Acute Spinal Cord Injury (SCI) in Children
The spinal cord is a bundle of
nerves that carries messages between the brain and the rest of the body. It sends
from the brain to the body and carries sensory information from the skin, bones,
muscles, and organs back to the brain.
An acute spinal cord injury (SCI)
is when the spinal cord is damaged from an accident or other event. An SCI may be
bruise (contusion), a partial tear, or a complete tear (transection) in the spinal
SCI is a common cause of long-lasting (permanent) disability and death in children.
Acute SCI is a medical emergency.
There are many causes of SCI in children. The more common injuries occur when the
area of the spine or neck is bent or squeezed (compressed). This can happen from:
- A motor vehicle accident, or being hit
by a vehicle while walking
- Sports injury
- Diving accident
- Trampoline accident
- Gunshot or stab wound
- Infection that forms an area of damage
(abscess) on the spinal cord
- Injury that blocks circulation to the spinal cord
Symptoms vary depending on where
the spinal cord is injured. Symptoms can be different in each child. Right after a
spinal cord injury, a child may have spinal shock. This causes a loss or decrease
feeling, muscle movement, and reflexes. As swelling goes away, other symptoms may
Healthcare providers divide SCIs
into 2 types. They are based on the symptoms below the point of injury:
Complete injury. This means there is no movement or
feeling below the point of injury.
Incomplete injury. This means there is still some feeling
or movement below the point of injury.
The symptoms of SCI may
- Muscle weakness
- Loss of voluntary muscle movement in
the chest, arms, or legs
- Breathing problems
- Loss of feeling in the chest, arms,
legs, or buttocks
- Loss of bowel and bladder
- Poor blood pressure control, sweating,
shivering, and abnormal function of the stomach and intestines (abnormal autonomic
Symptoms depend on where the spinal
cord is injured. Injuries at any level can cause loss of bowel and bladder control.
Injury to neck (cervical). This can cause loss of muscle
function or strength in the arms and legs and loss of feeling below the point of
injury. This is called tetraplegia (formerly known as quadriplegia) with sensory
Injury to upper spinal cord (thoracic). This often causes
weak chest muscles. The child may need to be on a breathing machine (ventilator) to
help with breathing. There is usually loss of muscle control and sensation below the
level of the injury.
Injury to lower spinal cord (lumbar and sacral). This can
cause paralysis and loss of function in the legs. It can also cause loss of nerve
muscle control to the bladder, bowel, and sexual organs. This is called paraplegia.
The symptoms of SCI can be like
other health conditions. Make sure your child sees a healthcare provider for a
The healthcare provider will ask
about your child’s symptoms, health history, and recent injuries. The provider will
your child a physical exam. The full extent of the SCI may not be known right away.
child may also have tests, such as:
Blood tests. Samples of your child’s blood may be taken to
check for problems.
X-ray. This test uses electromagnetic energy beams to make
images of internal tissues, bones, and organs onto film.
CT scan. This test uses X-rays and a computer to make
detailed images of the body. A CT scan shows detailed images of any part of the body,
including the bones, muscles, fat, and organs. CT scans are more detailed than
MRI. This imaging test uses large magnets and a computer
to make detailed images of organs and tissues in the body. MRI usually provides
better pictures of the spinal cord than CT scans.
Myelogram. This test may be used when MRI can't be done. During it, a dye is injected into
the spinal fluid. X-rays are then taken of the spinal cord and nerves. The dye helps
show more detail in the images.
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.
SCI may first be treated at the scene of the accident or injury. This is done by keeping
the head and neck from moving. Treatment may also include:
- Close watch in the intensive care unit
- Medicines such as corticosteroids to
help decrease the swelling in the spinal cord or antibiotics to treat infection
- Help with breathing from a breathing machine (mechanical ventilator or respirator)
- A tube placed in the bladder (bladder catheter) to drain urine into a bag
- Feeding tube placed into the stomach through a nostril or through a cut in the belly
(abdomen) to give nutrition
- Surgery to check the cord, treat
broken backbones, release pressure from the injured area, remove infection, or to
manage other injuries
Recovery from SCI requires a
long-term stay in the hospital and rehabilitation (rehab). A team of healthcare
providers, nurses, and other specialists will watch and manage your child’s health.
- Heart function
- Blood pressure
- Body temperature
- Nutritional status
- Bladder and bowel function
- Uncontrolled muscle shaking (spasticity)
During rehab, physical, occupational, or speech therapists will work with your child.
Rehab focuses on preventing muscles from becoming weak (wasting) or stiffening (contracture).
Therapists work to retrain your child to use other muscles for tasks and mobility.
Talk with your child’s healthcare providers about the risks, benefits, and possible
side effects of all treatments.
Ongoing (chronic) problems can include:
Pressure sores. These are also called bedsores. They are
wounds caused by ongoing pressure on 1 area of the skin. The healthcare team will
show you how to prevent these by moving your child’s body every few hours.
Lung infection (pneumonia). This is treated with
Acute spinal cord injury can be
very upsetting to your child and to your whole family. Your child's healthcare team
teach family members how to best care for a child with SCI. They will note what problems
will need medical attention right away. Your child will need frequent healthcare visits
and tests over time to track their progress.
It is important to focus on
maximizing your child's abilities at home and in the community. You can encourage
child to strengthen their self-esteem and have independence.
When to Call a Healthcare Provider
Call the healthcare provider if your child has:
- Symptoms that don’t get better, or get worse
- New symptoms
- Acute spinal cord injury (SCI) is when
the spinal cord is damaged from an accident or other event. It is a medical
- There are many causes of SCI in children. The more common injuries occur from a fall,
accident, sports injury, or during birth.
- Symptoms vary depending on where the
spinal cord is injured. They can be different in each child.
- The full extent of the SCI may not be known right away. An MRI or CT scan may help
figure out the extent of the injury.
- Treatment may include help with
breathing from a breathing machine (mechanical ventilator or respirator).
- Your child's healthcare team will teach family members how to best care for a child
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a
new diagnosis and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.