Fact Sheet: Pediatric Spinal Cord Injury

Spinal cord injuries (SCIs) during childhood or adolescence produce sudden, dramatic changes in physical abilities that can impact virtually every area of a child’s life. Sequelae of a SCI include paralysis, loss of sensation, and bladder, bowel, sexual and autonomic dysfunction, along with the risk of numerous medical complications.  

Prevalence and Course

In the United States, approximately 12,000 new cases of SCI are reported each year, with an estimated 265,000 persons currently living with SCI. Approximately 20 percent of traumatic SCIs occur in individuals younger than 21 years of age, with 3 percent to 5 percent occurring in those younger than 15. The most common etiologies include motor vehicle crashes, violence and sports. In addition to the frequent complications of SCI in adulthood (e.g., pressure ulcers and autonomic dysreflexia), children with SCI also may experience unique complications such as hypercalcemia, scoliosis, and hip dysplasia. Life expectancy is a function of neurological level and category, with longer survival in those with less severe lesions. The most common causes of death in pediatric-onset SCI are pneumonia, accidents and cardiovascular conditions.

Health and Psychosocial Consequences

During acute treatment and sometimes after, children with SCI are removed from the social context of school and peers and community activities that had previously contributed to their sense of normalcy and identity. Youth with SCI are at an increased risk for symptoms of depression and anxiety, identity struggles and poor health-related quality of life. Individuals with pediatric-onset SCI may also face health system discontinuities, such as the transition from pediatric medical care to adult care.

Evidence-based Assessment

The standard neurological assessment of individuals with SCI is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), acceptable for children 8 years of age and older. Other relevant domains of assessment include adjustment / coping; anxiety and depressive symptoms; posttraumatic stress disorder; neuropsychological functioning; pain; sleep behaviors; substance use; self-identity and relational issues; health behaviors; vocational issues; and participation.

Culture, Diversity, Demographic and Developmental Factors

Males are more likely to sustain SCIs during adolescence than females. Violence-related SCIs are more common in males, individuals from lower socioeconomic groups, and in African-American and Hispanic youth, among whom more than 50 percent of SCIs are caused by violence.

Evidence-based Interventions

Data regarding effective treatments are sparse in the adult population and lacking in the pediatric population. The American Spinal Injury Association (ASIA) is currently establishing evidence-based practice guidelines for rehabilitation of children and adolescents with SCI. Current adult treatment recommendations are to apply evidence based treatment (e.g., cognitive-behavioral therapies) from appropriate comparison groups. Within the pediatric population, it is also critical to involve family members, particularly caregivers, who are also at increased risk for mental health problems.   

References

Alexander, M.S., Anderson, K.D., Biering-Sorensen, F., Blight, A.R., Brannon, R., Bryce, T.N., et al. (2009). Outcome measures in spinal cord injury: recent assessments and recommendations for future directions. Spinal Cord, 47(8), 582-591.

DeVivo, M.J., & Chen, Y. (2011). Trends in new injuries, prevalent cases, and aging with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 92(3), 332-338.

Garma, S., Kelly, E.H., Daharsh, E.Z., & Vogel, L.C. (2010). Health-related quality of life after pediatric spinal cord injury. Journal of Pediatric Psychology, 36(2), 226-236.

Vogel, L., & DeVivo, M. (1997). Pediatric spinal cord injury issues: etiology, demographics, and pathophysiology. Topics in Spinal Cord Injury Rehabilitation 3, 1-8.

Zebracki, K., & Vogel, L. (in press). Epidemiology of childhood-onset spinal cord injuries in the United States. In V. Rahimi-Movaghar, S. Jazayeri & A. Vaccaro (Eds.), Epidemiology of spinal cord injuries. Hauppauge, NY: Nova Science Publishers, Inc.