Thinking about head injuries in children.

The number of head injuries in children is rising annually and the number is by no means insignificant. Although the relatively small number of severe injuries has been acknowledged to produce profound and long-term effects, the majority of injuries are comparatively mild. In the past, mild injuries have not been thought to produce significant cognitive or psychological sequelae. This view is now being challenged, suggesting that professionals need be aware of the subtle sequelae that can effect children's functioning in the home and classroom. Children, once seen as having an advantage over adults with regard to their recovery, may in fact be more vulnerable and have poorer prognoses. Adequate rehabilitation provision for the unique complexity of problems following head injury is rarely met by Health and Education Authorities. Children with head injuries are neither sick nor mentally handicapped, and they need a rehabilitation service that fits their special needs. Finally, little within the literature of children's head injury has been written on children's own experience of their predicament. One notable exception is the work of McCabe and Green (1987). Children are often acutely aware of their difficulties once they begin to recover, mourning the loss of past skills and abilities, and the loss of freedoms they once had. Yet they are only partially able to understand how their world is so different. Frustration, fear, anger and sorrow are not uncommon feelings expressed either verbally or through their behaviour. In thinking about head injury in children it is their experience of this trauma that must be foremost in our minds.