NICHD Pediatric Injury Research Information

NICHD supports and conducts a range of research and training activities related to pediatric injury, including pediatric trauma and critical care. NICHD-supported researchers investigate many psychosocial, behavioral, and physiological influences that affect child health outcomes in trauma, injury, and acute care. NICHD is interested in pediatric injury research that highlights effective practices, treatment guidelines, and other strategies to:

• Prevent trauma (psychological and physical), with emphasis on high-risk or vulnerable populations
• Prevent the effects of traumatic experiences from progressing to mental illness, high-risk behavior, disease, disability, or death
• Improve treatment modalities to optimize patient outcomes and minimize or eliminate negative sequelae of trauma exposure and critical illness

This work also includes efforts to:

• Study the prevention, treatment, management, and results of physical and psychological trauma and the surgical, medical, psychosocial, and systems interventions needed to improve results for traumatized, critically ill, and injured children at all stages of development
• Examine the short- and long-term effects of acute traumatic experiences, such as natural and man-made disasters, all forms of child abuse and neglect, violence, and exposure to violence
• Develop research linking trauma-informed care, pediatric emergency care, and critical care medicine to the study, prevention, and treatment of childhood disabilities

Institute Activities and Advances

NICHD’s research portfolio on pediatric injury encompasses topics including pediatric trauma (both psychological and physical), emergency medical services to children, pediatric critical care, treatment and rehabilitation, and prevention of pediatric injury, in part by understanding risk behaviors.

NICHD research aims to evaluate longer-term outcomes for medically fragile children—including those who have sustained serious and life-threatening injuries—after they receive critical care. Studies focus on linking pediatric critical care medicine and science to the epidemiology, prevention, and treatment of childhood disabilities that may result from injury. For instance, choice of ventilator and cardiovascular support techniques, choice of drugs for sedation and analgesia, and their longer-term effects on child health and development are all topics of interest. Because the use of resources is such a central issue in most pediatric critical care services, comparisons of nursing hours and other measures of service consumption are also of interest in weighing the eventual benefits for children and families. The Pediatric Trauma and Critical Illness Branch (PTCIB) in the Division of Extramural Research supports research in this area.

Through the National Center for Medical Rehabilitation Research (NCMRR) and PTCIB, the institute supports research to understand mechanisms of injury, including spinal cord injury (SCI), traumatic brain injury (TBI), and stroke, and to develop and assess medical rehabilitation therapies and interventions related to improving function, quality of life, and outcomes for pediatric patients. In addition, the program supports efforts related to secondary conditions of injury, such as muscle atrophy, speech and language problems, pain, and psychological and psychosocial effects of SCI, TBI, stroke, and other conditions.

In the Division of Population Health Research, the Social and Behavioral Sciences Branch (SBSB) conducts research on health behaviors within the context of injury prevention. SBSB has a comprehensive research program on the causes and prevention of motor vehicle crashes among teens and new drivers. This research includes naturalistic studies with instrumented vehicles, experimental studies using driving simulators and test tracks, and evaluation studies on the effects of intervention programs. In addition, SBSB investigators studied the integration of individually tailored health communications in the pediatric primary care setting, which may offer an innovative and effective way to reduce injury in young children.

Highlights from NICHD and NICHD-supported research on pediatric injury, injury prevention, and post-injury care include the following:

