FamilyOfaVet - Real world info about PTSD, TBI, & life after combat
FamilyOfaVet - Real World info about PTSD, TBI, & life after combat.
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Explaining TBI to Children

Explaining “invisible injuries” such a Traumatic Brain Injury, or TBI, to a child can be a
difficult task.  Often an individual with TBI exhibits a wide range of symptoms (i.e.
forgetfulness, changes in mood or personality, anger, etc.) but appears unchanged
physically.  To children, especially younger children, this can be both confusing and

While it may be a difficult concept to explain, it is extremely important that children of all
ages be informed about
TBI and its affects. Even the youngest of children are able to
sense the changes and stresses TBI can cause in a family.  Efforts to protect your child by
withholding information may simply backfire. Children can have very active imaginations
and may make up a scenario to explain the situation around him that is worse than reality.
Thus, it is essential that every family member be well educated about TBI.

The first step in deciding how to explain TBI is to determine how much and what type of
information your child will be able to understand and process.  This can vary given a child’s
age and maturity.  Therefore, each parent and family must decide how best to manage the
information given to each individual child.  Below are some general tips on how to explain
TBI to children in different age groups.  

Age 2-3:  

At this age children can identify most facial expressions of emotions and understand simple
and concrete concepts and objects.  Your child will be tuned-in to the stress levels and
emotional undertones of the household. They will be able to instinctively pick up on
changes in parental mood, behavior and anxiety. Therefore, these changes in other family
members may cause a stress reaction in the child.  

To explain Traumatic Brain Injury, be sure to use simple words and pictures when
appropriate.  You may wish to create a picture book explaining different scenarios they
might encounter.  For example, make a picture book depicting ‘Daddy’s trip to the doctor’,
or explaining ‘Why Mommy needs to rest.’ Seeing these things depicted in a picture story,
may help your child process new routines and situations when they arise.

Be on the lookout for signs of stress.  At this age a child’s inner feelings will often be
expressed through changes in temperament and behavior.  Things to watch for include:
increased clinginess, crying or whining; greater fear of separation from parent or other
primary caregiver; increase in aggressive behaviors; withdrawal or lack of interest in
favorite activities or interactions with familiar individuals; changes in sleeping or eating
habits; a return to earlier behaviors (e.g. toileting accidents, waking up at night, or thumb

Age 4-6:

At this age children generally have the ability to understand slightly more abstract
concepts. They will start to empathize with others, and regularly engage in pretend play or
“what if” scenarios.  However, it still may be difficult for a child to grasp a concept of an
“invisible” injury or illness, such as a

For this age group, be sure to use concrete examples whenever possible.  You may want
to explain TBI using scenarios familiar to your child.  For example you may tell your child
that a
Traumatic Brain Injury is a “hurt on the inside, like a stomach ache”.  Additionally,
be sure to prepare your child for specific changes in their parent’s behavior.  Explanations
such as, “Daddy may have trouble saying things because his brain was hurt”; “Mommy’s
medicine helps her to get better but makes her sleepy;” and “I know your Dad doesn’t smile
as much, but he still loves you,” can help explain the situation to children, validate any
confusion they may be having, and ensure them that they are not to blame for the changes
in their parent.  Finally, provide opportunities for your child to act out new environmental
situations in their daily routines and play.  You may want to supply your child with a doctor’s
kit and give them an opportunity to play doctor or hospital, or act out situations using dolls
or puppets.  Also, read books, watch programs, and do activities together which specifically
address topics your child is encountering.  One good option is the Sesame Street: Talk,
Listen, Connect programs and activities which can be viewed or downloaded for free at

Be on the lookout for signs of stress. At this age, a child may exhibit stress in a variety of
ways.  Watch for changes in behavior such as withdrawal from friends or other social
activities, hyperactivity, mood swings, problems in school, separation anxiety, changes in
eating habits, increased nightmares and/or problems sleeping.

Age 7-11:

At this age, children are capable or following rules and undertaking more responsibilities in
the home.  They have a better grasp of cause and effect, but still may have difficulty
understanding more complex relationships between two events.

