The pediatric<unk>  undergoes dramatic changes and significant pruning of neural networks throughout development. Whereby the areas for primary senses and motor skills are mostly developed by age 4, other areas, like the frontal cortices involved in higher level reasoning, decision-making, emotion, and impulsivity continue to develop well into the late teens to early 20s. Therefore, the patient's age and<unk>  developmental state influence what neuronal systems become most affected post-injury. Key structural features of the pediatric<unk>  make the<unk>  tissue more susceptible to the mechanical<unk>  during TBI than the adult<unk> : a larger water content in the<unk>  tissue and reduced myelination results in diminished shear resistance after<unk> . It has also been shown that more immature<unk> s have an enlarged extracellular space volume and a decreased expression of glial aquaporin 4 leading to an increased incidence of<unk>  swelling after TBI. Along with a delayed decrease in cerebral blood flow, these unique features of the developing<unk>  can mediate further secondary damage, through hypoxia, excitotoxicity, free radical damage, and neuroinflammation after the primary<unk> . Even properties of these secondary events differ between the developing<unk>  and the adult<unk> : (1) in the developing<unk> , the overexpression and activation of the N-methyl-D-aspartate receptor (NMDA-R) leads to an increased calcium influx and an increased capacity for excitoxicity when compared to the adult<unk>  and (2) the developing<unk>  has lower glutathione peroxidase activity and a decreased ability to maintain stores of glutathione peroxidase, therefore the developing<unk>  is more vulnerable to oxidative stress than the adult<unk> . Damage to the developing<unk> , by any of the above mechanisms, can disturb neuronal maturation, leading to neuronal loss, axonal destruction, and demyelination.
Childhood acquired brain injury
Pediatric stroke
Acquired brain injury
Childhood cancer
Traumatic brain injury
Trauma in children
Pediatric concussion
Primary and secondary brain injury