Concussion in Children: Signs, Recovery & Return to Play

Go to the emergency department now if your child has any of these

One pupil larger than the other
Drowsiness, or you can't wake them
A headache that keeps getting worse
Slurred speech, weakness, numbness, or poor coordination
Repeated vomiting
Convulsions or a seizure
Unusual behavior, increasing confusion, restlessness, or agitation
Loss of consciousness, even briefly
Neck pain, or you're concerned about a neck or spine injury — don't move them; call 911

For infants and toddlers, also: persistent crying that can't be consoled, refusing to feed or nurse, or any bump or bruise on the head in a baby.

If you're unsure, get them seen. A head injury in a child is always a reasonable reason to seek assessment.

What's changed, and why it matters

The old advice: complete physical and cognitive rest until every symptom resolved. Dark room, no screens, no school, no reading, no activity. Often called cocooning.

What the research found: no evidence that this facilitates recovery. Extended strict rest can prolong symptoms and contribute to low mood, deconditioning, and social isolation — problems that then look like continuing concussion symptoms.

Current guidance, from the Amsterdam consensus statement (2023):

First 24–48 hours: relative rest. Normal activities of daily living, with reduced screen time. Not a dark room.
From around day 2: early return to light physical activity — walking, ordinary daily movement.
Days 2–14: prescribed aerobic exercise at an intensity that doesn't meaningfully worsen symptoms, guided by a healthcare professional. This has been shown to reduce the likelihood of persisting symptoms.
The symptom rule: activity can continue and increase as long as any symptom increase is mild and brief — under about an hour.

How much difference this makes: a meta-analysis of seven studies found early physical activity and prescribed exercise improved recovery by a mean of 4.64 days (95% confidence interval 2.59 to 6.69 days).³ This refers to graded, prescribed exercise from around day 2 onward — not unstructured exertion in the first 24 hours.

Sleep matters, and the old myth is wrong

"Don't let them sleep" and "wake them every hour" are outdated. Once your child has been medically assessed and no red flags are present, sleep is important and should be protected. Sleep disturbance after concussion is associated with slower recovery. If you're unsure whether your child has been adequately assessed, that's a reason to seek assessment — not a reason to keep them awake.

Signs of concussion

Symptoms may appear immediately or develop over hours. Loss of consciousness happens in only a minority of concussions — its absence means nothing.

Physical — headache, nausea or vomiting, dizziness, balance problems, blurred or double vision, sensitivity to light or noise, fatigue
Thinking — feeling foggy or slowed down, difficulty concentrating, memory problems, confusion about recent events
Emotional — irritability, sadness, being more emotional than usual, anxiety
Sleep — sleeping more or less than usual, difficulty falling asleep

In younger children, watch for changes in behavior rather than reported symptoms: unusual irritability, changes in feeding or sleep, loss of interest in favorite toys, unsteadiness, or listlessness.

Sensitivity to light and noise is very common after concussion and is one of the more disruptive symptoms at school. It's a recognized part of recovery, not oversensitivity.

Return to learn — before return to sport

School comes first, and the sequence is not optional. A staged approach:

Daily activities at home that don't provoke significant symptoms — light reading, brief screen use
School-type activities at home — homework in short blocks
Part-time school return with breaks, reduced workload, and no tests
Full days with accommodations still in place
Full return with no accommodations

Accommodations worth requesting: shortened days, rest breaks in a quiet space, reduced screen time, extended deadlines, no tests during early recovery, permission to wear sunglasses or a cap indoors, and leaving class early to avoid crowded corridors.

Symptoms during school activity are expected and not automatically a sign of harm. The threshold is whether the increase is mild and settles within about an hour. If it's more than that, scale back and build up more gradually.

Tell the school in writing. Teachers, the school nurse, and coaches all need to know — coaches particularly, because a child who feels better may push to return.

Return to sport

Never the same day

A child or adolescent with a suspected concussion must not return to play on the day of injury, regardless of how quickly they say they feel better. This is a firm rule in every current guideline.

A second head injury before the first has resolved carries a rare but catastrophic risk. It is not a judgment call to be made on a sideline.

Return to sport follows a graduated protocol, supervised by a healthcare professional, moving through: light aerobic exercise → sport-specific exercise → non-contact training drills → full-contact practice after medical clearance → return to competition.

Key principles:

Return to learn comes first — full school participation before full sport
Each stage takes at least 24 hours
If symptoms return, step back and progress more slowly
Medical clearance is required before any contact
Children and adolescents recover more slowly than adults, so adult timelines don't apply
Research suggests female athletes may require longer recovery

When recovery takes longer

Most children recover within a few weeks. Some take longer, and that's where targeted assessment matters.

Vision and vestibular problems predict prolonged recovery in children⁴ — and they're frequently missed, because the symptoms get attributed to general concussion rather than identified as a specific, treatable problem.

Signs worth flagging:

Dizziness or unsteadiness persisting beyond the first days
Difficulty focusing the eyes, or words moving on a page
Nausea with head movement, or in busy visual environments
Difficulty tracking a moving object
Feeling worse in supermarkets, corridors, or crowds

These respond to targeted therapy. Vestibular rehabilitation and vision therapy are associated with better outcomes and faster recovery, and multidisciplinary care improves results. A physical therapist with vestibular training can assess and treat this — and it's one of the more concrete things available when recovery has stalled.

If symptoms persist beyond about four weeks, ask for referral to a concussion clinic or specialist. Prescribed aerobic exercise also has evidence for children whose symptoms have lasted over a month.³

Find a physical therapist with vestibular training near you.

