Concussion in Kids: Signs, Danger Signs, Recovery and Return to School
A parent's guide to concussion in children: how to recognize the signs after a bump to the head, which danger signs mean an emergency room visit, what to do in the first 24 hours, how recovery works and how to ease back into school and play.
Quick answer: a concussion is a mild traumatic brain injury caused by a bump, blow or jolt to the head or body. Signs include headache, dizziness, confusion, nausea, sensitivity to light or noise and feeling foggy, and they may not appear right away. Go to the emergency room immediately for danger signs such as repeated vomiting, a headache that keeps getting worse, a seizure, slurred speech, unusual drowsiness, one pupil larger than the other or loss of consciousness. A child with a suspected concussion should stop playing and see a health care provider, rest briefly, then return to school and activity in gradual steps.
Children hit their heads constantly. Toddlers topple off couches, school-age kids collide on the playground and teens take hits on the field. Most bumps are minor, but a few cause a concussion, and a concussion can be hard to spot because it does not show up on the outside. Parents often wonder how to tell the difference between a bump and an injury that needs medical attention. This guide is part of our family health and safety guide, and it explains the signs, the danger signs, the first steps at home and how children recover.
Sources: Centers for Disease Control and Prevention (CDC) HEADS UP concussion information for parents and schools; American Academy of Pediatrics (AAP) HealthyChildren.org guidance on concussions; Mayo Clinic information on concussion in children. This article is general information, not medical advice. A health care provider should evaluate any child with a suspected concussion.
What Is a Concussion?
A concussion is a type of mild traumatic brain injury. It happens when a blow, bump or jolt to the head, or a hit to the body that shakes the head back and forth, makes the brain move quickly inside the skull. The movement can stretch cells and change how the brain works for a time.
The word mild can be misleading. It refers to the fact that concussions are usually not life-threatening, not that they are trivial. A concussion can still affect thinking, mood, sleep and schoolwork, and it deserves proper care.
Several points are worth knowing:
- A child does not need to pass out. The CDC notes that most concussions happen without loss of consciousness.
- Scans usually look normal. Standard imaging often cannot show a concussion. Doctors rely on symptoms and an exam.
- Symptoms can show up later. Some signs appear hours or even a day or two after the injury.
- Every child is different. Two children with the same bump may have very different symptoms.
Common Signs and Symptoms
Symptoms usually fall into four groups.
| Type | What you may see or hear |
|---|---|
| Physical | Headache, nausea, vomiting, dizziness, balance problems, blurry vision, sensitivity to light or noise, tiredness |
| Thinking | Confusion, trouble concentrating, memory problems, feeling foggy or slowed down, answering questions slowly |
| Emotional | Irritability, sadness, nervousness, crying more than usual, mood swings |
| Sleep | Sleeping more or less than usual, trouble falling asleep |
Young children cannot always describe how they feel. Watch for changes in behavior instead:
- Unusual crankiness or crying that is hard to console
- Loss of interest in favorite toys or activities
- Changes in eating or nursing habits
- Changes in sleep patterns
- Loss of balance or unsteady walking in toddlers
- A vacant stare or a dazed look
If a baby or toddler has taken a hard fall, especially from a height, call the doctor even if the child seems fine.
Danger Signs: Go to the Emergency Room
A small number of head injuries involve bleeding or swelling in or around the brain. The CDC lists danger signs that call for immediate emergency care after a bump, blow or jolt to the head or body. Call 911 or go to the nearest emergency room if your child has any of the following:
- One pupil larger than the other
- Drowsiness or cannot be woken up
- A headache that gets worse and does not go away
- Weakness, numbness or decreased coordination
- Repeated vomiting or nausea
- Convulsions or seizures, which may look like twitching or shaking
- Slurred speech
- Increasing confusion, restlessness or agitation
- Unusual behavior, or not recognizing familiar people or places
- Loss of consciousness, even briefly
- Clear fluid or blood from the nose or ears
- A soft spot on an infant’s head that bulges
For infants and toddlers, the CDC also lists inconsolable crying and refusal to nurse or eat as danger signs. If a young child has a serious fall or a forceful blow, do not wait to see what happens.
Do not move a child who may have a neck or spine injury, such as after a fall from a significant height or a car crash, unless it is necessary for safety. Wait for emergency responders.
What to Do Right After the Injury
If your child hits their head and seems alert and well, stay calm and watch closely.
- Stop activity. Take your child out of the game, off the playground equipment or away from play. A child with a suspected concussion should not return to play that day.
- Check for danger signs from the list above. If any are present, call 911 or go to the emergency room.
- Apply a cold pack to a bump or swelling on the outside of the head, wrapped in a cloth, for short periods.
- Stay with your child and watch for new symptoms for the next 24 hours or longer.
- Call your child’s doctor the same day. Many pediatric offices have a nurse line that can help you decide how urgent the situation is.
- Write down what happened: when, how, and what symptoms you noticed. A short note helps the provider.
If your child’s symptoms are mild and your provider agrees, you can monitor them at home. Keep a phone nearby and trust your instincts. If something seems off, seek care.
Should You Wake Your Child at Night?
