What is a concussion?

A concussion is a brain injury that happens when the brain moves rapidly around inside the skull. This movement can temporarily disrupt brain function which can cause physical, cognitive and emotional symptoms. A concussion can cause a variety of symptoms and may affect the way your child learns.

What causes a concussion?

Any force that causes the brain to move around in the skull can potentially cause a concussion. This can happen by a direct hit to the head or indirectly through a hit to the body that causes the head to move back and forth or rotate.

The types of activities that can cause a concussion include falls, collisions with people or objects, and motor vehicle collisions. This could occur during sports or recreational activities, at recess or lunch, in the school building, or on the way to and from school.

You should suspect a concussion if your child has either hit their head or received a hit that could cause their brain to move rapidly in their head—EVEN if they don’t show any immediate signs of having one.

There is still much not known about concussions and the knowledge is continually changing. However, this website is updated on a regular basis and provides current education, tools, and resources to help support a child’s return to school following a concussion.

How serious is a concussion?

Any head injury needs to be taken seriously. Most concussions, managed appropriately, resolve without complications. Not recognizing a concussion or returning to activities too early can put a child at increased risk for a prolonged recovery and result in a subsequent concussion. If a child has another concussion, the effects can be worse and result in more complications.

Managing a child with a concussion

A concussion is a mild brain injury and the recovery period needs to be managed. This is best done in collaboration with key individuals in your child’s life such as coaches, school staff, health care providers, peers and parents. As a parent your position as the central caregiver is critical to your child’s recovery.

If you suspect your child has a concussion, check for Red Flag Symptoms immediately and review the steps on the  Concussion Response Tool

For more information take the Concussion Awareness Course for Parents

Concussion Facts

  • Concussions do not always include a loss of consciousness
  • Helmets DO NOT protect against concussions
  • A child does not need to be hit in the head to sustain a concussion
  • The signs and symptoms of a concussion can be delayed up to 2 to 3 days injury
Does my child have a concussion?

Any force that causes the brain to move around inside the skull can potentially cause a concussion. This can happen by a direct hit to the head or indirectly through a hit to the body that causes the head to move back and forth or side-to-side.

You should consider your child to have a concussion if your child has had an impact that caused a sudden jerk to the neck or head—EVEN if they don’t show any immediate signs of having a concussion.

If you suspect your child has a concussion you should seek medical attention as soon as possible.

Does your child have signs and symptoms of a concussion?

Signs and symptoms of a concussion can be delayed for several hours or even days following an incident. Signs and symptoms consistent with concussion include:

Thinking / Remembering Physical Emotional / Mood Sleep
Not thinking clearly

Feeling slowed down

Unable to concentrate

Unable to remember new information

Headache

Fuzzy or blurry vision

Nausea and vomiting

Dizziness

Sensitivity to light or noise

Balance problems

Feeling tired or having no energy

Easily upset or angered

Sad

Nervous or anxious

More emotional

Sleeping more

Sleeping less

Having a hard time falling asleep

If your child is showing any of these signs and symptoms then you should take your child to the doctor to investigate further. If your child has had a past concussion incident, even a minor hit to the head or body can trigger symptoms.

For more information on recognizing a concussion take the Concussion Awareness Course for Parents.

What do I do if I think my child has a concussion?

If your child shows any of the Red Flag Symptoms call 911 immediately. If you suspect your child has sustained a concussion seek medical attention as soon as possible. Monitor your child until they can be seen by a doctor. Do not leave your child alone. DO NOT give your child any prescription or over-the-counter medication unless directed by a doctor. Do not let your child drive or return to activities. Watch for Red Flags and signs and symptoms of concussion.

Concussion Response Tool

The Concussion Response Tool can assist parents to recognize and respond to a child with a concussion. The first two pages outline how to respond to a concussion at the time of the incident. The third page provides important information for parents caring for their child at home after the incident.

The Concussion Response Tool can also serve as an important communication tool for sharing information from the scene of the incident.

Preparing for the doctor

Your doctor will have questions for you and your child. The doctor will want specific details about the incident and your child’s medical history. Complete the  Concussion Response Tool  and take it with you to the doctor. This will help the doctor to assess your child.

Questions to Ask Your Doctor is a helpful resource that provides a variety of questions you can discuss with your doctor.

My child has a concussion. What is the recovery process?

A concussion is a medical event and the recovery starts at home and continues in the school setting. The recovery process includes resting the brain followed by a gradual and well-managed return to activities—learning and playing.

