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Health condition · Clinically reviewed

Brain injury in children and babies, from HIE and neonatal stroke to concussion and long-term rehab.

The developing brain is resilient and vulnerable in equal measure. Fast, specialist paediatric care and long-term multidisciplinary rehabilitation change outcomes.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, RCPCH, BPNA and specialist paediatric neurorehabilitation sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including therapeutic hypothermia for HIE, paediatric stroke pathways and concussion return-to-play.

Key facts

Paediatric brain injury at a glance.

The essentials, in plain English - the main causes, the urgent treatments, and the long-term picture.

  • What it is

    Any injury to the developing brain from perinatal, traumatic, infective, vascular, metabolic or hypoxic causes in babies, infants and children.

  • HIE and cooling

    Term neonates with moderate to severe hypoxic-ischaemic encephalopathy receive therapeutic hypothermia at 33 to 34C for 72 hours, started within 6 hours of birth.

  • Neonatal stroke

    Perinatal arterial ischaemic and cerebral sinovenous thrombosis present with seizures, apnoea or tone change and need urgent MRI.

  • IVH in prematures

    Intraventricular haemorrhage is graded Papile I to IV; grade III and IV risk post-haemorrhagic hydrocephalus and shunting.

  • Safeguarding is mandatory

    Any infant with head injury needs a safeguarding assessment, skeletal survey, retinal exam and social work review to exclude abusive head trauma.

  • Concussion recovery

    Relative rest then a graded five-day symptom-free return to school and sport under the Concussion in Sport Group protocol.

Why this guide matters

Ten pathways, one principle - fast specialist care.

Perinatal HIE, neonatal stroke, IVH, TBI, post-infectious injury, childhood stroke, tumour, hydrocephalus, prolonged seizures and inherited metabolic disease all sit on the same specialist pathway.

  • Perinatal - HIE and cooling

    Term neonates with moderate to severe HIE need therapeutic hypothermia at 33 to 34C for 72 hours, started within 6 hours of birth, in a specialist cooling NICU.

  • Trauma - safeguarding is mandatory

    Any infant with a head injury needs a safeguarding assessment - skeletal survey, retinal exam, social work and child protection notification to exclude abusive head trauma.

  • Long-term - multidisciplinary rehab

    Specialist paediatric neurorehabilitation - physio, OT, SLT, neuropsychology, education and family support - is the single biggest driver of long-term outcome.

How the diagnosis is made

From first presentation to a specialist plan.

The steps a UK paediatric neurology or PICU team will normally follow - so you know what to expect and why.

  1. 01

    Assessing

    Urgent specialist review

    Paediatric neurology, neurosurgery and PICU at a specialist paediatric centre coordinate acute care.

  2. 02

    Assessing

    Imaging - stepped approach

    Cranial ultrasound in the neonate, non-contrast CT in the emergency setting, and MRI as the gold standard for detail.

  3. 03

    Assessing

    EEG for seizures

    For clinical or subclinical seizures and for staging encephalopathy - continuous or amplitude-integrated EEG in the neonate.

  4. 04

    Confirming

    Infection and metabolic workup

    Lumbar puncture, blood cultures, viral PCR including herpes, and the neonatal metabolic screen where indicated.

  5. 05

    Confirming

    Safeguarding assessment

    Mandatory in infant traumatic brain injury - skeletal survey, retinal examination, social work and child protection notification.

  6. 06

    Planning

    Developmental and neuropsychology

    Structured developmental assessment and paediatric neuropsychology guide rehabilitation and education planning.

  7. 07

    Planning

    Selective genetic testing

    For suspected leukodystrophies, mitochondrial disease or urea cycle disorders - whole exome sequencing where appropriate.

Typical timeline: acute care in hours, subacute investigation in days, rehab planning in weeks.

Symptoms

What paediatric brain injury actually looks like.

Presentation depends on age, cause and severity. Neonates show seizures and tone change; infants bulging fontanelle and irritability; older children headache, focal deficit and behavioural change.

