Acute Spinal Cord Injury (SCI) in Children

The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body. It sends instructions from the brain to the body and carries sensory information from the skin, bones, muscles, and organs back to the brain.

An acute spinal cord injury (SCI) is when the spinal cord is damaged from an accident or other event. An SCI may be a bruise (contusion), a partial tear, or a complete tear (transection) in the spinal cord. SCI is a common cause of long-lasting (permanent) disability and death in children. Acute SCI is a medical emergency.

There are many causes of SCI in children. The more common injuries occur when the area of the spine or neck is bent or squeezed (compressed). This can happen from:

• Falls
• A motor vehicle accident, or being hit by a vehicle while walking
• Sports injury
• Diving accident
• Trampoline accident
• Gunshot or stab wound
• Infection that forms an area of damage (abscess) on the spinal cord
• Injury that blocks circulation to the spinal cord

Symptoms vary depending on where the spinal cord is injured. Symptoms can be different in each child. Right after a spinal cord injury, a child may have spinal shock. This causes a loss or decrease in feeling, muscle movement, and reflexes. As swelling goes away, other symptoms may occur.

Healthcare providers divide SCIs into two types. They are based on the symptoms below the point of injury:

• Complete injury. This means there is no movement or feeling below the point of injury.
• Incomplete injury. This means there is still some feeling or movement below the point of injury.

The symptoms of SCI may include:

• Muscle weakness
• Loss of voluntary muscle movement in the chest, arms, or legs
• Breathing problems
• Loss of feeling in the chest, arms, legs, or buttocks
• Loss of bowel and bladder function
• Poor blood pressure control, sweating, shivering, and abnormal function of the stomach and intestines (abnormal autonomic regulation)

Symptoms depend on where the spinal cord is injured. Injuries at any level can cause loss of bowel and bladder control. For example:

• Injury to neck (cervical). This can cause loss of muscle function or strength in the arms and legs and loss of feeling below the point of injury. This is called quadriplegia (or tetraplegia) if there is complete loss of function, or quadriparesis (or tetraparesis) if there is partial loss of function.
• Injury to upper spinal cord (thoracic). This often causes weak chest muscles. The child may need to be on a breathing machine (ventilator) to help with breathing. There is usually loss of muscle control and sensation below the level of the injury.
• Injury to lower spinal cord (lumbar and sacral). This can cause paralysis and loss of function in the legs. It can also cause loss of nerve and muscle control to the bladder, bowel, and sexual organs. This is called paraplegia if there is complete loss of function of the legs, and paraparesis if there is partial loss of function.

The symptoms of SCI can be like other health conditions. Make sure your child sees a healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms, health history, and recent injuries. The provider will give your child a physical exam. The full extent of the SCI may not be known right away. Your child may also have tests, such as:

• Blood tests. Samples of your child’s blood may be taken to check for problems.
• X-ray. This test uses electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.
• CT (computerized tomography) scan. This test uses X-rays and a computer to make detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
• MRI (magnetic resonance imaging). This imaging test uses large magnets and a computer to make detailed images of organs and tissues in the body. MRI usually provides better pictures of the spinal cord than CT scans.
• Myelogram. This test may be used when an MRI can't be done. During this test, a dye is injected into the spinal fluid. X-rays are then taken of the spinal cord and nerves. The dye helps show more detail in the images.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

SCI may first be treated at the scene of the accident or injury. This is done by keeping the head and neck from moving. Treatment may also include:

• Close watch in the intensive care unit
• Medicines such as corticosteroids to help decrease the swelling in the spinal cord or antibiotics to treat infection
• Help with breathing from a breathing machine (mechanical ventilator or respirator)
• A tube placed in the bladder (bladder catheter) to drain urine into a bag
• Feeding tube placed into the stomach through a nostril or through a cut in the belly (abdomen) to give nutrition
• Surgery to check the cord, treat broken backbones, release pressure from the injured area, remove infection, or to manage other injuries

Recovery from SCI requires a long-term stay in the hospital and rehabilitation (rehab). A team of healthcare providers, nurses, and other specialists will watch and manage your child’s health. This includes managing:

• Pain
• Heart function
• Blood pressure
• Body temperature
• Nutritional status
• Bladder and bowel function
• Uncontrolled muscle shaking (spasticity)                                                 

During rehab, physical, occupational, or speech therapists will work with your child. Rehab focuses on preventing muscles from becoming weak (wasting) or stiffening (contracture). Therapists work to retrain your child to use other muscles for tasks and mobility.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

Ongoing (chronic) problems can include:

• Pressure sores. These are also called bedsores. They are wounds caused by ongoing pressure on one area of the skin. The healthcare team will show you how to prevent these by moving your child’s body every few hours.
• Abnormal bowel and bladder function. This may result in incontinence and urinary infections. This is treated with bowel and bladder hygiene and medicines.
• Lung infection (pneumonia). This is treated with antibiotics.
• Pain. This is treated with pain medicines and surgery.
• Autonomic dysreflexia. This is when the nervous system sends abnormal signals to blood vessels. Blood pressure can get dangerously high. The higher the level of spinal cord injury, the more this is likely.

Acute spinal cord injury can be very upsetting to your child and to your whole family. Your child's healthcare team will teach family members how to best care for a child with SCI. They will note what problems will need medical attention right away. Your child will need frequent healthcare visits and tests over time to track their progress.

It is important to focus on maximizing your child's abilities at home and in the community. You can encourage your child to strengthen their self-esteem and have independence.

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms

• Acute spinal cord injury (SCI) is when the spinal cord is damaged from an accident or other event. It is a medical emergency.
• There are many causes of SCI in children. The more common injuries occur from a fall, accident, sports injury, or during birth.
• Symptoms vary depending on where the spinal cord is injured. They can be different in each child.
• The full extent of the SCI may not be known right away. An MRI or CT scan may help figure out the extent of the injury.
• Treatment may include help with breathing from a breathing machine (mechanical ventilator or respirator).
• Your child's healthcare team will teach family members how to best care for a child with SCI.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.