General considerations

• It is important to recognise that the parents are experts on their child. It is also important to acknowledge their need for information. The presence of families who are well informed and participating in care is beneficial to the recovery of the child.
• In some instances the child may not be the only member of the family to be seriously injured.
• Even when the family are physically unharmed, the psychological impact is widespread and long-lasting.
• It is well recognised that children who suffer major trauma often have learning or behavioural difficulties and some come from dysfunctional families. Such parents may have poor coping mechanisms. This impacts on parents’ relationships with staff caring for the child and they will require additional resources to help these families.

Clinical management issues to consider

• It is essential that there is an identified lead consultant to co-ordinate care (likely to be a paediatrician), liaising with other paediatric experts as necessary, eg. other paediatricians, paediatric neurologists, neuropsychologists and paediatric (general / neuro / orthopaedic) surgeons.
• 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.
• Neuropsychology services should be readily accessible for children and young people with traumatic brain injury, to assess the degree or neurological damage and its impact on learning, memory and mental health. Programmes should then be based on these assessments to improve function in these areas and to provide liaison with educational psychology services and local clinical psychology services for ongoing rehabilitation.
• A Counsellor or social worker support should be available to liaise with and support families throughout the child’s pathway of care.

Discharge planning

• Re-integration is paramount for children following major trauma and traumatic brain injury. Early and regular contact should be made with the local paediatrician, general practitioner and community multidisciplinary team so they can be involved in planning the long-term care of the child from an early stage. This must be an inclusive process involving all services and health professionals involved in the child’s care. The rehabilitation team should advise on school needs and liaise with school services.
• Essential rehabilitation equipment, including wheelchairs and mobility devices, should be made available as soon as possible.