Your child or adolescent was just diagnosed with a concussion. What do you do now?

For parents of K-12 students whose child has been seen by a medical provider after the injury

The first 12 hours - notes about medication for pain

If the concussion has caused a headache or other pain:

Avoid any pain medications for the first 4 hours post-injury.

From 4-12 hours after injury Acetaminophen is recommended (Tylenol or other brands).

From 4-12 hours, avoid pain meds that thin the blood:
- aspirin, ibuprofen (Advil, Motrin), or naproxen(Aleve)
After 12 hours, any kind of over-the-counter pain medication is OK, but consult with your doctor if your child needs these medications more than 10 times per month.
To learn more, see Medication and Headaches.

The first 24–48 hours – relative rest

Don’t cocoon

Many parents are inaccurately told by friends and healthcare providers (those who are not up-to-date on the most recent guidelines) to have their child rest until all symptoms are “resolved,” meaning the symptoms are gone. They might also advise your child to stay in a dark room during the day. This combination of complete and prolonged rest, sometimes combined with staying in a dark room, is called “cocooning.” Cocooning is outdated advice that impedes recovery. Do NOT have your child lie in a darkened room during the day for extended periods, even in the first 24-48 hours.

Your child can do activities of daily living

The newest guidelines recommend “relative rest” starting immediately after a concussion and up to 48 hours after the concussion. “Relative rest” includes doing activities of daily living even in the first 24-48 hours after the injury. For your child, activities of daily living might include helping with light household chores, visiting with friends and family in a calm environment, etc. They should stay home from school—but contact the school about your child’s concussion.

Your child can do light-intensity physical activity in the first 24 hours, such as walking

“Relative rest” includes a “return to light-intensity physical activity (PA), such as light walking that does not more than mildly exacerbate symptoms, during the initial 24–48 hours following a concussion.”

Starting light-intensity physical activity in the first 24-48 hours after a concussion reduces the risk of symptoms persisting longer than a month.

Sleep

Sleep is vital to the recovery process.
Let your child sleep as much as they want to and when they want to; do not wake them.
If they have irregular breathing or a change in skin color while sleeping, wake your child and seek immediate medical attention.

Cognitive and Physical Rest

Limit these kinds of activities:

Cognitive activities that require mental focus, concentration, memorization, or multitasking
Reading or doing homework
Playing musical instruments
Screen time (see below for more details)
Spending time in stimulating environments such as shopping malls or large stores
Going to the playground, exercising, sports, or any physical activity such as pick-up sports games
Driving
Running up or down the stairs

Reduce screen time to speed recovery

“Relative rest” includes reducing screen time in the first 48 hours; this lessens “cognitive exertion.” This recommendation is based on research that found that in the first 24-48 hours after a concussion, patients who limited their screen time to 130 minutes total, or 65 minutes a day for the first two days, recovered in half the time of patients who did not limit their screen time. Screen time includes phones, computers, and TV.

Monitor your child for red flag signs and symptoms

Ask how your child feels and watch for potential red flag symptoms. Take your child to the ER if they have any red flag symptoms on this list.

Myth Busters

Don’t wake your child up every few hours at night.
No need to draw the drapes during the day- they don't need to be in a dark room. Spending prolonged time resting in a dark room during the day is called “cocooning,” and it can slow recovery.

After 24–48 hours – gradual increase in physical activity, self-care, sleep routines

Sleep

Help your child return to a regular sleep schedule, and limit naps. For more sleep-related information, see our page on Sleep and Sleep Problems after a concussion.

Self-Care

We recommend reading our Overview of Self-Care for tips on nutrition, sleep, exercise, strategies for dealing with light and sound sensitivity, and mental wellness.

Physical Activity

Gradual, careful return to physical activity speeds recovery

Early return to physical activity has been found to reduce the number of symptoms and severity, and speed recovery, but it has to be done carefully. The largest study on this topic, of youth ages 10-18, found that non-contact physical activity starting at 72 hours after the injury is safe and “may also reduce symptoms and the risk of delayed recovery.”
Early return to physical activity is NOT THE SAME as early return to athletic or sports practice. Early return to sport practice is NOT recommended.
Returning to physical activity too quickly can make symptoms worse, trigger new symptoms, and slow recovery.

Walking, light jogging, or stationary bike are recommended types of physical activity. Swimming is also recommended, but limit activities that risk hitting the side of the pool with the head, such as flip turns.
Start with very short periods of physical activity; for example, walk 15 minutes at a moderate level the first day, and if that is OK, a short, very light jog the second day. It is OK if the activity makes symptoms only slightly worse. Any more than that, back off on the amount of time or vigorousness of the activity.
Follow these guidelines for a step-by-step return to activity or sports.
Read this article about physical activity for young children or those unable to do aerobic exercise.

