Minor head injury in children—out of sight but not out of mind

Mild head injury is a quiet disorder. It is common, typically bloodless and without call for significant medical intervention. It seems even more quiet because the noise it does make (its symptoms) is often attributed to other causes. Nevertheless the disruption in coping capacity and attendent breakdown in usual behavioral patterns causes more psychosocial and academic‐economic hardship than have begun to be appreciated. Cognitive mental changes such as impairment in attention, memory, and information processing even when mild and apparently transient can produce altered patterns of achievement and self confidence with long lived reverberations. Emotional irritability and lethargy also produce a chain of reactions likely to outlive the primary source of the disruption. Add to this decreased frustration tolerance, increased fatigability, lowered resilence to stress and uncertainty as to the origin of these difficulties and one has recipe for prolonged impairment. Place these ingredients into the person of a child, with all a child's limits on autonomy and verbal self report and the result is a myriad of reported and unreported social, academic and even familial disruptions exacerbated by the common clinical failure of identification of their correct underlying etiology.