Some medications can be extremely helpful for people who have had a brain injury. The amount and type of medication your child is given will depend on the stage of their brain injury. During an intensive care unit admission, children are often given many medications. These medications are stopped as soon as it is safe to do so. The aim is for children to be on as few medications as they need.

Intensive care or early stages medications

In the acute or early stages after a brain injury, children may need to be sedated using medications such as anaesthetics, morphine and midazolam. Sedation helps to protect the brain from agitation and restlessness. Agitation raises the pressure inside the skull and is not good for the injured brain. Some children require medications to control their blood pressure (eg beta blockers or clonidine) because the internal control mechanisms located in the brain are temporarily out of order.

If a child has seizures soon after their brain injury, they may be given anticonvulsants (usually phenytoin or carbamazepine) and these medications may be continued for a number of months. The child may be weaned off the medication after a period of time but only if they have not had any further seizures. Other children have anticonvulsant medication in the early days after a brain injury to protect against having a seizure. This is usually stopped before the children go home, provided that no seizures have occurred.

If a child has a lot of difficulty with muscle stiffness or spasticity, oral medications such as diazepam, baclofen or dantrolene sodium may be used. In rare instances, botulinum toxin injections can also be used to relieve localised areas of extreme stiffness. 

Medications after discharge

Once discharged from hospital, only a few children need ongoing medications related to their brain injury. Before starting any medication, check with your child's GP or specialist what the side effects could be, and what positive or negative effects you should look out for .

Problems that may respond to medication

Attention and concentration problems

After a brain injury, some children will have difficulty with attention, concentration and distractibility. Many strategies can be used at home and in the classroom to help children with these problems before you consider medication.

Some children respond to stimulant medications such as dexamphetamine or methylphenidate. This should be trialed with careful assessments to ensure your child responds well to the medication. Involving your child's teacher in this medication trial is also important.

If your child's attention and concentration improve on stimulant medication then it is worth staying on the medication for a reasonable amount of time (eg 12 months) to make the most of this benefit. Some children take stimulant medication for many years with no long-term side effects.

Common side effects of stimulant medications include nausea, abdominal pain, anorexia (poor appetite), sometimes weight loss and difficulty sleeping. The side effects are minimised by increasing the dose slowly and giving the medication early in the day.

Irritability or moodiness

Some children are extremely irritable after a brain injury. It is important to determine if this is due to an inability to control their impulses, or if it is a sign of depression. 

In this situation, some of the anticonvulsant medications have an additional beneficial effect of being a mood stabiliser. Carbamazepine or sodium valproate are the most commonly used drugs. Both of these medications can be very effective and are worth trying when behavioural, psychological and environmental adjustments have not helped. These children usually start on a lower dose than what is used for seizures. If the medication is helpful it should be continued for at least six months.

These medications are usually very well tolerated by children. Side effects are varied and may include rash, nausea, weight loss or gain and vomiting. If behavioural difficulties continue, or you suspect depression as a cause of your child's irritability, then consultation with a child psychiatrist is often required. Antidepressant medications (amitriptyline) or SSRIs (such as sertraline or fluoxetrene) may be useful.

Hormonal problems/pituitary failure

All of the following conditions are best investigated by an endocrinologist who can also start treatment for:

• Precocious (or early onset) puberty - which can occur if a child has had a significant brain injury before the onset of puberty
• Diabetes insipidus - excessive drinking and passing of urine which requires hormone replacement to restore the body's ability to conserve water
• Thyroid problems - which can occur early on and are best detected with a blood test
• Short stature or growth failure - which becomes apparent with time and regular height and weight measurements

Headache

More information about headaches can be found in our Kids Health Info fact sheet,  Headaches in children and teenagers.

Post traumatic seizures/epilepsy

For more information about seizures after an acquired brain injury, please see the Brain injury - Seizures after an acquired brain injury Kids Health Info fact sheet.

When to see a doctor?

Your GP or paediatrician will be the best person to rule out other causes for irritability, headache and pain. Your child may need to be seen by a rehabilitation specialist, neurologist or psychiatrist before commencing specific medications.

Key points to remember

• The type of medication your child is prescribed will depend on what problems they are experiencing following their brain injury.
• Common problems that often respond well to medication are headaches, seizures/epilepsy, irritability, attention/concentration and hormonal problems.
• Speak to your child's paediatrician, GP or pharmacist if you have any queries or concerns about your child's medications.

For more information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  Flemington Rd, Parkville, 3052
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
  

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service. We acknowledge the input of RCH consumers and carers.

Reviewed August 2020.

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