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

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 – rest

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

Monitor your child for red flag signs and symptoms

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 – starting 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.

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

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.

Limit screen time in the first 7-10 days

A recent study suggests that significantly reducing screen time in the first 48 hours speeds recovery; read more on our blog post. A second study found a Goldilocks effect. This “just right” moderate amount of screen time is between 2 hours and 7 hours per day for the first 7-10 days after a concussion. Those engaging in moderate screen time had fewer cognitive and somatic (body) symptoms in the six months following a concussion than those engaging in less than 2 hours or more than 7 hours per day. Read more on our blog post.

One reason that screen time in moderation is best for recovery is 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. The visual strain of screens can be reduced with apps and devices (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


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 Guidelines

Return to School strategy

Scroll below this chart for instructions on how to implement this Return to School strategy

How to use the Return to School strategy

When using the Return to School strategy in the chart above, follow these instructions from the Concussion Awareness Training Tool:

  • 24 hours is the minimum time between each stage of a strategy.

  • The amount of time in each stage will vary for each person, some stages may take longer than others, and sometimes your child will need to move back a stage.

  • Stage one is rest until symptoms improve, or for a maximum of 48 hours.

    • Initial rest supports concussion recovery by allowing the brain the energy it needs to heal.

    • Prolonged rest has not been found to be beneficial and may even delay recovery.

  • There should be no new or worsening symptoms for 24 hours before your child moves to the next stage.

  • The goal for each stage is that your child tolerates the new activity, and the activity is not making symptoms worse. Your child doesn’t need symptoms to disappear entirely to have completed a stage.

  • Wait at least 24 hours before attempting the next stage.

  • If the activity of a new stage makes symptoms worse, move back to the previous stage.

Return to Learn Planning Tool

return to learn planning tool

Return to 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 Sport strategy

We recommend the Return to Sport strategy developed by the Concussion Awareness Training Tool (CATT) and the BC Injury Research and Prevention Unit. See the chart below; scroll below the chart for an explanation of how to use it.

How to use the Return to Sport strategy

When using the Return to Sport strategy in the chart above, follow these instructions from the Concussion Awareness Training Tool:

  • 24 hours is the minimum time between each stage of a strategy.

  • The amount of time in each stage will vary for each person, some stages may take longer than others, and sometimes your child will need to move back a stage.

  • Stage one is rest until symptoms improve, or for a maximum of 48 hours.

    • Initial rest supports concussion recovery by allowing the brain the energy it needs to heal.

    • Prolonged rest has not been found to be beneficial and may even delay recovery.

  • There should be no new or worsening symptoms for 24 hours before your child moves to the next stage.

  • The goal for each stage is that your child tolerates the new activity, and the activity is not making symptoms worse. Your child doesn’t need symptoms to disappear entirely to have completed a stage.

  • Wait at least 24 hours before attempting the next stage.

  • If the activity of a new stage makes symptoms worse, move back to the previous stage.

What is an average recovery time?

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.

Social support for your child or adolescent is vital

Adolescents may benefit from learning more about concussions