Longitudinal Developmental Outcomes after Traumatic Brain Injury in Young Children: Are Infants More Vulnerable Than Toddlers?
Open accessAbstract
Children under 4 years of age have the highest incidence of traumatic brain injury (TBI) among the non-elderly and may be at high risk of poor developmental outcomes. We prospectively enrolled a cohort of children injured before 31 months old with TBI or orthopedic injury (OI), from 2013 to 2015 at two pediatric level 1 trauma centers to study very young children's developmental outcomes after injury. We used Ages & Stages-3 and Ages & Stages: Social-Emotional screening tools to measure children's development at pre-injury and 3 and 12 months post-injury. The cohort included 123 children with TBI categorized as mild (n = 48), complicated-mild or moderate (n = 54), and severe (n = 21) and 45 children with OI. Generalized linear models examined effects of injury severity and age at injury controlling for pre-injury ratings. Children with mild or complicated-mild/moderate TBI generally remained on developmental track. Compared to OI, children with severe TBI tended to have a negative developmental trajectory with decrements in communication (-7.07; 95% confidence interval [CI], -13.7, -0.48), gross motor (-15.2; 95% CI, -21.1, -9.19), problem solving (-11.6; 95% CI, -17.9, -5.29), personal-social (-16.8; 95% CI, -22.8, -10.8), and social-emotional (21.0; 95% CI, 7.32, 34.7) domains 12 months post-injury. Developmental effects from TBI differed by age at injury: Infants had more difficulties than older children in communication and problem-solving domains. Despite low development…
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Previous studies show that children with mild TBI and complicated mild TBI generally demonstrate few deficits in cognitive performance after three months post-injury, while children with severe TBI demonstrate consistently poorer cognitive performance compared to children with orthopedic injury.
“Previous studies show that children with mild TBI and complicated mild TBI generally demonstrate few deficits in cognitive performance after three months post-injury, while children with sTBI demonstrate consistently poorer cognitive performance compared to children with OI (Babikian & Asarnow, 2009; Chadwick et al., 2021; Keenan et al., 2018).”
From Evaluating cognitive performance using the National Institutes of Health Toolbox Cognitive Battery in children with traumatic brain injury (2025) · cites this paper as Keenan et al., 2018
Because of the low number of patients with moderate TBI, children with complicated mild to moderate TBI were combined for analysis (n = 86), consistent with current approaches to analyzing cognitive recovery after TBI in children and adults.
“Because of the low number of patients with moderate TBI, we combined children with complicated mild to moderate TBI (cmmTBI) for analysis (n = 86), consistent with current approaches to analyzing cognitive recovery after TBI in both children (Keenan et al., 2018; Keenan et al., 2019; Levin et al., 2008) and adults (Tulsky et al., 2017).”
From Evaluating cognitive performance using the National Institutes of Health Toolbox Cognitive Battery in children with traumatic brain injury (2025) · cites this paper as Keenan et al., 2019
Because of the low number of patients with moderate TBI, children with complicated mild to moderate TBI were combined for analysis (n = 86), consistent with current approaches to analyzing cognitive recovery after TBI in children and adults.
“Because of the low number of patients with moderate TBI, we combined children with complicated mild to moderate TBI (cmmTBI) for analysis (n = 86), consistent with current approaches to analyzing cognitive recovery after TBI in both children (Keenan et al., 2018; Keenan et al., 2019; Levin et al., 2008) and adults (Tulsky et al., 2017).”
From Evaluating cognitive performance using the National Institutes of Health Toolbox Cognitive Battery in children with traumatic brain injury (2025) · cites this paper as Keenan et al., 2018
Cites
Levin, H. S., Hanten, G., Roberson, G., Li, X., Ewing-Cobbs, L., Dennis, M., Chapman, S., Max, J. E., Hunter, J., Schachar, R., et al. (2008) · Journal of Neurosurgery: Pediatrics · doi:10.3171/ped/2008/1/6/461 · Cited by 201 · see citing works
Self-citationEwing-Cobbs, L., Prasad, M. R., Mendez, D., Barnes, M. A., & Swank, P. (2013) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617713000210 · Cited by 21 · see citing works
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Petersen, B., Vo, N.-T. N., Anton, N., Yeates, K. O., & Treble-Barna, A. (2025) · Journal of the International Neuropsychological Society · doi:10.1017/s135561772510146x · Cited by 1 · see citing works
- Authors
- Keenan, H. T., Presson, A. P., Clark, A. E., Cox, C. S., & Ewing-Cobbs, L.
- Affiliations
- University of Utah (US)
- The University of Texas Health Science Center at Houston (US)
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas.
- Corresponding author
- Keenan, Heather T.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2019-01-15
- Volume
- 36
- Issue
- 2
- Pages
- 282-292
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- PMC
- PMC6338576
- OpenAlex
- W2884466727
- Cited by
- 56
- References
- 2
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 8 · 2023: 4 · 2022: 15 · 2021: 4 · 2020: 10 · 2019: 6
- FWCI
- 3.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Neurotrauma (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR002538)
- Centers for Disease Control and Prevention (U01CE002188)
- National Institute of Child Health and Human Development
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24HD072984)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- traumatic brain injury, infants, toddlers, developmental outcomes, injury severity, age at injury, orthopedic trauma, communication, problem solving, social-emotional development, early childhood intervention, developmental vulnerability
- MeSH terms
- Brain Injuries, Traumatic, Developmental Disabilities, Child, Preschool, Female, Humans, Infant, Longitudinal Studies, Male, Recovery of Function
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