Beyond rehabilitation: toward developmental and trans-sectoral systems of support for complex acquired brain injury in children.

Pediatric acquired brain injury (ABI) can disrupt developmental trajectories across physical, cognitive, behavioral, emotional, and social domains. While rehabilitation pathways typically focus on recovery during the acute and subacute phases, many children and youth experience persistent or emerging difficulties long after formal rehabilitation treatment has ended. These difficulties may become more visible as developmental, educational, and social demands change, particularly during transitions across childhood and adolescence. Current systems, however, are often organized around sector-specific and time-limited models of service, resulting in fragmented support across healthcare, education, children and youth services, and settings. In this Perspective Paper, we introduce 'pediatric ABI with complex consequences' (ABI+) to draw specific attention to children and youth with ABI whose support needs in the community extend beyond acute care and sub-acute conventional rehabilitation pathways. ABI + is not proposed as a new diagnostic category, but as a vulnerable population as a result of ongoing dynamic interaction between neurological injury, child development, family functioning, and environmental factors over time. We argue that pediatric ABI rehabilitation should move from a phase-based, healthcare-centered model toward a developmental and trans-sectoral system of support. To illustrate this perspective, we describe the Dutch Pediatric ABI Network (Netwerk Kind & NAH), an integrated national network connecting community-based support, multidisciplinary expertise, research, policy, and lived-experience. Drawing on initial lessons learned from the development of this network, we aim to offer transferable insights that may inform the design of integrated systems supporting recovery, participation, and family functioning throughout the developmental course of children and youth with ABI.