Concussion: Managing your child's return to everyday activities

A concussion is a head injury that should be taken seriously and managed properly. When your child is diagnosed with a concussion, the key to their recovery is physical and cognitive (mental) rest.

Every child’s brain responds differently to a concussion and recovers at a different pace. Some concussions have mild symptoms at first and heal quickly, but others may have more intense symptoms that take longer to resolve. Most people recover fully after a concussion, but how long this takes depends on factors such as the severity of the concussion, their health before they received the concussion and how they managed their recovery.

A gradual return to regular activities, including school and sports, will allow you and your child to assess their concussion symptoms and adjust their activity as needed. It also gives the brain more time to heal.

Symptoms after a concussion

Concussion may cause a variety of effects in your child.

Physical signs and symptoms

• Headache
• Nausea
• Dizziness
• Being bothered by light or sound
• Poor co-ordination
• Sleeping more or less than usual

Cognitive symptoms

• Confusion
• Feeling dazed
• Difficulty concentrating or remembering

Emotional symptoms

• Irritability
• Anxiety
• Emotional ability

The most common mistake among concussion sufferers is to return to their normal activities too soon. Until your child’s concussion symptoms go away completely, assume that they have not fully recovered from their concussion.

How to manage recovery immediately after a concussion

If you are concerned that your child has a concussion, have them assessed by a health-care professional to confirm the diagnosis and see if they need any immediate treatment. A health-care professional can also help create a return-to-activity program tailored for your child.

First night of sleep

During your child’s first night of sleep after their concussion, check on them a few times to make sure their concussion symptoms have not worsened. Check that their breathing is normal and that they are not moaning, vomiting or having seizures. Nudge them lightly to make sure they are responsive, but, if possible, do not wake them fully. A full night’s sleep is very important for recovery. If there are any signs of poor sleep, take your child to the emergency department.

It was once common to wake concussion patients during their first night of sleep to make sure they did not fall into a coma. This practice is recommended less often now unless your child lost consciousness, lost their memory or was still experiencing concussion symptoms before going to sleep.

Recovery at home

• Make sure your child sleeps and rests as much as possible. Keep their sleep schedule regular with no sleepovers or late nights.
• Give your child acetaminophen or ibuprofen for headaches.
• Avoid activities that are physically demanding or need a lot of concentration for at least the first 24 to 48 hours after injury.
• Although rest is important, extreme extended rest can delay your child’s recovery.

Returning to school after a concussion

During recovery from a concussion, students can have difficulty with concentration, memory and processing speed. These can all hinder how well your child learns and performs at school.

The brain needs proper rest to recover from a concussion. Trying to complete schoolwork before the brain has fully recovered can overuse the brain when it needs to heal. Allowing your child time to rest sometimes means excusing them from school. It is important to strike a balance between the importance of returning to school and brain recovery.

After your child spends a few days at home and their symptoms improve, they can try some brief cognitive challenges, such as chores, homework or TV, to see if symptoms return. If symptoms do not increase with these activities, or they recur but reduce after breaks, your child can return to school with a lighter workload. Once your child is back at school, make sure that you arrange proper accommodations for their schoolwork.

Possible accommodations for a schoolchild with concussion

• Speak to your child’s teachers or give them a note to discuss a gradual return to schoolwork. Your doctor can communicate with the school to arrange appropriate accommodations.
• Allow your child to take half days or frequent breaks if their symptoms get worse during the school day.
• Encourage your child to take mental or physical breaks (leaving the classroom) every 20 minutes if they have trouble concentrating.
• For headaches, give your child enough acetaminophen or ibuprofen to help with pain throughout the day. Make sure that your child is well hydrated and takes frequent breaks.
• Excuse your child from certain classes, for example gym, shop, music or any class with computers.
• If sound or light is bothering your child, they can use sunglasses and earplugs. They should avoid noisy areas such as the cafeteria and assemblies.
• Excuse your child from tests or exams until they feel mentally prepared to write them.
• Limit homework time to 20-minute blocks. Slowly increase this as their symptoms improve.