Many parents were once told to wake a child every hour after a head injury. Current guidance from the CDC says that it is fine to let a child sleep after a concussion, and that you do not need to wake them unless a health care provider tells you to. If you are worried about how your child is sleeping, for example if you cannot rouse them or they seem unusually hard to wake, treat that as a danger sign and seek care. Ask the provider for guidance specific to your child.
How a Doctor Evaluates a Concussion
A health care provider will ask how the injury happened and what symptoms followed. They will check thinking, memory, balance, coordination, vision and reflexes. They may ask about earlier head injuries, migraines, learning problems or mood issues, because these can affect recovery.
Imaging such as a CT scan is not needed for every child. Providers use guidelines to decide when a scan is warranted, since CT involves radiation. If the doctor suggests one, ask what signs prompted it. If they do not, ask what warning signs to watch for at home.
Rest, Then Gradual Return
Older advice recommended days of strict rest in a dark room. Current guidance from the CDC and other medical groups has changed. A short period of relative rest, usually a day or two, is appropriate, with light activity that does not make symptoms worse. After that, children are encouraged to return to normal activities step by step.
First 24 to 48 hours: Rest, limit screens and avoid activities that raise symptoms. Short walks around the house or neighborhood are usually fine if they do not worsen symptoms.
After that: Slowly bring back routines. Light physical activity, schoolwork in short blocks and normal meals and sleep schedules help the brain recover.
What to avoid: Anything that risks another blow to the head, including sports, bike riding, climbing and rough play, until your provider says it is safe.
Too much rest for too long can slow recovery and worsen mood and sleep, while returning too quickly to full activity can prolong symptoms. The balance is what your provider can guide you on.
Returning to School
Many children can return to school within a few days, sometimes with temporary changes. Talk with the school nurse, teachers and counselor.
- Shorter days or breaks during the day
- Extra time for assignments and tests
- Reduced homework while symptoms improve
- A quiet place to rest if headaches or light sensitivity flare
- Permission to skip gym or recess until cleared
- Reduced screen time in class if screens cause headaches
Ask your provider for a letter that lists the accommodations your child needs. Share it with the school, and check in with the teacher every week or two about how your child is managing.
Signs that school is too much include headaches that return or worsen, difficulty concentrating, irritability or tearfulness once the school day is over, and complaints that things feel too loud or bright.
Returning to Sports and Play
A child should return to sports only after symptoms are gone at rest and the provider says it is safe. Return is usually gradual, in stages such as light aerobic activity, sport-specific movement, non-contact practice, full practice and then games. Each step takes at least 24 hours, and if symptoms come back, the child goes back to the previous step. Many states have laws that require a youth athlete with a suspected concussion to be removed from play and to receive written clearance from a health care provider before returning. Check your state’s rule and your league’s policy.
Never let a child return to play the same day. A second injury before the brain has healed can lead to a more serious problem, and it can prolong recovery.
How Long Does Recovery Take?
Most children recover within a few weeks. The CDC notes that symptoms of a concussion usually get better within two to four weeks in children, though some take longer. Children and teens can take longer than adults, and a child who has had a previous concussion may take longer too.
If symptoms last more than a month, or if they interfere with school, sleep or mood, talk with your provider. Some children benefit from a specialist, vision or balance therapy or help with sleep and mood. Persistent symptoms are not a sign of weakness, and getting help early is better than waiting.
Preventing Head Injuries
You cannot eliminate every bump, but you can lower the risk.
- Use helmets for biking, scootering, skating, skiing and sports where recommended, and make sure they fit. Our guide to bike helmet fit and safety rules for kids explains how to check.
- Use the right car seat or booster every trip, and see our guide to car seat stages by age and size.
- Make playgrounds safer with soft surfaces, age-appropriate equipment and supervision. See our playground safety guide.
- Prevent falls at home with stair gates for babies and toddlers, window guards and anchored furniture.
- Teach safe play, such as no head-first sliding on playground slides and no jumping from heights.
- Follow sports rules and teach children to speak up if they feel unwell after a hit.
Talking With Your Child
Children sometimes hide symptoms because they want to keep playing. Make it clear that telling you or a coach about a headache, dizziness or fogginess is a sign of good judgment. Say that the brain needs time to heal, just like a sprained ankle, and that missing a game is better than missing a season. Praise honesty, and avoid shaming a child for being hurt.
Frequently Asked Questions
How can I tell if my child has a concussion?
Look for headache, dizziness, confusion, nausea, sensitivity to light or noise, fogginess or behavior changes after a bump to the head or body. Symptoms can appear hours later, so a provider should evaluate any suspected concussion.
Is it okay for my child to sleep after hitting their head?
Per CDC guidance, sleep is fine after a concussion unless a provider has told you otherwise. If your child cannot be woken or seems unusually drowsy, go to the emergency room.
Does a child have to lose consciousness to have a concussion?
No. Most concussions happen without loss of consciousness.
How long does a concussion last in a child?
Most children improve within two to four weeks, but some take longer. Talk with your provider if symptoms linger.
When can my child go back to school?
Many children return within a few days with short-term adjustments. Work with the school nurse and your provider.
When can my child play sports again?
Only after symptoms are gone and a health care provider gives clearance, following a stepwise return.
