AbstractThe researchers developed a brain injury screening tool—SAFE CHild—and educational materials appropriate for the parents of preschool-aged children. Implementation in pediatricians’ offices provided a means of identifying children who may be at risk for later academic, emotional, cognitive, behavioral, and social challenges associated with brain injury.

ParticipantsParticipants included 1,229 parents accompanying children to 6-month, 18-month, 30-month, and 48-month well-child check-ups in the offices of three pediatrician groups in a Midwestern metropolis.

SAFE CHild Screening Tool

Today’s date: Child’s date of birth: Gender: Male FemaleRelationship to child:Race: African American Caucasian Asian Hispanic Native American Other

Sickness Has your child ever had a seizure, high fever (greater than 104 degrees), meningitis, encephalitis, or loss of consciousness? Yes No

Accidents Has your child ever been in a car accident, experience a near drowning or suffocation, stopped breathing for one minute or longer, or sustained a blow to the head? Yes No

Falls Has your child ever fallen from a height greater than 18 inches (i.e., fallen down stairs, rolled off a changing table, fallen from playground equipment, fallen while climbing, or fallen when riding a tricycle/bike/scooter) resulting in a blow to the head? Yes No

Emergency Room Has your child required emergency medical attention because of a loss of consciousness or hit on the head? Yes No

CHanges If you answered YES to any of the questions, have you noticed any of the following changes in your child? Check all that apply:

Decreased strength Decreased coordinationDecreased sucking/swallowing Decreased ability to lift or hold headDecreased smiling/vocalization Decreased language/communicationDecreased tolerance to light Decreased appetiteFrequent rubbing of eyes/head Decreased ability to focusExtreme irritability Unequal size of pupils

ProceduresAll parents over a 6-month period who brought a child to a participating pediatrician’s office for a 6-month, 18-month, 30-month, or 48-month well-child check-up received a copy of the SAFE-CHild screening tool and the educational pamphlet. Parents responded to screening questions by marking appropriate yes/no boxes and making a checkmark next to any observed change(s) in their child. Upon completion, screening forms were returned to nursing staff and forwarded to the researchers for data entry and analysis. Parents were encouraged to discuss any questions or concerns about a possible BI sustained by their child with the pediatrician during the well-child check-up.

DiscussionAwareness about instances of possible BI is crucial to ensure children have the opportunity to reach their maximum potential regarding academic, cognitive, social, emotional, and behavioral development. Performing simple screening procedures on a routine basis during preschool years improves the likelihood that parents and professionals are aware of events potentially contributing to later developmental challenges. In particular, knowledge about possible instances of mild BI identified through administration of the SAFE CHild screen may alert parents and professionals about children at risk for cognitive and psychosocial challenges. This early identification and awareness is particularly important regarding BI, because effects of early neurological traumas often do not appear until several years later when children must synthesize, integrate, and manipulate substantial quantities of information in rapid and efficient manners.

Falls are the leading cause of traumatic brain injury in children between 0 and 4 years.

Play safely: Make sure playground equipment is properly designed and maintained, and have a safe, soft landing surface in case a child falls.Make home safety improvements: Install stair gates, guard rails, and guards on windows above ground level.Keep sports safe: Make sure your child wears a helmet when bike riding, skating, or playing active sports.Supervision is key: Always supervise a young child around stairs and playground equipment.

Brain injury looks different in every child. Have a doctor examine your child if any of the following changes persist after a blow to the head: decreased strength or coordination changes in sucking or swallowing decreased appetite decreased smiling, vocalizing or talking frequent rubbing of the eyes or head decreased ability to focus the eyes unequal pupil size increased sensitivity to light or sound extreme irritability

Sustaining multiple concussions is particularly dangerous to young children. Even when a blow to the head seems minor, a second equally-minor injury can have devastating results.

Keep a record of any injuries to the head that your child sustains. Symptoms of an early brain injury may not appear until a child reaches late elementary or middle school years.

Knowing how to prevent brain injuries helps keep children safe.Brain injury lasts a lifetime.

For more information:Nebraska Brain Injury Website -www.braininjury.ne.govBrain Injury Association of America - www.biausa.orgBrain Injury Assn.-NE - BIANE.orgBrainline - brainline.orgCenters for Disease Control - www.cdc.govHotline for Disability Services – 1-800-742-7594

Funded in part by TBI Implementation Partnership Grant #H21MC06758 from the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration, Maternal and Child Health Bureau. Contents are the responsibility of the authors and do not necessarily represent the official views of HHS. This brochure is in the public domain. Please duplicate and distribute widely. Developed by the NE Brain Injury Task Force for Children and Youth, TBI Implementation Partnership Grant.

SAFE CHild: Screening Preschool-aged Children for Possible Brain Injury

Holly Schifsky, Peggy Reisher, Lauren Pierce, Karen Hux, & Rosalie DymacekResults

Positive response to S, A, F, or E question: n = 385/1229; 31.33%.

Positive response to S, A, F, or E question and confirmation of one or more behavioral changes (i.e., CH question): n = 23/385; 1.87%.

•15 males and 8 females•56.52% of the positive screens identified a single change•21.74% identified 2 changes•8.70% identified 3 changes•4.35% identified 4, 7, or 12 changes

Frequency of Occurrence of Each SAFE CHild Change across 23 Positive Screens