In this section
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.
In the acute/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 (see Kids Health Info factsheet Brain Injury - dysautonomia).
If a child has seizures soon after their brain
injury, they may be given anticonvulsants (usually phenytoin
or carbemazepine) 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
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.
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 doctor
(GP or specialist) what the side effects could be, and what
positive or negative effects you should look out for.
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.
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. Carbemazepine 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
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 (Amitryptiline) or the
SSRIs (such as Zoloft or fluoxetrene [Prozac]) may be useful.
All of the following conditions are best investigated by an
endocrinologist who can also start treatment for:
See Kids Health Info factsheet: Headaches in children and teenagers
See Kids Health Inof factsheet: Brain injury - Seizures after an acquired brain injury
Start by seeing your local doctor or
paediatrician who will be the best person to rule out other causes for
the irritability, headache, pain, etc. Your child may need to be seen by a rehabilitation specialist, neurologist or psychiatrist before
commencing specific medications.
Developed by the RCH Paediatric
Rehabilitation Service. First published in March 2007. Updated
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.