Helping Kids and Teens Recover from a Brain Injury

Girl resting on sofa, concussion recovery
Resting is crucial for concussion recovery. Caroline Woodham

Helping your child through concussion recovery is tricky. Symptoms and signs of concussion can look different in everyone, and there are no easy tests (like an x-ray for a broken bone) that can help you and your child's doctor evaluate her progress. Even if your athlete took a baseline test of cognitive function (such as Immediate Post-Concussion Assessment and Cognitive Testing, or ImPACT) prior to injury, re-testing may not always be a good indicator of healing.

In most cases, doctors recommend a graduated recovery plan with frequent monitoring of symptoms. To begin, once a concussion is suspected, an athlete should immediately be removed from play and sit out the rest of that day's game or practice, and be evaluated by a doctor, nurse, or athletic trainer who is trained in concussion care. Each player's concussion recovery plan should be individualized and take into consideration his or her past history of concussion (also called mild traumatic brain injury, or mTBI). Kids should be referred to a specialist in concussion if symptoms are worsening, do not resolve in about 2 weeks, or if the patient has other risk factors, most notably multiple previous concussions.

Concussion Recovery Plan: Rest

The first step is physical and cognitive rest for as long as it takes for symptoms to subside. This could take a day, a week, or even longer. International Consensus Concussion Guidelines state that each step in the progression to return to play should generally take at least 24 hours, so that the full return takes at least a week.

And the Centers for Disease Control and Prevention (CDC) says that "the younger the child, the more conservative the treatment." So it's important to allow your child enough time to rest and recover before she returns to play or even school.

Concussion Recovery Plan: Gradual Return to Physical Activity

The CDC outlines this return-to-play progression, to start only after the player has been symptom-free for at least 24 hours.

Your child should try out each step and see how he feels. If symptoms return, he should go back to resting until his symptoms go away, then try the same level of activity again.

  1. Light aerobic exercise: Just 5 to 10 minutes of walking, jogging, or riding a stationary bike—enough to raise the heart rate a bit. Avoid jumping, hard running, weightlifting.
  2. Moderate exercise: This could include moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting. The goal is to add physical activity but keep head and body movement limited.
  3. Non-contact exercise: At this point, the player can start getting close to his former practice routine, adding intensity (but avoiding any contact with other players).
  4. Practice: As long as he's feeling okay after step 3, the player can try participating fully in regular team practices and workouts.
  5. Play: If practice goes smoothly, then the player may be ready to return to competition.

Concussion Recovery Plan: Gradual Return to School

Many parents are surprised to learn that cognitive rest is an important part of recovering from a concussion. But some concussion symptoms (like problems with memory and concentration, and trouble sleeping) can make it hard for kids to learn and participate in school.

And trying too hard can actually slow down recovery. So immediately after a concussion, a child's treatment plan may recommend complete or partial cognitive rest. That means limits, or a total ban, on going to school, studying, reading, watching TV, using a computer, playing video games, texting, and so on until concussion symptoms go away.

Just like the return to physical activity, the steps to returning to cognitive activity should be gradual and will be different for every kid. Some might be able to rest for a weekend and then return to school on Monday. Others will need to miss school, then attend with accommodations (such as skipping some classes, taking rests during the day, and postponing tests).

Most kids and teens do recover fully from concussions. But it's important that they take their time.


Randolph, C. Baseline Neuropsychological Testing in Managing Sport-Related Concussion: Does It Modify Risk? Current Sports Medicine Reports, Vol. 10 No. 1, January 2011.

Centers for Disease Control and Prevention. A "Heads Up" on Managing Return to Play. December, 2011.

Sady, MD, Vaughan, CG, and Gioia, GA. School and the Concussed Youth – Recommendations for Concussion Education and Management. Physical medicine and rehabilitation clinics of North America, Vol. 22 No. 4, November 2011.

McGrath, N. Supporting the Student-Athlete's Return to the Classroom After a Sport-Related Concussion. Journal of Athletic Training, Vol. 45 No. 5, September-October 2010.

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