Returning to Activity After a Childhood Concussion (Mild Traumatic Brain Injury): Care Instructions

Overview

A concussion is a kind of injury to the brain. It happens when the head or body receives a hard blow. The impact can jar or shake the brain against the skull. This interrupts the brain's normal activities.

Any child who has had a concussion at a sports event needs to stop all activity and not return to play until their symptoms are gone. Being active again before the brain recovers can raise your child's risk of having a more serious brain injury.

Your doctor will decide when your child can go back to activity or sports. In general, children should not return to play until they have no symptoms, are back at school, and are no longer taking medicines for the concussion. The risk of a second concussion is greatest within 10 days of the first one.

Follow-up care is a key part of your child's treatment and safety. Be sure to make and go to all appointments, and call your doctor if your child is having problems. It's also a good idea to know your child's test results and keep a list of the medicines your child takes.

How can you care for your child at home?

At home

• Help your child rest their body and brain. Your child should rest for 1 to 2 days. Let your child know that rest—even though it can be hard—can speed up recovery.
  • Pay close attention to symptoms as your child slowly returns to a regular routine. Avoid anything that makes symptoms worse or causes new ones.
  • Make sure your child gets plenty of sleep. It may help to keep your child's room quiet, dark or dimly lit, and cool. Have your child go to bed and get up at the same time, and limit foods and drinks with caffeine.
  • Limit housework, homework, and screen time.
  • Avoid activities that could lead to another head injury.
  • Follow your doctor's instructions for a gradual return to activity and sports.

Back to school

• Wait until your child can focus for 30 to 45 minutes at a time before you send your child back to school.
• Tell teachers, administrators, school counselors, and nurses what symptoms your child has or could develop. Sign a release form so the school can coordinate care with your child's doctor.
• Arrange for any special changes your child needs. For example, depending on symptoms, your child may need to:
  • Start back to school with shorter days.
  • Take 15-minute breaks after every 30 minutes of classwork.
  • Have more time for assignments, postpone tests, or have another student take notes.
  • Avoid bright lights. (You can suggest dimmed lighting or that your child wear sunglasses.)
  • Avoid noisy places, like the gym or cafeteria.
• Check in with school staff often. Discuss how your child is doing, academically and emotionally. A concussion can make kids grouchy and emotional. And needing extra help or extra rest can be hard for some kids.
• If your child doesn't recover within 3 to 4 weeks, talk with your doctor and the school staff. They may recommend a 504 plan. It's a plan for kids who need ongoing adjustments at school.

Returning to play

• Follow the steps that doctors and concussion specialists suggest for returning to sports after a concussion. Use these steps below as a guide. In most places, your doctor must give you written permission for your child to begin the steps and return to sports. Your child should slowly progress through the following levels of activity:
  1. Limited activity. Your child can take part in daily activities as long as the activity doesn't increase symptoms or cause new symptoms.
  2. Light aerobic activity. This can include walking, swimming, or other exercise. No resistance training is included in this step.
  3. Sport-specific exercise. This includes running drills or skating drills (depending on the sport), but no head impact.
  4. Noncontact training drills. This includes more complex training drills such as passing. Your child may also begin light resistance training.
  5. Full-contact practice. Your child can take part in normal training.
  6. Return to normal game play. This is the final step and allows your child to join in normal game play.
• Watch and keep track of your child's progress. It should take at least 6 days for your child to go from light activity to normal game play. But it can take longer for some children.
• Make sure that your child can stay at each new level of activity for at least 24 hours without symptoms, or as long as your doctor says, before doing more.
• If one or more symptoms come back, have your child return to a lower level of activity for at least 24 hours. Your child should not move on until all symptoms are gone.

When should you call for help?

Call 911 anytime you think your child may need emergency care. For example, call if:

• Your child has a seizure.
• Your child passes out (loses consciousness).
• Your child is confused or hard to wake up.

Call your doctor now or seek immediate medical care if:

• Your child has new or worse vomiting.
• Your child seems less alert.
• Your child has new weakness or numbness in any part of the body.

Watch closely for changes in your child's health, and be sure to contact your doctor if:

• Your child does not get better as expected.
• Your child has new symptoms, such as headaches, trouble concentrating, or changes in mood.