  • Neonatal seizures and apnoea

    Subtle eye deviation, cycling, apnoea or tone change in the first days of life - always investigate urgently.

  • Bulging fontanelle

    A tense or bulging anterior fontanelle in an infant suggests raised intracranial pressure - hydrocephalus, IVH or infection.

  • Vomiting and irritability

    Persistent vomiting, irritability, poor feeding or a high-pitched cry in an infant warrants urgent assessment.

  • Reduced consciousness

    A drowsy child, a GCS drop or a change in arousal after a head injury is an emergency - go to hospital.

  • Focal neurology

    A weak arm or leg, facial droop, new squint or unequal pupils can signal stroke, haemorrhage or a mass effect.

  • Headache and behavioural change

    A new persistent headache, personality change or developmental regression in an older child needs review.

  • Concussion symptoms

    Headache, confusion, amnesia, dizziness, loss of consciousness, emotional lability and sleep disturbance after impact.

  • Red flag - status epilepticus

    Any seizure lasting more than five minutes, or repeated seizures without recovery, is a medical emergency.

Treatment

How paediatric brain injury is treated in the UK.

Acute PICU stabilisation, cause-specific interventions - cooling for HIE, surgery for haematoma, shunt for hydrocephalus - then specialist paediatric neurorehabilitation.

  • PICU stabilisation

    Airway, ventilation, circulation, ICP management, normothermia, normoglycaemia and normocarbia in a specialist paediatric intensive care unit.

  • Therapeutic hypothermia (HIE)

    Cooling to 33 to 34C for 72 hours, started within 6 hours of birth, for term neonates with moderate to severe HIE.

  • Seizure control

    Phenobarbital, levetiracetam and midazolam infusion protocols - tailored to age and cause, with continuous EEG in the neonate.

  • Neurosurgery

    Evacuation of expanding haematoma, elevation of depressed fractures, decompressive craniectomy and invasive ICP monitoring (Camino or Codman).

  • Shunt for hydrocephalus

    Ventriculoperitoneal shunt or endoscopic third ventriculostomy for progressive post-haemorrhagic or congenital hydrocephalus.

  • Paediatric stroke care

    Specialist paediatric stroke centre input - supportive care, selective antiplatelet or anticoagulation, and transfusion or hydroxycarbamide for sickle cell.

  • Concussion return-to-play

    Relative rest then a graded five-day symptom-free progression through school and sport under the Concussion in Sport Group and IRB protocol.

  • Specialist neurorehabilitation

    Multidisciplinary paediatric neurorehab - physio, OT, SLT, neuropsychology, education and social work - with long-term family support.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your paediatric neurology team knows your child and can tell you which parts apply. If you are worried about a child, seek urgent medical help.

  • NICE. Head injury: assessment and early management (NG232).

  • BAPM and NICE. Therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy.

  • Royal College of Paediatrics and Child Health (RCPCH). Stroke in childhood - clinical guideline for diagnosis, management and rehabilitation.

  • British Paediatric Neurology Association (BPNA). Paediatric neurology standards.

  • Concussion in Sport Group (CISG) and World Rugby. Consensus statement on concussion in sport and graded return protocols.

  • RCPCH and Child Safeguarding Practice Review Panel. Guidance on abusive head trauma in infants.

Red flags

When paediatric brain injury needs urgent attention.

These are the situations where minutes matter - call 999 or go straight to a paediatric emergency department.

  • Suspected abusive head trauma

    Any infant with unexplained head injury, retinal haemorrhages or subdural bleeds needs urgent safeguarding review - skeletal survey, social work and police notification.

  • Status epilepticus

    Seizure longer than five minutes or repeated seizures without recovery - emergency treatment and PICU review.

  • GCS 8 or less

    Severe traumatic brain injury - airway protection, intubation, urgent CT, neurosurgical review and PICU admission.

  • Signs of raised intracranial pressure

    Bulging fontanelle, worsening headache, vomiting, drowsiness, unequal pupils or Cushing response - immediate imaging and neurosurgery.