• PTCIB supports a portfolio of research on preventing, treating, and reducing all forms of child abuse, trauma, injury, and critical illness. NICHD focused on PTCIB’s accomplishments in key areas, including pediatric injury prevention and pediatric critical care.
• Nine in 10 U.S. teens killed by an intimate partner may be girls. Researchers analyzed mortality and law enforcement data along with other records.
• Teen drivers with attention-deficit/hyperactivity disorder (ADHD) have a higher crash rate than adolescents who do not have ADHD. Teen drivers with ADHD may also be more likely to engage in other risky driving behaviors.
• Crash risk may increase sevenfold for teens who reach for objects while driving. This study was the first to use real-time driving data to quantify visual inattention.
• Training videos for kids may help them avoid dog bites. Researchers developed a video series explaining risky dog behaviors combined with safety messages for 3- to 5-year-olds.
• Almost one-third of children with concussions experience symptoms up to a year after their injury. Headache, irritability, and fatigue can be worse and last longer in girls than boys.
• Teen drivers are up to eight times more likely to be in a crash or have a near miss within 3 months of getting their license. Teens are also more likely to engage in risky driving behaviors during this period.
• Treatment with IV fluids does not appear to make brain swelling worse in children being treated for diabetic ketoacidosis.
• Youth in a sexual minority may experience higher rates of depression due to cyberbullying and problems with family relationships. Researchers analyzed survey data from nearly 3,000 high school students.
• Researchers establish the best blood pressure levels to maintain while treating children in cardiac arrest with CPR.
• Acetaminophen may decrease risk of kidney injury in pediatric heart surgery. Researchers found that children who received acetaminophen in the first 48 hours following cardiac surgery may have a lower rate of acute kidney injury. (PMID: 29799947)
• Researchers identify protein responsible for post-nerve-injury pain and inflammation.
• A home visit program in child maltreatment cases strengthens parent-child interaction. Listen to a podcast about this study or read the podcast transcript.
• A third of young adults have ridden with an impaired driver. Researchers also identified factors that increased young adults’ risk of riding with an impaired driver.
• The prevalence of bruising among infants in pediatric emergency departments (EDs). This multicenter study determined the prevalence of bruising in previously healthy infants presenting to pediatric EDs. (PMID: 26233923)
• Use and utility of skeletal surveys to evaluate occult fractures in young injured children. Researchers describe the percentage and characteristics of children under 24 months old with non-motor vehicle crash­–related injuries who undergo a skeletal survey and have occult fractures. (PMID: 30121318)

Other Activities and Advances

NICHD supports several research and training networks, consortia, and centers, which include:

• The Collaborative Pediatric Critical Care Research Network (CPCCRN) is a national resource for studying the scientific bases of pediatric critical care medicine. CPCCRN provides infrastructure to pursue rigorous clinical trials and descriptive studies in pediatric critical care medicine, with the goal of reducing morbidity and mortality from pediatric critical illness and injury by enhancing knowledge of the scientific bases of pediatric critical care practice. The network currently includes nine collaborative clinical sites with large pediatric intensive care units.
• The CAPSTONE Centers for Multidisciplinary Research in Child Abuse and Neglect conduct innovative and high-quality efficacy and effectiveness trials of child abuse and neglect interventions; prospective studies examining the long-term impact of specific and understudied types of maltreatment, including abusive head trauma, sexual abuse, and medical child abuse and neglect; studies examining the neurobiology of abuse and neglect; and studies testing the development of screening tools and assessment measures for early identification and treatment of specific types of abuse and neglect to decrease morbidity and mortality and to identify potential comorbidities.
• The NICHD Consortium for Research on Pediatric Trauma and Injury Prevention encourages multidisciplinary collaborations within NICHD to target gaps in research on pediatric trauma and injury prevention. The team science approach encouraged by this initiative generates research resources to advance the relevant area of biomedical research and devises breakthrough ideas, concepts, and approaches to therapies in pediatric trauma and injury prevention research.
• The Medical Rehabilitation Research Resource Network (MR3 Network) receives funding through NCMRR with additional support from the National Institute of Neurological Disorders and Stroke and the National Institute of Biomedical Imaging and Bioengineering. The MR3 Network builds research infrastructure in medical rehabilitation by providing investigators with access to expertise, courses and workshops, technologies, and collaborative opportunities from allied disciplines, such as neuroscience, engineering, applied behavior, and the social sciences.
• The NIH Pediatric Research Consortium (N-PeRC) is a trans-NIH initiative that aims to capitalize on pediatric research expertise and resources across NIH’s 27 institutes and centers through increased collaboration. N-PeRC aims to harmonize activities across institutes, explore gaps in the overall pediatric research portfolio, and share best practices to advance science. NICHD leads the consortium.
• Through the NICHD-led Safe to Sleep^® campaign, the institute is working with Safe Kids Worldwide to share safe infant sleep messages and strategies at the community level. Read this item of interest to learn more.
• NICHD also supports the Pediatric Critical Care and Trauma Scientist Development Program, a national faculty training and career development program that develops successful pediatric critical care and trauma physician scientists who conduct research to enhance the scientific understanding, clinical management, and rehabilitation of pediatric critical illness.
• NICHD also funds various prevention research, including for issues related to pediatric illness and injury.