Children and adolescents tend to experience a longer recovery than adults. On average, an adult takes about 7 to 10 days to recover, whereas many children will take 2 to 4 weeks to heal, and most (about 85%) will fully recover within 3 months. Take your child to the doctor if you are worried that your child is not improving or their symptoms are prolonged.

The recovery process involves balancing your child’s activity level so they don’t do too much or too little. It is a fluctuating process where your child can be doing well one day but not the next.

The recovery period may be negatively influenced by many factors including:

  • Prior concussions
  • History of headaches or migraines
  • Learning disabilities
  • Mental health issues
  • Use of drugs or alcohol
  • Return to activities too soon
  • Lack of family or social supports
  • ADHD

A Return to Learn Protocol which monitors your child’s symptoms and addresses issues such as workload, breaks, assessment and emotional adjustment works best.

Concussion Recovery Process

The Rest Stage

The first and most important step in your child’s recovery from a concussion is rest. Your child will need both physical and cognitive rest after sustaining a concussion.

Physical rest means participation in daily life activities that do not result in an increased heart rate or breaking a sweat.

Cognitive rest means limiting activities that require concentration and learning.

The goal is to not trigger or worsen symptoms.

Once symptom-free for a 24 hour period your child can begin to add activities and focus on returning to school. Time within this stage varies with each child.

As new activity levels are introduced, symptoms could return or new symptoms could appear. This means the brain needs more time to heal. If at any point symptoms return, stop the activity and rest until symptom-free.

PHYSICAL
Restrict Activities that may be tolerated
Exercise
Sports
Riding a bike
Running
Play wrestling
Daily activities that do not increase heart rate or break a sweat.
COGNITIVE
Restrict or Limit Activities that may be tolerated
Computers
Smartphones
Video games
School work
TV
Playing music
Headphone use
Loud music
Reading
Socializing
School attendance
Driving
Work
Drawing
Playing with lego
Playing cars/trains
Baking
Talk on phone
Crafts
Basic board games
Photography** Low Level Social Interactions (try in short periods)

Social interactions that do not cause symptoms are important in preventing social isolation or depression and anxiety. Some suggestions for low level social interactions are short conversations on the phone with friends and family or a meal with grandparents.

It is important that your child has successfully returned to school full-time before they return to sports and recreational activities. A focus on return to learn first has been shown to lead to a quicker return to play. Returning to play too early may result in a prolonged recovery.

The Return to Learn Protocol can be found in the Resources section of this website.

Coping with your child’s emotions

After sustaining a concussion, your child may feel anxious, angry and sad during the recovery period. Many children worry about school and social failure.

Reassure your child that this is only a temporary situation. Talk with your child about these issues and offer encouragement and support.

For some children the emotional symptoms can interfere with their recovery. Your child may be feeling depressed or anxious due to a loss of place in school, on a team or in their social life. Depression in some children can be the result of physical changes in their brain associated with the injury itself.

If you think your child is depressed or having problems with anxiety talk to your doctor.

More information on supporting a child’s emotional well-being is available in the Resources section.

How does my child successfully return to school?
Return to Learn

It is important that children and adolescents follow a controlled, gradual return to school. One of the most common problems during recovery is returning to full activities too soon.

Inform the school and your child’s teachers that your child has sustained a concussion as soon as possible so planning for your child’s return to school can begin. You may want to set up a meeting with the principal, your child’s teacher(s), learning support teacher and school counselor to discuss the best Return to Learn Plan for your child.

The Return to Learn Protocol will help guide your child’s return to school. The goal of working through the Return to Learn stages is to increase cognitive activity gradually without triggering or worsening any symptoms.

School work will be assigned by your child’s teacher(s). The amount of time your child should focus on the work will be decided together by you, your child and the teacher.

If your child’s symptoms worsen while doing schoolwork, have them STOP the activity and rest until symptoms subside. Once their symptoms subside your child can return to doing schoolwork.

For example, if reading for 30 minutes produces a headache the child should stop reading until their headache subsides. Once their headache subsides, the child can resume reading, but for a maximum of 20 minutes. After 20 minutes of reading, even if the child has not experienced an increase in symptoms, the child should take a break. After a short break, they can resume reading for another 20 minutes. This can be repeated several times a day as tolerated.

The time it takes to successfully return to learn varies with each child.

How will my child increase their school work?

Usually school work will begin at home where the environment can be better controlled. Your child will start with school work that has a low demand on the brain. Help your child choose work that they enjoy and is one of their strengths. Consideration should be given to how much thinking and stimulation is involved. The work should be at your child’s current level and therefore less likely to overwork their brain.