Browse providers by city and state.

Browse the DrSensory Therapy Directory →

Headache after concussion

Common, and often the most persistent symptom.

Generally used: acetaminophen is usually the first choice. NSAIDs are also used, but clinicians often hold off on them in the first day or two after a head injury until any significant bleeding has been ruled out. Opioids should be avoided. Where headaches have migraine features, a clinician may consider migraine-specific treatments. (This medication guidance comes from general pediatric and AAP sources, not from the Amsterdam consensus statement itself.)

Watch for medication overuse. Frequent painkiller use over weeks can itself cause headaches, which then look like continuing concussion symptoms. Discuss frequency with your child's doctor.

Non-medication approaches matter: regular sleep, hydration, regular meals, managing screen exposure, and identifying triggers.

Doses come from your child's doctor. Any new or worsening headache after a head injury should be assessed rather than treated at home.

Children with existing conditions

Concussion assessment is harder when a child already has neurological or developmental differences, and it's more easily missed. If your child is autistic, has ADHD, a learning difference, or existing sensory processing differences:

Baseline matters. Clinicians assess change from a child's own normal, so describe what your child was like before the injury.
Existing sensory sensitivity can mask or amplify concussion symptoms.
Communication differences may mean a child can't report symptoms in the expected way — watch behavior instead.
Recovery may take longer, and existing accommodations may need temporary expansion.

Say the pre-existing diagnosis out loud at every assessment. It changes how findings are interpreted.

Myths worth clearing up

"You have to lose consciousness to have a concussion." No. Most concussions involve no loss of consciousness.

"Wake them every hour." Outdated. Once assessed with no red flags, sleep should be protected.

"They need a dark room and no screens until they're better." No longer recommended. Relative rest with reduced screens for 24–48 hours, then gradual return to activity.

"A CT scan will show a concussion." It won't. Imaging looks for bleeding or fracture. Concussion is diagnosed clinically, and a normal scan doesn't mean no concussion.

"They said they're fine, so they can play." No. Same-day return after a suspected concussion is not permitted regardless of how the child feels.

"Helmets prevent concussions." They substantially reduce skull fractures and severe brain injury, but do not eliminate concussion risk.

Frequently Asked Questions

How do I know if my child has a concussion?

Common signs include headache, nausea, dizziness, sensitivity to light or noise, feeling foggy, memory problems, irritability, and changes in sleep. Loss of consciousness occurs in only a minority. Any suspected concussion should be assessed by a doctor.

Should I keep my child awake after a head injury?

No. Once they have been medically assessed and no red flags are present, sleep is important and should be protected. "Wake them every hour" is outdated advice. Sleep disturbance after concussion is associated with slower recovery.

Do children need complete rest after a concussion?

No — this guidance changed. Research found no evidence that strict rest until symptoms clear aids recovery, and it may prolong it. Current guidance is relative rest with reduced screens for 24 to 48 hours, then early return to light activity, which has been shown to shorten recovery.

When can my child return to sport?

Never the same day a concussion is suspected. Return to school comes before return to sport, and return to sport follows a graduated protocol with at least 24 hours per stage and medical clearance before any contact.

How long does concussion recovery take in children?

Most recover within a few weeks, though children and adolescents typically recover more slowly than adults. If symptoms persist beyond about four weeks, ask for referral to a concussion clinic.

Will a CT scan show a concussion?

No. Imaging looks for bleeding or a skull fracture, not concussion, which is diagnosed clinically. A normal scan does not mean your child does not have one.

What if my child is still dizzy weeks later?

Vision and vestibular problems predict prolonged recovery in children and are frequently missed. They respond to targeted therapy — vestibular rehabilitation and vision therapy are associated with better outcomes. Ask for assessment by a physical therapist with vestibular training.

Can my child get a concussion without hitting their head?

Yes. A blow to the body that causes rapid head movement can cause one. Whiplash-type injuries can produce concussion without direct head contact.

Sources

Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine. 2023;57(11):695–711. doi:10.1136/bjsports-2023-106898 (PMID 37316210)
Davis GA, Schneider KJ, Anderson V, Babl FE, Barlow KM, Blauwet CA, et al. Pediatric sport-related concussion: recommendations from the Amsterdam consensus statement 2023. Pediatrics. 2024;153(1):e2023063489. doi:10.1542/peds.2023-063489 (PMID 38044802)
Leddy JJ, Burma JS, Toomey CM, Hayden A, Davis GA, Babl FE, et al. Rest and exercise early after sport-related concussion: a systematic review and meta-analysis. British Journal of Sports Medicine. 2023;57(12):762–770. doi:10.1136/bjsports-2022-106676 (PMID 37316185)
Master CL, Master SR, Wiebe DJ, Storey EP, Lockyer JE, Podolak OE, et al. Vision and vestibular system dysfunction predicts prolonged concussion recovery in children. Clinical Journal of Sport Medicine. 2018;28(2):139–145. doi:10.1097/JSM.0000000000000507 (PMID 29064869)
Centers for Disease Control and Prevention. HEADS UP — concussion signs, symptoms and danger signs. Checked August 18, 2026.
American Academy of Pediatrics, HealthyChildren.org — concussions: return to learn and return to play. Checked August 18, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. If your child has any red flag symptom listed at the top of this page, go to an emergency department immediately. Any suspected concussion should be assessed by a healthcare professional, and return-to-sport decisions require medical clearance.

Concussion in Children: What to Do and How Recovery Actually Works