What Parents Should Know About Returning to School After a Concussion

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A child sitting on the pavement, holding their head.

New research reveals that kids who return to school earlier than previously recommended experience fewer symptoms and a faster recovery. 

Concussions are a common injury in youth sports. More than 44 million children and teens participate in sports each year in the United States, and 1.1 to 1.9 million sustain a sport-related concussion (Podolak et al., 2021).  

Concussions are a type of mild traumatic brain injury (mTBI) brought on by a bump, blow, or jolt to the head (Centers for Disease Control and Prevention [CDC], 2019). When a child suffers a blow to the head, the brain moves back and forth inside the skull. This motion may lead to bouncing or twisting of the brain.  

When this brain movement occurs, it causes chemical changes inside the brain. Sometimes the brain stretches and brain cells are damaged (Centers for Disease Control and Prevention, 2022). Children with concussions have different needs than adults (Zimmerman et al., 2021) because the brain continues to develop beyond childhood and adolescence into early adulthood until around age 25 (Arain at al., 2013; Taki & Kawashima, 2012).  

What are the signs and symptoms? 

When a child sustains a concussion, it isn’t always immediately obvious. Although concussions may develop quickly after the injury, sometimes it can take hours before symptoms develop 

(Centers for Disease Control and Prevention, 2019). If your child or teen complains of “not feeling right” following a bump to the head or body or exhibits more than one of the symptoms listed below, they may have sustained a concussion (Centers for Disease Control and Prevention, 2019). These symptoms include: 

  • Dazed or stunned appearance 
  • Forgetting an instruction, or are unclear about an assignment or position, or are uncertain about the game, score, or opponent 
  • Dizziness, poor coordination, clumsy movements, or balance problems 
  • A slow response to questions 
  • Loss of consciousness (even if brief) 
  • A change in mood, behavior, or personality 
  • Inability to remember events before the hit or fall 
  • Headache or “pressure” in their head 
  • Nausea or vomiting 
  • Vision problems, such as double or blurry vision 
  • Sensitivity to light or noise 
  • Fatigue, fuzzy, foggy, or sleepy feeling 
  • Trouble with concentration or memory 
  • Confusion, difficulty focusing, or memory issues 
  • “Feeling off,” “feeling down,” or “not feeling right.”  

Signs of danger and more severe symptoms 

The CDC says that although rare, sometimes a blow to the head can cause a brain injury that is more severe than concussion. For example, a hematoma may form, which is when blood collects in the brain and causes the brain to become pressed against the skull (2019). You should call 9-1-1 or bring your child to the emergency room immediately if, after experiencing a bump, blow, or jolt to their head or body, they show any of the following symptoms (Centers for Disease Control and Prevention, 2019): 

  • One pupil is a different size than the other 
  • Sleepiness or trouble waking 
  • A headache that worsens over time and does not go away 
  • Slurred speech, numbness, weakness, or lack of coordination 
  • Repeated vomiting or nausea, convulsions, or seizures (uncontrollable shaking or twitching) 
  • Strange behavior; increasing confusion, anxiety, or restlessness 
  • Passing out or being struck unconscious—any loss of consciousness, even brief, should be taken seriously 

When should my child return to school? 

When children and teens sustain a concussion, most guidance recommends 24 to 48 hours of rest, often from school and sports (Podolak et al., 2021). However, a recent study published in JAMA Network Open indicates that returning to school (RTS) sooner than previously recommended may be associated with less symptom burden 14 days after an injury and may result in a quicker recovery. 

About this study 

The study analyzed data from 1,630 children ages 5 to 18 who visited an emergency room in Canada within 48 hours after sustaining a concussion. The study found that children and teens ages 8–18 years with an early return to school (within two days or less), experienced fewer symptoms 14 days after their concussion compared to children and teens who spent three or more days away from school (Vaughan et al., 2023).  

The study’s authors believe that social interaction, returning to regular school schedules and normal sleep schedules, participating in light to moderate physical activity, and experiencing less stress from missing school may contribute to a faster recovery (Vaughan et al., 2023). 

What does this mean going forward? 

Results from this study indicate that extended time (more than two days) away from school after a concussion is associated with more symptoms and slower recovery. However, they noted that more research is needed to determine the ideal time for kids to return to school (Vaughan et al., 2023). 

