As many as 3 of every 1,000 babies carried to term will be affected by brain injuries, according to New York Times health reporter Jane Brody. But the immediate effects of brain damage can be difficult to identify, and will vary depending on how – and how much – a child’s brain has been harmed. In this article, we’ll cover some of the most common signs and symptoms of brain damage in infants.
Signs Of Brain Damage From Lack Of Oxygen
Most newborn brain injuries are sustained when an infant’s oxygen supply is cut off during or shortly before delivery. Usually, this type of brain damage – known as hypoxic-ischemic encephalopathy – won’t make itself known as obvious head trauma. Instead, doctors will watch for abnormalities in a child’s behavior and organ function.
The brain, of course, is responsible for controlling nearly everything that happens in the human body. As a result, we’re looking not so much for direct signs of physical trauma, but for problems in activities and bodily functions that the brain makes possible.
Low Apgar Scores
Doctors use a simple test to monitor a child’s general health immediately after birth. The Apgar score was developed in 1952, and it’s still used as a quick method of gauging a newborn’s overall health. In most delivery rooms, obstetricians will measure an infant’s Apgar score at one minute after birth, and then complete a follow-up exam five minutes after birth.
- A – Appearance
Babies with poor circulation often have a condition called cyanosis – blue or pale skin. This coloration is a sign that oxygenated blood isn’t reaching every part of the circulatory system properly. For the purposes of an Apgar score, infants with bluer skin will receive lower scores, while children with normal coloration will receive high scores.
- P – Pulse Rate
Doctors closely monitor a baby’s heartbeat within the first minutes of life. Infants with pulses within a normal range, over 100 beats per minute, will receive higher scores on the Apgar test. Children with abnormally low – or entirely absent – pulses receive low scores.
- G – Grimace (or “reflex irritability”)
How does the child respond to stimulation? When stimulated, usually with a light pinch, healthy newborns will grimace reflexively, and often cough, sneeze or begin to cry. A response like that will garner a higher score, while impaired or absent reflex responses warrant a lower score.
- A – Activity
Muscle tone – whether or not a child’s muscles are appropriately “tense” – is measured by observing an infant’s movements. Children who appear to have “loose” or “floppy” muscles will score low on this particular metric, while infants who move actively will score high.
- R – Respiration
As a final test, obstetricians will monitor a child’s ability to breathe. Infants with a strong cry will score high, while babies who aren’t breathing at birth, along with children who cry weakly, whimper or grunt will receive low scores.
Lots of children will receive low Apgar scores at the one-minute mark, but then quickly improve by five minutes. Change – or lack of change – is what we’re really trying to monitor here. An Apgar score that stays low over time – between 10 and 30 minutes after delivery – can be a possible sign of neurological injury.
Doctors don’t use the Apgar test to diagnose medical conditions or predict long-term health consequences. Instead, a child’s Apgar score will indicate whether or not immediate medical attention is necessary. Conclusive diagnosis comes later.
Abnormalities In Behavior & Bodily Function
In reviewing the Apgar test, we’ve already touched on many of the common signs of brain damage in infants:
- abnormalities in muscular function, like low muscle tone
- impairments in reflex response, or absent reflexes
- weak or absent cry after birth
- difficulty breathing
- circulatory problems, like low blood pressure
In the above list, we outlined some of the most common indirect signs and symptoms of infant brain damage. But it’s important to note that most – if not all – of these potential warning signs aren’t just symptoms of neonatal brain injuries. They can also lead to further brain damage.
There’s a feedback loop between the symptoms of a brain injury and the injury itself. Experiencing seizures, or having difficulty breathing, can damage brain cells even more.
Breathing, for example, is perhaps the most vital bodily function. Almost every cell in the body requires a fairly constant supply of oxygen to survive. In severe cases of oxygen deprivation, an infant may fail to start breathing immediately after delivery and need to be resuscitated. Apnea – when an infant stops breathing for prolonged periods of time – is a related symptom that may also indicate brain injury.
Seizures are common in babies who have suffered severe brain injuries during or shortly before the delivery process. A seizure is caused by an abnormal discharge of electricity within the brain. Experiencing seizures within the first 48 hours of birth is often the only sign that an infant has sustained a brain injury, according to the editors at Medscape.
Signs Of Head Trauma In Infants
Some babies will suffer brain damage due to mechanical trauma. In newborns, traumatic head injuries are rare, but become more likely in assisted deliveries – when obstetricians use forceps or vacuum machines to pull a child through the birth canal.
In these cases, signs of potential brain damage can be immediately apparent after birth. Serious head trauma, for example, can be obvious on visible inspection alone – as injuries, bruising, bleeding or brain swelling in babies. But again, cases of direct physical trauma – severe enough to cause brain damage – are extremely rare.
How Do You Know If Your Baby Has Brain Damage?
Doctors use a battery of diagnostic tests to monitor an infant’s brain functioning and confirm a suspected brain injury. For a conclusive diagnosis, parents will have to wait – which can be a terrifying process. But a family shouldn’t have to wait long. Prompt diagnosis is extremely important. Some of the most effective treatments for brain injury – like hypothermia therapy – need to be initiated within hours of a child’s birth.
In the first hours of life, parents should watch for the following potential signs of a brain injury:
- your child wasn’t breathing immediately after birth
- your baby has experienced apnea – intermittent periods during which their breathing stops
- your child was placed on a mechanical ventilator shortly after birth
- your child experienced seizures during the first 48 hours of life
- your baby’s reflexes seemed slow or impaired in some way
- your child’s movements seemed loose or stiff
None of these signs and symptoms are conclusive evidence that an infant has suffered brain damage. The warning signs, however, are extremely important in clinical practice, since newborns who have sustained brain injuries require immediate medical interventions. Doctors will usually use CT or MRI scans to confirm a child’s condition, and gain crucial insights on the extent of brain damage.
To complicate the picture, some effects of early brain trauma won’t become apparent until later in a child’s life. Babies aren’t born with fully-developed brains. As the brain develops, it takes on more and more complex responsibilities. Thus, an injury sustained in early life may only become clear after months or years of growth, even though it wasn’t obvious from the start.