Your Medical Fiction Questions Answered 2/15/10

Okay, gang... the Doctor is IN!

Disclaimer: The information provided in this post is intended for writing purposes only and does not represent medical advice. (Sorry, my lawyer-boy husband makes me say that.)

Hello

I saw in the Query tracker members who can help with research topic that you could help with medical problems with children.

Can a fall down a flight of steps at the age of 3 cause a brain injury severe enough to impede a child's educational progress, but not any physical problems?

I appreciate your help.

Cheermom

Well, Cheermom, that's an interesting question. If I was evaluating a 3-year-old after a fall down the stairs, here is how the evaluation would go:

I'm assuming that a fall significant enough to cause permanent damage would result in paramedics being called. They would assess the child's breathing and heart function (and if the child wasn't breathing, would need to intubate the patient). They would apply a c-collar to protect for a potential broken neck. They would take the patient to the hospital where (s)he would have a CT scan to look for bleeding in the brain.

If the patient was not breathing after the injury, this could result in inadequate oxygen to the brain, which could also cause permanent problems.

After a significant brain injury, the child would be at risk for seizures, which could contribute to educational problems for several reasons:

• a prolonged seizure could also result in the patient not receiving enough oxygen
• seizure medications (especially when more than one medication is necessary) can make patients sleepy, which can interfere with their functioning
• frequent seizures can impair learning due to missing the time during and shortly after the seizures.

Head injuries can be quite tricky in regards to symptoms. Traumatic brain injuries can be extremely dramatic or quite subtle. For example, a patient may simply have trouble remembering numbers or retrieving the correct word. The brain is an extremely complicated organ and the exact details of how it works are still not completely understood.

That said, children are extremely resilient creatures. A brain injury in a young child will be much better handled than in older people, as their ability to adapt is much higher.

So whatever injury occurred in this child would have to be fairly serious to cause lasting damage. For example, the fall would probably have to be enough to knock the child unconscious. A head injury that does not cause loss of consciousness generally will cause no permanent damage whatsoever.

It is absolutely possible, though, that the patient may have long term subtle problems that could interfere with his or her educational progress, without causing obvious physical problems. It would also be possible that (s)he may suffer from subtle physical problems as well... such as clumsiness due to decreased balance or problems coordinating their eye movements, resulting in impaired depth perception.

I hope this information is helpful. With a significant head injury, you have a lot of room for plausibility in regards to what problems your character might have. The only limitations, really, would be in regards to some of the physical problems... the motor centers of the brain are mapped out next to each other down a little wedge on the right and left sides of the middle of your brain (the right side of the brain controls the left side of the body and vice versa), so the problems there would have to be continuous (like you wouldn't expect a weak right hand and a weak right foot to be caused by the same injury, unless there were also problems with everything in between.)



Good luck, and thanks for the question, Cheermom!

Remember, if YOU have a medical fiction question, email me at hldyer at querytracker.net and include "medical question" in the subject title. You'll receive an automatic reply confirming that your question has safely arrived in my email box.