Children in this age group are more able than ever to truly grasp the reality of what is
occurring with their parent.  So, be sure to include many direct, reality-based facts and
explanations in your discussions with your child.  Some specific examples can be found in
the article “How to Talk to Children about Brain Injury” (
CLICK HERE to download a copy).
Also, include the sequence of events involved with the specific injury (as appropriate for
the child’s age and maturity level), as well as a realistic and age-appropriate description of
what to expect in both the immediate and long-term future.  It is important to keep the lines
of communication open by allowing your child an opportunity to ask questions as well as
asking them questions to check their comprehension of the situation.  Be sure to answer all
questions honestly and avoid empty promises or well-meaning clichés such as “Everything
will be OK” or “It will all work out”.  While you want to be reassuring, you also do not want to
create false hope which may be shattered later.  If you are unable to answer your child’s
question, admit it and promise to find the answer.  Additionally, you might seek out the help
of a therapist or physician to answer questions about Traumatic Brain Injury you cannot or
questions your child may be uncomfortable asking you.

Be on the lookout for signs of stress. In this age group a child who is depressed or
stressed may exhibit a wide range of behaviors.  As with younger children they may
withdraw socially, exhibit changes in mood and behaviors, start becoming preoccupied with
death or dying, act out (e.g. become confrontational, start fights), or start having problems
in school (socially, behaviorally or academically).

Age 12 and up:

During this age range children are experiencing many changes biologically, emotionally
and socially.  Puberty, hormones and peer issues can make this time especially trying for
both teens and families. Adding the stressors associated with
TBI can make this complex
time even more difficult to navigate.  However, children at this age are also more
independent, develop more intimate relationships and are generally more thoughtful and
caring than their younger counterparts.

When communicating with your teen about a
Traumatic Brain Injury speak honestly and
realistically.  Give your child all the information possible; including diagnosis, prognosis,
description of the treatments and possible outcomes.  Share new developments (good and
bad) as they occur. Honestly acknowledge changes and problems that the family might be
facing and listen to their thoughts and opinions on these matters. Be sure to talk to your
child frequently and give them time to ask questions and discuss their concerns.  

Be on the lookout for signs of stress. Signs may be very subtle during this age.  Teens may
appear to be coping well but can be hurting desperately inside. Signs of problems may
include withdrawal, changes in sleeping or eating, lack of interest in favorite activities,
mood-swings, increases in anger or frustration, and engaging in risk-taking or risky
behaviors (e.g. drugs, alcohol, promiscuity).  

General Tips on How to Cope as a Family

  • Allow an opportunity for all members to express their concerns and feelings.  Don’t
    give the impression that you expect everyone to be brave and not express their
  • Set aside specific family time and engage in activities as a family that everyone can
  • Try to keep life as normal as possible; keep up routines and family rituals whenever
  • Set up a place for quiet time for both the injured parent and other family members.
  • Develop a sign or signal for the injured parent to use when feeling overwhelmed.
  • Help children stay in touch with friends and partake in their usual activities.
  • Share details about the family situation with your children’s teachers, school and
    other caregivers.
  • Spend quality time with each child individually.
  • Allow your child to take on more responsibility in the home or take part in the parent’
    s recovery, but be sure not to place too much responsibility on the child.  Allow them
    time and space to be children.
  • Seek professional help (either individually or as a family) if members are having
    problems coping.



Communicating with Your Child                                     

Supporting Young Children Affected by a Parent’s Military Injury

How to Talk to Children About Brain Injury

Life with a Brain Injury: Preparing Yourself and Your Family                         

Supporting Young Children: Combat Stress Injuries of War                 

The Impact on a Parent’s Brain Injury on a Child: What Research Suggests and Ways
Speech-Pathologists Help                                                    


Brain Injury Association of America       

Defense and Veterans Brain Injury Center        

National Institute of Neurological Disorders and Stroke - TBI Section                

Sesame Street: Talk, Listen, Connect        

Traumatic Brain Injury: The Journey Home     

This article was written by Kelly Finley-Miller, the wife of an active duty soldier and OIF
veteran.  Kelly holds a Bachelor of Science in Psychology, a Master of Arts in Special
Education, and a graduate certificate in Applied Behavior Analysis.  She has spent several
years working first hand with military children as part of the DoDDS school system.  If you
would like to contact Kelly, send her an e-mail at kelly -at-

Kelly is also a member of our Grassroots Team - a group of volunteers dedicated to
helping us expand to help more veterans and their loved ones.  If you
would like to volunteer from home, as little as an hour or two per month, please
HERE for more information!  We could really use your help :)

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