidural haematomas than adults with similar injury severity, as measured by Glasgow Coma Scale (GCS) score (Sarkar et al., 2014). Although pathophysiological and repair mechanisms are incompletely understood, the immature brain may exhibit a more robust inflammatory response than in the adult brain, with greater disruption of the blood–brain barrier and elaboration of cytokines, a decreased response to oxidative stress due to inadequate expression of certain antioxidant molecules, and may be less able to detoxify free iron after TBI-induced haemorrhage and cell death (Potts et al., 2006). Increased age-dependent apoptotic neurodegeneration in the developing brain has also been...