Your child should not be expected to catch up on missed school work or maintain current school work. Your child’s Return to Learn Plan will provide direction in regards to testing, homework and other learning accommodations. It’s important to provide the school with input from both you and your child when decisions about their workload are being made or when their plan is reviewed.

For some children, falling behind in school work is difficult and this might cause them to increase their workload on their own or they might continue to work despite experiencing an exacerbation of symptoms. These children may need closer monitoring and reassurance to prevent a more prolonged recovery.

Who is responsible for monitoring my child’s progress at school?

Have your child’s school identify a school contact who will discuss your child’s progress with you during this process. The school contact could be a school counsellor, teacher, principal, vice principal or other appropriate school personnel. You should let the school contact know how your child is coping at home, including any worsening of symptoms or emotional issues, and any directions from your child’s health care professional that might be important for the school to know (e.g. restricted activity).

Ask the school contact if the school has a concussion protocol. The Return to Learn Planning Tool, Concussion Awareness Course for School Professionals and other Resources on this website can help guide the school to support your child’s return to learn.

For a child who works

A child who both works and goes to school should return to school before work. If your child works but does not go to school, they should focus on returning to cognitive aspects of work before physical activities. Use the Return to Learn guidelines to help guide this process. Once they are successfully back to a normal cognitive level of activity they can use the Return to Play Protocol to guide their return to physical activities.

When can my child go back to school?

Every child’s recovery from a concussion is unique and so the decision about when your child can return to school should be made between:

  • You
  • Your child
  • Your child’s school
  • Your child’s physician
  • Any other health professionals involved in your child’s care

The Return to Learn Protocol provides a stepwise process for gradually guiding your child back to school.

Following the initial period of rest (Stage 1) to allow the brain to rest, and your child has remained symptom-free for 24 hours, your child can start doing light cognitive activities at home (Stage 2). This could begin with short periods (5 to 15 min) of activity such as reading, drawing, puzzles, building blocks, watching TV and limited computer time, as long as the activity does not worsen symptoms. Slowly increase the time doing cognitive activity to 30 minutes. This can be done several times a day with a break between each session as tolerated by your child. As in the rest period, the student should not attend school, participate in sports, drive or go to work .

When your child reaches stage 2, you should contact the school to discuss your child’s Return to Learn Plan. Usually school work will begin at home where the environment can be better controlled. Once your child tolerates 60 minutes of school work, in two 30 minute sessions with a break between without worsening symptoms, they may be ready to return to school part time.

Once back at school, your child’s Return to Learn Plan should be followed to guide them through the protocol until they are back to school full time. This is a fluctuating process where your child may do well one day and not the next. It could take 2 to 4 weeks until your child is back to school full time.

If your child does not progress past stage 3 after 4 to 6 weeks, you should seek further medical advice.

The Return to Learn Protocol can be found in the Resources section of this website.

The Return to Learn Planning Tool, Concussion Awareness Course for School Professionals and other Resources on this website can help guide the school to support your child’s return to learn.

How can a concussion affect my child at school?

A concussion can affect your child’s physical, cognitive and emotional functioning. These symptoms can have an effect on your child’s learning in the following ways:

Physical Cognitive Emotional
Tires easily

Sensitive to light

Sensitive to noise

Fatigues as day/week progresses

Restlessness

Unsteadiness when walking

Headaches

Visual disturbances

Neck pain

Dizziness/lightheadedness

Nausea/vomiting

Sleep disturbance

Tires easily

Decreased academic achievement

Attendance issues

Late/incomplete homework

Difficulty concentrating

Difficulty remembering

Easily distracted

Difficulty organizing

Slowed information processing

Difficulty multitasking

Difficulty understanding concepts

Difficulty expressing themselves

Difficulty reading

Difficulty learning new information

Irritable/angry

Sad/depressed

Behaviour changes

Problems with motivation

Social issues (with peers)

Frustration

Gets upset easily

Anxiety

Restlessness

Symptoms can be situational and triggered by elements in the environment. For example, a student may experience a headache in the classroom from the fluorescent lights but the headache subsides when they go outside.

A healing brain has to work harder to accomplish anything which leaves limited energy for other tasks. For many children this limited energy is compounded by:

  • Changes in their sleep patterns
  • Overexerting themselves
  • Feeling pressure to keep up with school work
  • Dealing with the emotional impacts of concussion

What learning accommodations could help my child at school?

