TEMPO Ch7 Paeds Rehabilitation

The adult rehabilitation section should be read alongside this guidance as many of the overriding principles are relevant to children.

Children have ongoing developmental needs. The goal of paediatric rehabilitation is not just to return to pre-injury levels of functioning, but for the child to continue learning new skills.
Children should be cared for within a specialised designated service which meets their complex and rapidly changing rehabilitation needs.
It is essential to have an identified lead consultant (likely a paediatrician) to co-ordinate care and liaise with other specialists as required.
All staff across each discipline must be able to understand and manage developmental change within the context of the recovery process.

In some instance, the child may not be the only member of the family injured.
A holistic approach to the needs of the family is essential and the whole family should be kept informed at every stage and involved in any decision making.
It has been shown that good, high quality support for and with the parents is likely to improve outcomes for children as they grow up.

From the outset, every injured child should have a rehabilitation prescription tailored to their needs and should involve co-ordination of care between the hospital, local services and the community team.
All services should be involved from an early stage, including education, educational psychology, social care, psychology, physiotherapy, speech and language, occupational therapy and primary care.
Definitive planned surgery for amputations should be performed in consultation with the consultant in rehabilitation medicine and prosthetic services, allowing pre-amputation discussion with the child (if appropriate) and parents.
Early discharge planning, in consultation with the local hospital and community team, is the key to effective and seamless transfer of care.

Cognitive, emotional and behavioural problems may become worse at times of change.
Further assessment and rehabilitation will become essential during transition between schools and different education systems, particularly moving from primary to secondary education.
It is also important to ensure seamless transition from paediatric to adult services by planning ahead as this can be a very stressful time for the family.
It may be necessary to continue rehabilitation prescription until early adulthood in order to meet the needs of an individual.
Continued liaison should ensure continuity of care and ideally a key worker allocated prior to discharge from hospital.

Unlike adults, children who make good recovery from impairment for a specific time should not be discharged from the rehabilitation prescription; brain development is not complete until around the age of 22 and many acquired injuries may not show themselves for several years.
Children and young people often go on to develop cognitive, emotional and behaviour problems several years after the initial injury as they move from childhood to adolescence to adulthood.

Child Brain Injury Trust
www.childbraininjurytrust.org.uk
Helpline: 0303 303 2248
email: helpline@cbituk.org

Headway
www.headway.org.uk
Helpline: 0808 800 2244
email: helpline@headway.org.uk

The Childrens Trust Brain Injury Hub
https://www.braininjuryhub.co.uk/
Tel: 01737 365 000