Once you feel your child’s symptoms are gone or at least much improved, they can start returning to their standard workload at school. If symptoms worsen at any time, they should reduce their activity levels. If symptoms persist, speak to your child’s doctor, as your child may need more tests or accommodations.

Returning to sports after a concussion

Physical rest is as important as mental rest for your child’s recovery. If your child is an active athlete, they should take a similar gradual approach to their return to athletic activities.

A child should never return to play their sport the same day that they receive a concussion. This not only slows recovery but may actually make the injury worse or cause complications.

Your child should only resume physical activities when all concussion signs and symptoms have resolved and:

• they are back to full-time school attendance without accommodations
• they have been medically cleared.

They can then progress through a medically supervised activity protocol in stages. Your child should spend at least one day on each stage and move to the next stage only if their symptoms do not return. If their symptoms return during any of the stages, they should sit out and rest immediately. Once their symptoms disappear again, they should return to the last stage they completed without experiencing any symptoms.

Stages of a return to sport

• Rest stage: Your child should not do any physical activity besides light stretching and walking. They should stay at this stage until they are symptom-free and for a few days afterwards, especially if it takes longer than a week for their initial symptoms to go away. Your child should stop taking acetaminophen or ibuprofen after this stage to properly gauge how their brain is recovering.
• Light exercise stage: Suggested activities include walking, swimming, light jogging and stationary cycling and at no more than 50 percent intensity. The goal is to test how your child’s brain responds to an increase in their heart rate.
• Sport-specific exercise stage: Your child can add running or skating drills at a moderate intensity, but they should still avoid contact or complex training drills. They should also avoid all types of weight and resistance training.
• Non-contact training drills stage: Suggested activities for your child include more complex training drills that include passing, shooting, advanced movements and quick decision making. Teenagers who play sports can add light intensity resistance and weight training.
• Full-contact practice stage: Once your child has been cleared by their doctor, they can start taking part in normal full-contact training activities, including hitting, blocking and tackling. Make sure your child still keeps track of their symptoms very carefully during this stage.
• Return-to-play stage: At this stage, your child may return to normal game play. Your child’s concussion symptoms are gone and you are confident that they have fully recovered.

Children who play full-contact sports should be especially careful as they return to practice after a concussion. They should always be cleared for a return to practice by their doctor and make a gradual return to full-contact practice.

Your child faces a higher risk of having another concussion if they return to active play before they recover fully from the symptoms of their first concussion. With this second concussion, symptoms may be worse and last longer.

If your child has a history of multiple concussions, they should follow these stages even more strictly.

Baseline cognitive testing

Some contact sport leagues are implementing baseline neuro-cognitive or neuropsychological assessments.

This type of testing allows coaches, parents and medical professionals to compare test results from before and after a concussion to see if your child’s brain has fully recovered from the injury. Neuropsychological testing is also useful for athletes who have had multiple concussions or children whose symptoms worsen or fail to improve despite physical and cognitive rest.

These tests are a very useful, objective way of evaluating your child’s recovery progress and may identify specific cognitive deficits and help guide educational planning.

Avoiding driving until fully recovered

Teenagers should not drive until they have completely recovered from their concussion and have been medically cleared by a doctor. Driving requires many mental functions, such as spatial awareness, co-ordination and quick reaction time. These are all impaired by a concussion.

Reasons for slow recovery after a concussion

Your child’s recovery might be slow for a number of reasons.

• Your child has suffered from previous concussions, especially within the last year. Children who have received multiple concussions often take more time to recover with each additional concussion.
• Your child is suffering from a mood disorder, anxiety or a sleep disorder.
• Your child has a history of headaches. Migraine in particular can result in slower recovery.
• Your child is taking medication that is masking their physical symptoms or interfering with their recovery.
  

When to see your child’s doctor for a concussion

Your child should have regular follow-up appointments with their doctor until symptoms disappear. Their doctor can help manage symptoms, create an individualized program for returning to play and school, and provide medical clearance once your child has recovered. They can also recommend other ways to manage symptoms, such as persistent headaches and any mental health disorders, and advise on how to promote good sleep and alertness.

If your child is still suffering from post-concussion symptoms after a month of proper mental and physical rest, your child’s doctor may refer them to a specialist.