Be careful with physical activity to avoid the risk of another concussion

While recovering, your child has 3 times higher risk of suffering another concussion.
Additional concussions can contribute to more symptoms and slower recovery.
In very rare instances, one or more additional concussions while recovering from the first concussion can cause Second Impact Syndrome, which can be permanently disabling or fatal.

Choose safe activities and avoid contact activities

Avoid riding a bike or other activities (including sports) that could result in contact or a fall.
Keep in mind that coordination is reduced after a concussion.

More information about physical activity to help speed recovery

Graduated exercise therapy has been shown to speed recovery; read about it on this page. Your adolescent can work with a physical therapist to set up this exercise program. Graduated exercise therapy can also be done without a physical therapist, following our guide.

Myth Busters

“Rest until all symptoms” are gone is no longer recommended. A gradual return to activity speeds recovery.

Return to Sports Go to this section.

About screen time (phone, computer, TV)

The current international concussion guidelines recommend reducing screen time in the first 48 hours, based on research that found that in the first 24-48 hours after a concussion, patients who limited their screen time to 65 minutes a day for the first two days recovered in half the time of patients who did not limit their screen time. Screen time includes phones, computers, and TV. To learn more, read our blog post.

After this 48-hour period, Pedsconcussion recommends that “the use of devices with screens may be gradually resumed. The use of these devices can be increased according to symptom tolerance as the child/adolescent recovers.keep screen time at a moderate level and cut back if screen time is making symptoms worse.”

Read the research behind the recommendation of moderate levels of screen time in our blog post.

Keep in mind that phones are essential to staying connected socially and maintaining a sense of identity, as are video games for some. Taking away these digital devices can increase the risk of developing or worsening depression and anxiety–which can prolong recovery from a concussion.

Computers are integral to school and work life, so screens need to be included in the recovery process. Apps and devices can reduce the visual strain of screens (see the section below). Prolonged sensitivity to screens may indicate that the concussion has created a vision problem; see our section on Vision Therapy.

Encourage your child to use their limited screen time for connecting with friends. Social connection and feeling supported are vital to recovery – see our blog post, Social support during youth concussion recovery.
There are ways to somewhat reduce the negative effects of screens; see our resource on Sensory Sensitivity.
Try audio entertainment, such as podcasts.

Return to School Guidelines

In the first days after the injury while your child is home resting, communicate with the school to develop a return-to-school plan, even if just an informal one. Consider talking with your child’s teachers, the school nurse, coach, and possibly the school principal or vice-principal.
“The child/adolescent should return to their school environment as soon as they are able to tolerate engaging in cognitive activities without exacerbating their symptoms, even if they are still experiencing symptoms.” Source: PedsConcussion
“Complete absence from the school environment for more than one week is generally not recommended. Children/adolescents should receive temporary academic accommodations (such as modifications to schedule, classroom environment and workload) to support a return to the school environment in some capacity as soon as possible.” Source: PedsConcussion.
We recommend following this Return to School strategy; see the chart below.
We recommend this Return to Learn Planning Tool, which will help you work with your child’s school to plan their gradual return.
Ask the school for return-to-learn accommodations such as:
- return to school part-time
- identify some periods that the student can take off and rest in the nurse's office
- Talk with the teacher about scaling back assignments
- Ask if your student can do passing periods a bit late or early, to avoid crowded, noisy hallways
- Talk with the teacher about postponing tests, or setting up special testing accommodations:
  - taking the test in a quiet room
  - time and a half to take the test
- See the Learning Accommodations and Modifications for Students Following a Concussion developed by the Concussion Awareness Training Tool: it gives excellent suggestions specific to each common concussion symptom.

Help your child reduce the effects of an over-stimulating school environment

Your child may be sensitive to noise and sound for a while. To learn general coping tips, read our page on Sensory Sensitivity.

Try these tips to reduce stimulation in hallways and the cafeteria
- Wear a baseball cap, which deflects away fluorescent lighting
- Wear sunglasses if the baseball cap doesn't work
- Wear earplugs or headphones when not in class
- If your child takes the bus to school, consider driving them to school if you can. The bus can be challenging if your child is experiencing noise sensitivity, and the bouncing of the bus may worsen a concussion-induced headache.

Return to School Strategy

This Return to School strategy below was developed by PedsConcussion and incorporates the most recent concussion guidelines. Scroll below this chart for instructions on how to implement this Return to School strategy.

A chart titled "Living Guideline Return to School/Learn Protocol

Click on the image or on this text to access this in PDF format.

Instructions for using the Return to School strategy

The instructions and definitions below are from Pedsconcussion.