Although an early return to school may be appropriate for most kids, there isn’t a one-size-fits-all approach to managing concussions and determining when a child should return to school and activities. Evidence shows concussions can trigger and worsen mental health problems, possibly delaying recovery and psychological and social outcomes (Gornall et al., 2021). More research is needed to determine whether early RTS might prevent some mental health concerns from developing postconcussion. 

Parents should talk with their healthcare providers about their approach to RTS, as it is important to evaluate and treat each child and their symptoms individually, taking into careful consideration their physical and mental health history. These factors can affect how severe the symptoms are and how long a child may take to recover. 

How can I keep my child or teen safe? 

One of the most important things you can do is talk to your child about concussions—what they are, how they might feel if they have one, and even what a concussion might look like in a teammate. If they think they or a friend may have experienced a concussion, tell them to report the injury to you and their coach immediately to reduce the risk of further injury and receive treatment. It is common for children and teens to brush off a concussion and think it isn’t anything to worry about or they fear they may lose their position on the team if they report it. Still, framing the situation and letting them know it is better to miss one game than the entire season is helpful (Centers for Disease Control and Prevention, 2019). 

Children and teens who continue to play after sustaining a concussion or return to play too soon while the brain is still healing are at greater risk of getting another concussion. A child or teen who suffers a second concussion while their brain is still recovering from the first injury can suffer long-term effects or, in some cases, death (Centers for Disease Control and Prevention, 2019). 

Steps to take if your child has a possible concussion 

The CDC recommends that if you suspect your child or teen may have a concussion, take the following steps: 

  1. Remove your child or teen from play. 
  2. On the day of the injury, prevent your child or teen from playing. Bring your child or teen to the doctor. They should not resume playing sports until they are given the “all clear” by a doctor with experience diagnosing concussions. 
  3. Ask your doctor for written instructions on how to assist your child or teen in returning to school and return-to-play instructions. You can give the instructions to your child or teen’s school nurse and teacher(s), coach, and/or athletic trainer.  

References 

Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776 

Centers for Disease Control and Prevention. (2019). HEADS UP Concussion Signs and Symptoms, National Center for Injury Prevention and Control. Retrieved April 3, 2023, from https://www.cdc.gov/headsup/basics/concussion_symptoms.html 

Centers for Disease Control and Prevention. (2022). Mild TBI and Concussion. Retrieved April 3, 2023, from https://www.cdc.gov/traumaticbraininjury/concussion/index.html 

Centers for Disease Control and Prevention. (2019). A Fact Sheet For High School Parents. Retrieved April 4, 2023, from https://www.cdc.gov/headsup/pdfs/youthsports/parents_eng.pdf 

Gornall, A., Takagi, M., Morawakage, T., Liu, X., & Anderson, V. (2021). Mental health after paediatric concussion: A systematic review and meta-analysis. British Journal of Sports Medicine, 55(18), 1048–1058. https://doi.org/10.1136/bjsports-2020-103548 

Podolak, O. E., Arbogast, K. B., Master, C. L., Sleet, D., & Grady, M. F. (2021). Pediatric sports-related concussion: An approach to care. American Journal of Lifestyle Medicine, 16(4), 469–484. https://doi.org/10.1177/1559827620984995 

Taki, Y., & Kawashima, R. (2012). Brain development in childhood. The Open Neuroimaging Journal, 6, 103–110. https://doi.org/10.2174/1874440001206010103 

Vaughan, C. G., Ledoux, A. A., Sady, M. D., Tang, K., Yeates, K. O., Sangha, G., Osmond, M. H., Freedman, S. B., Gravel, J., Gagnon, I., Craig, W., Burns, E., Boutis, K., Beer, D., Gioia, G., Zemek, R., & PERC 5P Concussion Team (2023). Association between early return to school following acute concussion and symptom burden at 2 weeks postinjury. JAMA Network Open, 6(1), e2251839. https://doi.org/10.1001/jamanetworkopen.2022.51839 

Zimmerman, S. D., Vernau, B. T., Meehan, W. P., 3rd, & Master, C. L. (2021). Sports-related concussions and the pediatric patient. Clinics in Sports Medicine, 40(1), 147–158. https://doi.org/10.1016/j.csm.2020.08.010