  • Neonatal seizures

    Any seizure in a neonate - urgent EEG, imaging, infection and metabolic workup, and specialist neonatology review.

  • Sickle cell and stroke

    Focal neurology in a child with sickle cell disease - urgent MRI and consideration of exchange transfusion.

  • Meningitis or encephalitis

    Fever with reduced consciousness, seizures or focal neurology - urgent antibiotics, aciclovir and lumbar puncture.

  • Second-impact concussion risk

    A second head injury before full concussion recovery risks catastrophic brain swelling - no same-day return to play.

  • Developmental regression

    New loss of skills, especially in a young child - consider leukodystrophy, mitochondrial disease or urea cycle disorder.

Living with it

Rehab, school, family and the long view.

Recovery from a childhood brain injury is a marathon. Specialist rehab, education planning and family support carry a family through the years that follow.

A quiet reminder

Small gains compound over years.

The developing brain rewards persistence - specialist multidisciplinary rehab, kept up over months and years, changes outcomes.

  1. 01 Rehab

    Multidisciplinary from day one

    Physio, OT, SLT, neuropsychology and education working together at a specialist paediatric neurorehabilitation centre.

  2. 02 School

    Education plan and EHCP

    A Statement or Education, Health and Care Plan brings tailored support - request assessment early and review often.

  3. 03 Family

    Support for the whole family

    Charities like Cerebra, The Children’s Trust, Brain and Spine Foundation, Sibs, Contact and Different Strokes offer real help.

  4. 04 Transition

    Plan for adult services

    Start transition planning early - lifelong follow-up, Access to Work and adult neurorehab keep gains going.

Frequently asked

Everything families ask about paediatric brain injury.

Quick answers on HIE cooling, concussion recovery, IVH, safeguarding and long-term support.

  • What is brain injury in children and babies?

    It is any injury to the developing brain from perinatal causes (HIE, neonatal stroke, IVH), trauma (falls, sport, road traffic, abusive head trauma), infection (meningitis, encephalitis), stroke, tumour, hydrocephalus, prolonged seizures or inherited metabolic disease. Outcomes depend on age, mechanism and severity and on how quickly specialist care is started.

  • What is HIE and why does cooling matter?

    Hypoxic-ischaemic encephalopathy is brain injury from a lack of oxygen and blood flow around birth. It is staged using the Sarnat system. Term neonates with moderate to severe HIE benefit from therapeutic hypothermia at 33 to 34C for 72 hours, started within 6 hours of birth, in a specialist neonatal cooling centre. Cooling reduces death and disability.

  • How is a child with a head injury assessed?

    Assessment follows NICE head injury guidance - Glasgow Coma Scale, mechanism, symptoms and risk factors. Mild injury is GCS 13 to 15, moderate 9 to 12 and severe 8 or less. CT is used urgently when indicated, MRI gives more detail, and infants always need a safeguarding assessment to exclude abusive head trauma.

  • When can my child go back to sport after concussion?

    After relative rest and once symptoms have settled, a graded five-day symptom-free return to school then sport is followed, based on the Concussion in Sport Group and World Rugby protocol. No return to play on the same day. A specialist concussion clinic can help if symptoms persist beyond four weeks.

  • What is IVH and when does it need a shunt?

    Intraventricular haemorrhage is bleeding in the ventricles, most common in premature babies and graded Papile I to IV. Grade III and IV can cause post-haemorrhagic hydrocephalus, which sometimes needs a ventriculoperitoneal shunt or endoscopic third ventriculostomy. Care sits with specialist neonatology and paediatric neurosurgery.

  • What long-term support is available?

    Specialist paediatric neurorehabilitation centres (Great Ormond Street, Alder Hey, Sheffield, Ryegate, Chailey Heritage, Percy Hedley, The Children’s Trust Tadworth and others) provide multidisciplinary care. Statements or EHCPs support school. Charities like Cerebra, Brain and Spine Foundation, Sibs, Contact and Different Strokes support families, and transition to adult services should be planned early.

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