{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T08:04:14Z","timestamp":1789718654310,"version":"4.0.1"},"reference-count":32,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Among children, infants and toddlers have some of the highest rates of traumatic brain injury (TBI), but longitudinal information on their developmental outcomes to guide postinjury surveillance is sparse.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate infants\u2019 and toddlers\u2019 development over 3 years following TBI compared with those with orthopedic injury (OI).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A longitudinal observational cohort study was conducted at 2 level 1 pediatric trauma centers from January 20, 2013, to September 30, 2015; data analysis was performed from May 12 to October 20, 2021. Participants included children injured when younger than 31 months with TBI or OI who received emergency department care.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Mild, moderate, or severe TBI or OI.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Parents completed baseline measures representing preinjury status and 3-, 12-, 24-, and 36-month postinjury status, using the Ages &amp;amp; Stages Questionnaire-3 (ASQ-3), with a mean reference value of 50 and higher scores indicating more advanced development. Linear mixed models characterized children\u2019s outcomes for each ASQ-3 domain after adjustment for baseline ASQ-3, injury severity and group, age, injury mechanism (abuse or not), sex, prematurity, family function, social capital, and time. Interactions with time were evaluated.<\/jats:p><\/jats:sec>Results<\/jats:title>Consent for participation was provided for 195 children; 184 parents (94%) completed a baseline survey. The cohort included 168 children who completed at least 1 follow-up survey: 48 (29%) mild; 54 (32%) complicated mild\/moderate; 21 (13%) severe TBI; and 45 (27%) orthopedic injury. The cohort included 95 boys (57%), 49% injured before age 1 year; and 13% injured by abuse. Mean (SD) age at the time of injury was 13.9 (9.4) months. At 36 months, children with mild or complicated mild\/moderate TBI performed similarly to children with OI across ASQ-3 domains. Children with severe TBI performed poorly as shown by negative mean differences in communication (\u20138.8; 95% CI, \u201313.8 to \u20133.8); gross motor (\u201310.1; 95% CI, \u201315.1 to \u20135.1); problem solving (\u20136.6; 95% CI, \u201311.2 to \u20131.9), and personal social (\u20136.3; 95% CI, \u201310.4 to \u20132.1) domains with little recovery over time. Children with abusive injury experienced decrements in ability over time in fine motor and personal social skills. Social capital was protective in communication (mean, 1.5; 95% CI, 0.3-2.7) and problem solving (mean, 1.2; 95% CI, 0.1-2.3) domains.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of children with TBI, children with severe injury showed little recovery. These findings suggest that early childhood intervention is needed, while children with milder injury remained on their developmental track and should continue routine developmental surveillance.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.51195","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T16:06:51Z","timestamp":1673971611000},"page":"e2251195","source":"Crossref","is-referenced-by-count":39,"title":["Longitudinal Developmental Outcomes of Infants and Toddlers With Traumatic Brain Injury"],"prefix":"10.1001","volume":"6","author":[{"given":"Heather T.","family":"Keenan","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Clark","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rich","family":"Holubkov","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Ewing-Cobbs","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Children\u2019s Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"issue":"2-3","key":"zoi221458r2","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1080\/87565641.2003.9651915","article-title":"Early brain injury in children: development and reorganization of cognitive function.","volume":"24","author":"Ewing-Cobbs","year":"2003","journal-title":"Dev Neuropsychol"},{"issue":"6","key":"zoi221458r3","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1542\/peds.2004-1728","article-title":"Functional plasticity or vulnerability after early brain injury?","volume":"116","author":"Anderson","year":"2005","journal-title":"Pediatrics"},{"issue":"2","key":"zoi221458r4","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1089\/neu.2018.5687","article-title":"Longitudinal developmental outcomes after traumatic brain injury in young children: are infants more vulnerable than toddlers?","volume":"36","author":"Keenan","year":"2019","journal-title":"J Neurotrauma"},{"issue":"1-2","key":"zoi221458r5","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1080\/87565641.2004.9651924","article-title":"Modeling of longitudinal academic achievement scores after pediatric traumatic brain injury.","volume":"25","author":"Ewing-Cobbs","year":"2004","journal-title":"Dev Neuropsychol"},{"issue":"4","key":"zoi221458r6","doi-asserted-by":"publisher","first-page":"287","DOI":"10.3171\/ped.2006.105.4.287","article-title":"Late intellectual and academic outcomes following traumatic brain injury sustained during early childhood.","volume":"105","author":"Ewing-Cobbs","year":"2006","journal-title":"J Neurosurg"},{"issue":"3","key":"zoi221458r7","doi-asserted-by":"publisher","first-page":"e616","DOI":"10.1542\/peds.2006-2313","article-title":"Neurodevelopmental consequences of early traumatic brain injury in 3-year-old children.","volume":"119","author":"Keenan","year":"2007","journal-title":"Pediatrics"},{"issue":"5","key":"zoi221458r8","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1001\/jama.290.5.621","article-title":"A population-based study of inflicted traumatic brain injury in young children.","volume":"290","author":"Keenan","year":"2003","journal-title":"JAMA"},{"issue":"2","key":"zoi221458r9","doi-asserted-by":"publisher","first-page":"e174","DOI":"10.1542\/peds.2004-2739","article-title":"Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy.","volume":"116","author":"Barlow","year":"2005","journal-title":"Pediatrics"},{"issue":"2","key":"zoi221458r10","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1542\/peds.2005-0979","article-title":"Child outcomes and family