Livie, a vivacious preschooler living in Austin, Texas, loved to sing and dance, and was the type of child who would make up an impromptu song about the milk she spilled. She had a favorite flower in the yard she liked to visit and talk to, which the family had dubbed Dr. Iris, since she would sometimes tell it her problems.

This all changed a week before her fourth birthday, when Livie’s world would come crashing down. She and her brothers, ages 6 and 1, were outside playing in the yard. It was a calm, sunny day, and the Persian silk trees were in bloom. As Livie stood beneath the branches of a pecan tree, a loud crack was heard, followed by a whooshing noise and then a scream.

Livie had been whacked with the falling branch. Her right pupil was blown—a sign that her brain was rapidly swelling. A CT scan revealed a large fracture across her crown, forking off into smaller branch-like cracks, as if the tree that hit her had left its signature on the little girl’s skull.

Doctors removed a 4 by 6 inch piece of her cranium to alleviate the swelling. Livie spent the next two weeks in a coma with severe brain injuries. It was several weeks before she started to get some semblance of consciousness back. She couldn’t talk, but would only shriek—were they shrieks of terror? Pain? Confusion? The only way to stop the shrieking was to give her intense koala hugs: she was the bear, mommy and daddy the tree.

Her parents were initially hopeful that Livie would learn to walk and talk again, but sadly, the girl would not make a full recovery. She can now respond through gestures to simple questions or commands, and has a very limited control of muscle movement, but cannot walk, talk or play like she used to.

It’s hard to gauge what this child perceives or wrap our brains around her experience. What parts of her brain are damaged? Do some work better than others? Is she now more like a newborn, with limited comprehension? Or is she a combination of vegetable and normal little girl?

Most terrifying of all is the possibility hat her memories from before the accident are still mostly in tact, swirling around inside a brain that cannot seem to execute all the things she needs it to do. Livie likes to see pictures and videos of herself before the accident, and her parents report that these often help to motivate her for therapy. Which suggests a degree of comprehension of her pre-accident self that makes this nightmare scenario a distinct possibility.

“Now it’s like I have two daughters, in a way,” says her father, Daniel. “One that passed away, and now this one.” The accident basically split Livie in half–the vibrant, animated, talkative preschooler they had before, and the post-accident girl they have today. “If I thought of it as that she died, and that there’s this new child here, it felt like a release,” he says. “I guess it’s hard to explain why, but it made it easier.” Livie’s 7-year-old brother, Noah, reflects on the accident in that blunt way that children do: “How come in stories there’s always a happy ending, and that’s not true in real life, like with Livie?”

Many people don’t realize that traumatic brain injury (TBI) is the leading case of disability in children. Whether through car accidents, household mishaps, or things like shaken baby syndrome, it seriously disables more than 100,000 children each year. There isn’t always something that can be done to prevent the type of freak tragedy that struck this family. But there are steps parents can take to limit the risk in other areas of life:

• Make sure your child wears a helmet when biking, sledding, skating or skiing.
• Watch little kids closely around baseball parks.
• Periodically check the health of trees in your yard, and prune away any dead or diseased branches.
• Go through you house and check all paintings, shelves and TV units. If it can wiggle and fall, it can seriously injure your child.

1. Daniel Engber, “The engineers’ daughter,” The Atlantic, Nov. 2021, pp.. 48-59