Learning accommodations are changes to school work, expectations, or the learning environment that teachers can use to support a student with specific learning needs. Learning accommodations are individual. What works for one child may not work for another and performance may fluctuate daily. If learning accommodations are used for your child, your child’s teacher will monitor their effectiveness and adjust as needed.

The following are some examples of how teachers can support a concussed students return to school:

Physical Cognitive Emotional
Frequent rest breaks

Restrict physical activity including PE, team sports, recess, and lunch break

Allow student to wear sunglasses/hat, noise reducing earplugs

Seat student away from windows or bright lighting

Preferential seating to reduce distractions

Allow for a modified timetable

Access to a quiet space for breaks

Restrict classes with noise and/or safety issues

Allow class transition before bell

Reduce:
– Amount of time at school
– Academic expectations
– Work loadLimit time focusing on school workPrioritize essential school work

Avoid stimulating or noisy environments

Provide a quiet space for schoolwork

Provide class notes

Frequent rest breaks

Allow extra time to complete tasks

Allow access to the learning support teacher

Consider tutoring support

Provide opportunities for socialization

Allow student to remove themselves from situations they aren’t tolerating well

Provide avenues for student to express themselves

Access to school counsellor/psychologist

Provide supportive feedback/reassurance

Ultimately, the goal of learning accommodations is to support your child in participating in school to the best of their ability and to avoid:

  • Exacerbating symptoms
  • Delaying their recovery
  • Having a negative impact on their grades or social relationships

Schools can refer to the Concussion Awareness Course for School Professionals and other Resources on this website for more information on the effects of concussion on learning and learning accommodations.

What's my role in supporting my child's return to school?

As the parent or guardian, you have a central role in supporting your child’s return to school. You are the advocate for your child between any healthcare professionals, your child’s school and any other organization your child is involved in.

It is your responsibility to report a non-school related concussion or suspected concussion to your child’s school. For concussions that occur at school, you are responsible for responding to the school and for ensuring your child is assessed as soon as possible by a healthcare professional.

You should ensure that the school identifies a school contact. It is your responsibility to maintain communication with the school contact to discuss how your child is coping with returning to school, such as coping with homework, workload, etc. In addition, you should provide the school with any directions from your child’s healthcare professional that might be important for the school to know, such as restrictions on your child’s physical activity.

You have an important role to play in the development and implementation of your child’s Return to Learn Plan. You and your child should work collaboratively with the school to create a plan that includes:

  • How your child’s needs will be met at school
  • The learning accommodations needed to support your child
  • What school work will be done at home

Once the plan is created, you should help support your child’s progress by following the Return to Learn Plan at home, and communicating with the school contact about how your child is tolerating the plan.

You are responsible for completing any paperwork the school requests you to complete. This includes getting the required written medical clearance from your child’s healthcare professional to participate in physical activity as outlined in the Return to Learn and Return to Play protocols.

What physical activity can my child do at school?

Initially your child’s physical activity should be limited to prevent your child from prolonging their recovery and from sustaining another concussion. It is easier for a child recovering from a concussion to sustain another concussion. Your child should not participate in any physical activity that puts them at risk for falling, or receiving a direct hit to their head or hit to their body.

Because every child with a concussion is unique, you should seek advice from your child’s healthcare professional to determine the level of physical activity in which your child can participate.

Should my child participate in PE?

Unless under the direction of a healthcare professional, your child should not participate in PE or any activity that puts them at risk for falling, or receiving a direct hit to the head or a hit to the body. For example: use of climbing equipment, running activities, gymnastics, team sports, etc. should be restricted.

Your child should be able to tolerate regular classroom activity like moving around in the room. However, any activity that involves more physical exertion, such as a field trip where the class is going hiking or skating, should be avoided until written medical clearance is obtained for increasing your child’s physical activity.

The first priority for your child is to get back to school full-time before focusing on increasing physical activity. Once back at school full-time, you should obtain written medical clearance by a healthcare professional before your child focuses on increasing physical activity. Your child’s gradual return to physical activities should be guided by the Return to Play protocol before returning to full participation in PE.

For information on the Return to Play protocol visit the Concussion Awareness Course for Parents

How do I know if my child is progressing?

A Return to Learn Plan is effective if your child is progressing. The goal is to have your child remain symptom-free or in cases where a child returns to school with symptoms, to not exacerbate the symptoms.