characteristics 1 year after severe inflicted or noninflicted traumatic brain injury.","volume":"117","author":"Keenan","year":"2006","journal-title":"Pediatrics"},{"issue":"2","key":"zoi221458r11","doi-asserted-by":"publisher","first-page":"E126","DOI":"10.1097\/HTR.0000000000000626","article-title":"Long-term intellectual function after traumatic brain injury in very young children.","volume":"36","author":"Crowe","year":"2021","journal-title":"J Head Trauma Rehabil"},{"issue":"4","key":"zoi221458r12","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1037\/neu0000618","article-title":"It\u2019s a matter of surgency: traumatic brain injury is associated with changes in preschoolers\u2019 temperament.","volume":"34","author":"S\u00e9guin","year":"2020","journal-title":"Neuropsychology"},{"issue":"1","key":"zoi221458r13","first-page":"50","article-title":"Persistent changes in child behavior after early mild traumatic brain injury.","volume":"45","author":"Gagner","year":"2020","journal-title":"J Pediatr Psychol"},{"issue":"9","key":"zoi221458r14","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1017\/S0033291717003221","article-title":"Behavioral consequences of mild traumatic brain injury in preschoolers.","volume":"48","author":"Gagner","year":"2018","journal-title":"Psychol Med"},{"issue":"12","key":"zoi221458r16","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"12","author":"von Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"1","key":"zoi221458r18","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/BF00274080","article-title":"Assessing the conscious level in infants and young children: a paediatric version of the Glasgow Coma Scale.","volume":"4","author":"Reilly","year":"1988","journal-title":"Childs Nerv Syst"},{"issue":"43","key":"zoi221458r20","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1080\/16501960410023877","article-title":"Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.","author":"Carroll","year":"2004","journal-title":"J Rehabil Med"},{"issue":"6","key":"zoi221458r21","doi-asserted-by":"publisher","first-page":"461","DOI":"10.3171\/PED\/2008\/1\/6\/461","article-title":"Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury.","volume":"1","author":"Levin","year":"2008","journal-title":"J Neurosurg Pediatr"},{"issue":"12","key":"zoi221458r22","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/j.injury.2006.07.009","article-title":"AIS 2005: a contemporary injury scale.","volume":"37","author":"Gennarelli","year":"2006","journal-title":"Injury"},{"issue":"5","key":"zoi221458r25","doi-asserted-by":"publisher","first-page":"e1468","DOI":"10.1542\/peds.2012-3313","article-title":"Validity of the ages and stages questionnaires in term and preterm infants.","volume":"131","author":"Schonhaut","year":"2013","journal-title":"Pediatrics"},{"key":"zoi221458r26","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1111\/j.1752-0606.1985.tb00028.x","article-title":"The McMaster family assessment device: reliability and validity.","volume":"11","author":"Miller","year":"1985","journal-title":"J Marital Fam Ther"},{"issue":"1, pt 1","key":"zoi221458r27","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1542\/peds.101.1.12","article-title":"Children who prosper in unfavorable environments: the relationship to social capital.","volume":"101","author":"Runyan","year":"1998","journal-title":"Pediatrics"},{"issue":"4","key":"zoi221458r29","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1007\/s11065-014-9261-x","article-title":"Functional plasticity in childhood brain disorders: when, what, how, and whom to assess.","volume":"24","author":"Dennis","year":"2014","journal-title":"Neuropsychol Rev"},{"issue":"5","key":"zoi221458r30","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1001\/jamapediatrics.2017.5746","article-title":"Secondary attention-deficit\/hyperactivity disorder in children and adolescents 5 to 10 years after traumatic brain injury.","volume":"172","author":"Narad","year":"2018","journal-title":"JAMA Pediatr"},{"issue":"3","key":"zoi221458r31","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/j.jpeds.2013.10.075","article-title":"Functional outcomes in children with abusive head trauma receiving inpatient rehabilitation compared with children with nonabusive head trauma.","volume":"164","author":"Risen","year":"2014","journal-title":"J Pediatr"},{"issue":"5","key":"zoi221458r32","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1177\/0706743716643741","article-title":"A systematic review of psychiatric, psychological, and behavioural outcomes following mild traumatic brain injury in children and adolescents.","volume":"61","author":"Emery","year":"2016","journal-title":"Can J Psychiatry"},{"key":"zoi221458r15","volume-title":"The ASQ Users Guide","author":"Squires","year":"2009"},{"key":"zoi221458r17","volume-title":"Central Nervous System Injury Surveillance Data Submission Standards: 2002","author":"Marr","year":"2004"},{"key":"zoi221458r23","volume-title":"Child Monitoring System for Social-Emotional Behavior","author":"Parent-Completed","year":"2002"},{"key":"zoi221458r24","volume-title":"Paul H","author":"Ages & Stages Questionnaires in Spanish","year":"2009"},{"key":"zoi221458r1","unstructured":"Centers for Disease Control and Prevention. Surveillance report of traumatic brain injury\u2013related hospitalizations and deaths by age group, sex, and mechanism of injury\u2014United States, 2016-2017. 2021. Accessed March 4, 2022. https:\/\/www.cdc.gov\/traumaticbraininjury\/pdf\/TBI-surveillance-report-2016-2017-508.pdf"},{"key":"zoi221458r19","unstructured":"Centers for Disease Control and Prevention. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. September 2003. Accessed March 4, 2022. https:\/\/www.cdc.gov\/traumaticbraininjury\/pdf\/mtbireport-a.pdf"},{"key":"zoi221458r28","unstructured":"United States Census Bureau. Poverty thresholds. Accessed January 18, 2022. https:\/\/www.census.gov\/data\/tables\/time-series\/demo\/income-poverty\/historical-poverty-thresholds.html"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2800486\/keenan_2023_oi_221458_1673285880.47275.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T16:07:03Z","timestamp":1673971623000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2800486"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.51195","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,17]]}}}