"Students should begin a gradual increase in their cognitive load with the goal of minimizing time away from the school environment. The return to school should not be restricted if the student is tolerating full days.

Progression through the strategy may be slowed when there is more than a mild and brief symptom

exacerbation**; however, missing more than one week of school is not generally recommended.

Definitions:

*Relative rest: activities of daily living, including walking and other light physical and cognitive activities, are permitted as tolerated.

**Mild exacerbation (worsening) of symptoms: No more than a 2-point increase when compared with the pre-activity value on a 0-10-point symptom severity scale.”

***"Brief" exacerbation of symptoms: Worsening of symptoms for up to 1 hour.

***0-10 point symptom severity scale: Please see the Visual analog scale for an example of a 0-10 symptom severity scale.”

A scale and images of a range of happy to sad faces, "Rate Your Overal Concsition: Choose a number from 10 to 10 and describe your condition

Return to Learn Planning Tools and Learning Accommodations

There are several planning tools for guiding the return to school process. Below are tools we recommend from the Concussion Awareness Training Tool and Pedsconcussion. Click on the image or the link below the image to download the full PDF.

Click on the image above or on this text to access this in pdf format. This “Return to Learn Planning Tool” was developed by the Concussion Awareness Training Tool and the BC Injury Research and Prevention Unit.

Accommodations and modifications recommended for specific concussion symptoms

The Concussion Awareness Training Tool has created a chart of learning accommodations and modifications for each type of concussion symptom.

Click on the images below or here to access the Learning Accommodations and Modifications in PDF format. This information is part of a Concussion Information Package for Parents/Caregivers created by the Concussion Awareness Training Tool and the BC Injury Research and Prevention Unit.

A chart of learning/school accommodations and modifications by symptoms

Return to Activity/Sports Guidelines

Youth athletes

It is OK if your student starts a gradual return to sport at the same time that they are gradually returning to school.
The student should be fully returned to school BEFORE they return to full sports activities.
A gradual return to sport is essential; see the Return to Sport strategy below.
Get medical clearance before your child fully returns to athletic activity.

Return to Activity/Sports Strategy

We recommend the Return to Sport strategy developed by Pedsconcussion. Scroll down for instructions on how to use this Return to Activity/Sport Protocol.

Click on this link or the image above to access the pdf version of this guide.

How to use the Return to Activity/Sports Strategy

When using the Return to Sport strategy in the chart above, follow these instructions from Pedsconcussion.

“Begin Step 1 (i.e., relative rest) within 24 hours of injury, with progression through each subsequent step taking a minimum of 24 hours. If more than mild exacerbation (worsening) of symptoms (i.e., more than 2 points on a 0-10 scale***) occurs during Steps 1-3, stop the activity and attempt to exercise the next day.

People experiencing concussion-related symptoms during Steps 4-6 should return to Step 3 to establish full resolution of symptoms with exertion before engaging in at-risk activities. Written determination of medical clearance should be provided before unrestricted Return to Sport as directed by local laws and/or sporting regulations.”

Definitions

“*Relative rest: activities of daily living, including walking and other light physical and cognitive activities, are permitted as tolerated.

**Mild exacerbation (worsening) of symptoms: No more than a 2-point increase when compared with the pre-activity value on a 0-10-point symptom severity scale***. "Brief" exacerbation of symptoms: Worsening of symptoms for up to 1 hour.

***0-10 point symptom severity scale: Please see the Visual analog scale for an example of a 0-10 symptom severity scale.

These definitions were harmonized with and modified with permission from the Amsterdam International Consensus Statement on Concussion in Sport).”

What is an average recovery time?

Children: the average recovery time is one month.
Adolescents and college students: the average recovery time is 28 days, according to new research. (The consensus until recently was 10-14 days.)
15 – 30% of concussion patients develop persistent symptoms. This is referred to as persistent post-concussive symptoms (PPCS) which require a multidisciplinary approach to care. Please read about PPCS here, and learn about finding a multidisciplinary clinic here. You can read about treatment options for persistent symptoms here.

When should you check back with your doctor, and for what kinds of symptoms?

Return for medical follow-up every one to two weeks to:

Monitor progress
Identify potential factors for prolonged recovery, if applicable.
Refer to multidisciplinary care if recovery takes longer than 28 days.

Request referral to physical therapy as soon as the first week if your child is experiencing these symptoms:

Neck problems; neck issues from a concussion don’t typically resolve on their own. Read more about Physical Therapy.
Dizziness; dizziness can impede your child’s gradual return to activity, which can slow recovery. You can request a vestibular therapist; read more about Vestibular Therapy.

Read our blog post, Social Support During Youth Concussion Recovery.