Your child’s Return to Learn Plan should include how to monitor the plan’s effectiveness including:

  • Mode and frequency of communication between you and the school contact – this could be using school agendas, email, and phone calls
  • Mode and frequency of communication between the school contact and the teachers
  • Timing of regular meetings to discuss your child’s progress and make adjustments as needed
  • How your child’s academic progress will be monitored
  • How your child’s emotional adjustment is monitored, by whom and what actions to take should there be concerns
  • Any issues that develop and what strategies will be implemented to address those issues

Each child’s recovery is unique. Most will make academic progress independently, but some children may benefit from temporary learning support or tutoring to guide their progress.

When should I be concerned?

If your child does not progress within a 4 to 6 week period or if you are concerned about your child’s mental health, you should seek further medical advice. In addition, other professional resources can be consulted such as the school counsellor, learning support teacher or school psychologist for further recommendations.

For more information on concussions take the Concussion Awareness Course for Parents.

My child seems more anxious than usual. Is this normal with a concussion?

A concussion can cause a child to become anxious, or if a child has pre-existing anxiety their symptoms may worsen with a concussion.

There are many concerns that could lead a child with a concussion to be anxious. For some children, concerns with falling behind in school, not participating in sports, fear of reinjury or an unknown recovery period can lead to feelings of anxiety.

For some children, providing supportive feedback and reassurance can help them manage their anxiety. Others may need additional resources such as a school counsellor, school psychologist or other community based mental health services to cope with their anxiety.

Early intervention is key. Contact your healthcare professional if you are concerned about your child or if they have any of the following warning signs:

  1. Symptoms of anxiety with a change or deterioration in functioning at school or in relationships with family or peers
  2. Symptoms of anxiety or other emotional changes (e.g. acting out) that lasts longer than 3 months
  3. Any expression of self-harm or suicidal thinking

More information on supporting a child’s emotional well-being can be found in the Resources section.

My child seems sad or depressed. Is this normal with a concussion?

A concussion commonly causes emotional symptoms such as feeling sad, down, irritated or frustrated—particularly in adolescents. If your child has pre-existing mental health concerns the symptoms may worsen with a concussion.

Emotional changes in some children can be the result of physical changes in their brain associated with the injury itself. For others, not being able to go to school, participate in team sports, or attend social functions may lead to feelings of sadness and isolation. These emotional symptoms can interfere with recovery. Early intervention is key.

Monitor your child throughout the recovery period for signs of emotional changes. You should contact your child’s healthcare professional if you notice any of the following warning signs:

  1. Symptoms such as anxiety, sadness or depression with a change or deterioration in functioning at school or in relationships with family or peers
  2. Symptoms of depression (withdrawn, sadness, etc.) that last most of the day and for longer than 2 weeks, or other emotional symptoms (anxiety, acting out, etc.) that lasts longer than 3 months
  3. Any expression of self-harm or suicidal thinking

If you are concerned, you should contact your healthcare professional. Additional resources may include a school counsellor, school psychologist or other community based mental health services.

Strategies that can help support your child’s emotional well-being include:

  • Providing opportunities for socialization
  • Allowing your child to remove him/herself from situations they aren’t tolerating well
  • Providing avenues for your child to express him/herself
  • Accessing school resources e.g. school counsellor or psychologist

More information on supporting a child’s emotional well-being can be found in the Resources section.

How can I help to prevent concussions?

Though not all concussions can be prevented, there are steps you can take to decrease the risk of your child sustaining one.

Ensuring your child has the right equipment

Helmets and mouth-guards are vital pieces of equipment that protect your child from serious skull and dental injuries, but they do not prevent the brain from moving around when there is impact to the head.

There is no equipment that can totally prevent concussions. Ensuring that your child has the required equipment for the sport, that it is in good condition and fits correctly, could decrease incidents that cause concussions.

Encouraging fair play

A child’s behaviour and attitude has a major impact on concussion causing incidents. Remember your child is watching you. You can encourage fair play by modeling respect and fair play in the presence of your child.

Creating a positive attitude for reporting

Children will often hide symptoms of concussion because they don’t want to fall behind in school or disappoint their team or parents. Creating a positive avenue for reporting concussion symptoms sooner can make the biggest difference in preventing more serious concussion outcomes and associated risks.

Learning more about concussions

Educating yourself is the first step in preventing concussions and reducing associated risks for your child. Take the Concussion Awareness Course for Parents and check out the Parent Resources where you will find videos, expert talks and articles.

Teaching your child

Teaching your child about concussions helps them understand how serious a concussion injury can be. It also gives them the tools to recognize and report if they do sustain a concussion. An informed child is more likely to comply with the recovery process. Use the resources in the Students section of this website to help teach your child about concussions.

As a parent you have a key role in your child’s recovery from a concussion