Returning to Sports and Play After a Concussion in Children – Instructions

A concussion is a brain injury from a direct blow to the head or body. This blow causes the brain to shake quickly back and forth inside the skull.

This can damage brain cells and cause chemical changes in the brain. Concussions can have serious effects on a child’s developing brain.

Children may get a concussion while playing sports or doing athletic activities. A concussion can cause temporary problems with certain brain functions, including speech, memory, balance, and coordination.

It can cause dizziness, nausea, and trouble thinking clearly. Symptoms usually go away in a couple of weeks. Sometimes they last longer.

It is important for children to wait to return to sports and play until:

• Their symptoms are completely gone.
• Their health care provider says it is safe.

Returning to sports and play too soon increases the risk of another concussion. Young people who have more than one concussion are at greater risk for chronic headaches and problems with learning.

When can my child return to sports and play?

Children with a concussion should never keep playing once the injury occurs. They need to rest, both physically and mentally. Children should also be carefully watched while they are resting.

How quickly your child can return to sports and play depends on:

• The severity of the concussion.
• Your child’s health before the injury.
• Whether your child has had a previous concussion.

After a concussion, children should return to their schoolwork before going back to sports. However, the return to schoolwork needs to be gradual and may require temporary, limited, or no use of screens. Your child’s health care provider may also restrict participation in gym class and recess. Once your child is back to a normal school routine without return of symptoms, he or she can then start the process of returning to sports.

What are the steps for returning to sports and play?

Children should not resume their sports or activities until they are symptom-free without medicine for at least 24 hours. Your child’s health care provider will determine when the symptoms are completely gone and it is safe for your child to play sports again.

You child should not try to do too much too soon. Your child should follow these five steps to return to sports:

1. Begin with just light aerobic activity to increase his or her heart rate. Your child may bike, walk, or jog for up to 10 minutes. Your child should not jump or run.
2. Get moderate physical activity with some head and body movements. Running short distances, fast jogging, using a stationary bike, and moderate-intensity weight lifting are okay.
3. Participate in high intensity exercise without physical contact.
4. Return to the normal practice routine, which may include full contact.
5. Return to play in games, matches, or other competitions.

Some children can progress quickly through these steps. Others will need several days to go from one step to the next. Your child should not move on to the next step until he or she has been symptom-free for at least 24 hours following the previous step. Symptoms to watch for include:

• Fatigue.
• Headache.
• Problems with balance, coordination, or memory.

If you notice any of these warning signs, have your child rest for at least 24 hours or until the symptoms go away. Your child can then resume activity. Start at the step before symptoms began.

What symptoms are important to report to my child’s health care provider?

Concussion symptoms may not appear right away. They could also get worse at any time. It is important to let your child’s health care provider know if your child has any of the following symptoms:

• Drowsiness or fatigue.
• Headache.
• Memory loss.
• Confusion.
• Trouble concentrating.
• Loss of consciousness.
• Problems with balance and coordination.
• Nausea or vomiting.
• Weakness or numbness.
• Slurred speech.
• Seizures.
• Trouble recognizing faces or places.
• Irritability.
• Changes in sleep habits.
• Personality changes.

Certain health issues may make recovery from a concussion take longer. Let your child’s health care provider know if your child has a developmental disorder, such as ADHD. Also let your child’s provider know if your child has a history of migraines, previous concussions, or a mental health disorder.

What are some questions to ask my child’s health care provider?

When your child has a concussion, learning as much as you can about this injury can help you protect your child’s long-term health. Ask your child’s health care provider the following questions:

• Is it safe for my child to participate in gym class?
• Can my child play at recess?
• Should I limit the amount of time my child watches TV, plays video games, or uses a computer?
• Does my child need more sleep than usual?
• Does my child need medicine?
• What are the potential long-term effects of a concussion?
• Will my child have problems with memory or learning?
• What could happen if my child returns to sports and other activities too soon?
• What happens if my child gets another concussion?
• Could my child have a concussion without my knowing it?
• When should I take my child to the emergency room?
• How can I prevent my child from getting another concussion?