Acquired brain injury (ABI)

  • Acquired brain injury (ABI) is when the brain is damaged due to something that happens after birth. There are many different causes of brain injury, including traffic accidents, sports accidents or infections and lack of oxygen to the brain (e.g. drowning).

    The effects of an ABI on children can vary greatly, and will depend on the part of the brain that suffered the damage and the amount of damage caused. The effects can range from mild to severe, and may include changes in your child's physical ability, cognitive (thinking) skills, personality, behaviour and how they communicate.

    Each child's recovery will be different and takes different lengths of time. Recovery often takes many years after the injury, and many children will have long-term damage.

    Signs and symptoms of acquired brain injury

    Initially after a brain injury, your child might be in a coma (be unconscious) or have concussion (be drowsy and confused). These are short-term effects of an ABI.

    In the longer term, your child may show changes in:

    • physical function (e.g. weakness, poor balance, poor coordination)
    • levels of fatigue (they can become tired out more easily, both mentally and physically)  
    • cognitive skills (e.g.  problems with attention and concentration, difficulty in planning and organisation) 
    • personality and behaviour (e.g. problems with emotional control, less aware of other’s feelings)
    • communication (e.g. problems expressing themselves or understanding other people).

    Call an ambulance for any child who has had a head injury involving a change in their level of consciousness (e.g. slurred speech, confusion, seizures, unable to be roused). Doctors will examine the child to determine whether they have a brain injury and how serious it is.

    What causes acquired brain injury?

    In Australia, the most common causes of ABI in children are:

    • traumatic brain injury (from falls, motor vehicle accidents, sports)
    • infections around the brain, such as meningitis and encephalitis
    • stroke in childhood
    • a lack of oxygen to the brain (also called hypoxic-ischaemic events), which can result from near-drowning accidents, prolonged seizures or cardiac (heart) complications.

    Brain injury can be classified as focal or diffuse. A child can have both types of injury as a result of trauma.

    • Focal injuries usually happen after a direct blow to the head, causing a skull fracture. There is often bruising to the brain below the fracture.
    • Diffuse injuries often happen after a motor vehicle accident or a fall, where the brain has had a shake that causes damage to the connections between nerve cells. This type of damage is called diffuse axonal injury and is spread across a larger part of the brain than a focal injury. Because a larger part of the brain is damaged, it means your child may have more problems as a result of the injury.

    How serious is my child’s brain injury?

    It takes a long time to work out how serious a brain injury is and what the long-term effects may be. Doctors use many methods to determine the severity of a brain injury, including the rate of recovery, the area of the brain affected, the response to treatment or rehabilitation, and the time following the injury when they are confused, disorientated and have a poor day-to-day memory (post-traumatic amnesia) 

    Treatment for acquired brain injury

    Children with an ABI are treated by a rehabilitation team, which may include doctors, nurses, occupational therapists, physiotherapists, social workers, speech pathologists, music therapists and psychologists. The team will work in partnership with your child and family to maximise recovery.

    The rate of recovery is different for everyone. For children with more severe ABI, recovery usually continues for several years following the injury, but is usually most rapid in the early weeks to months afterwards. 

    Key points to remember

    • After a brain injury, there may be changes that affect your child's physical function, cognition (thinking), personality, behaviour and communication.
    • A reliable way for doctors to determine the severity of a traumatic brain injury is to measure how long your child has post-traumatic amnesia (PTA).
    • Treatment for ABI is managed by a rehabilitation team. 
    • The recovery rate is different for each child and for a more severe injury recovery usually continues for many years.

    For more information

    Common questions our doctors are asked

    What can I do to help my child recover more quickly?

    Early on in your child’s recovery, you will meet with the rehabilitation team to talk about the best approach to helping your child recover. While each child is different, early recovery is generally assisted by having a low-stimulation environment (e.g. keeping the number of visitors in the room to a minimum). The rehabilitation physiotherapist and occupational therapist will help determine when it is safe for your child to start moving around, and the speech therapist determines when it is safe for them to take food by mouth.

    How will an ABI affect my child's development?

    This depends on the severity of the injury. Most children with a mild brain injury will make a full recovery, while others may have some ongoing problems with their balance and movement, or their thinking and learning.

    When will my child be able to return to school?

    The rehabilitation team will help your child return to school after their ABI. When first returning to school, the amount of school time is often reduced to a few hours a day. The amount of time is then slowly increased, depending on your child’s level of fatigue and ability to cope in the classroom. Some children may require additional support (e.g. a teacher’s aid or specialised equipment). The rehabilitation education consultant will assist you by being in contact with your school to provide information on what to expect when your child returns to school. They help to make the return to school process as smooth as possible for your child and your family.

    Developed by The Royal Children's Hospital Paediatric Rehabilitation Service. Adapted with permission from information provided by the Brain Injury Service at the Children's Hospital at Westmead. We acknowledge the input of RCH consumers and carers.

    Reviewed October 2018.

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit


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