Brain injury - Cognitive fatigue

  • What is it?

    Cognitive fatigue is a unique kind of fatigue, or tiredness. It is a common problem that can happen after a mild, moderate or severe brain injury.

    When a child has cognitive fatigue, it means their brain has to work harder to concentrate on tasks it used to be able to do much more easily before the brain injury. A child may have trouble concentrating, and may not be able to think for as long as they used to.

    Cognitive fatigue is not related to a child's intellectual capacity or physical energy levels. Cognitive fatigue can lead to behavioural problems, educational difficulties and mood swings.

    What are the symptoms?

    • Difficulty maintaining attention
    • Poor endurance for tasks involving thinking
    • Can concentrate initially but then loses the ability to concentrate over time
    • Behaviour when fresh and rested is very different to when they are feeling tired
    • Child or young person 'gives up' easily on thinking tasks
    • Poor school performance
    • Needing more sleep than usual, possibly needing a nap at or after school to get through the day
    • Behavioural difficulties including hyperactivity, irritability, tearfulness and feeling miserable
    • When a child becomes muddled
    • Headaches
    • Children/young people tend to 'soldier on' but then become exhausted
    • Fatigue accumulates so children may feel more tired in the afternoon or towards the end of the school week
    • Fatigue can also be associated with feelings of low self-esteem, worry, depression and anxiety over how they will perform

    When to see a doctor?

    Your GP should see your child and exclude any other medical cause for the fatigue (for example chronic infections, thyroid problems, anaemia or a heart condition).

    What is the treatment?

    Unfortunately, there is no quick fix. Understanding the problem is the first step. Knowing that your child is not lazy, naughty or lacking motivation can reduce the stress for them and you when dealing with their fatigue. Fatigue will lessen with time as your child's brain injury stabilises, although sometimes a permanent change to their lifestyle is needed. A well balanced diet, good sleeping routines and regular exercise are important. Recognition of fatigue and taking steps to minimise its effect are also important.

    Allow your child to have the sleep they need

    • More sleep either each night or at the weekends
    • Plan for rest breaks throughout the day

    Allow 'down time'

    • For example, ask the school not to give assignments during the holidays
    • Plan breaks during homework time to do something physical

    Managing academic workload

    • Negotiate a reduced homework load and establish which homework is the most important for your child to complete
    • Negotiate a reduced school work load, e.g. one less subject to provide some 'free' periods when your child can recharge their 'brain batteries'
    • Ask for extra time to finish assignments
    • Arrange for assignments to be provided at the beginning of term so that your child can work on them evenly throughout the term
    • Apply for consideration with examinations (e.g. rest breaks and extra time) through the Department of Education

    Key points to remember

    • Cognitive fatigue means that a child has more trouble paying attention for long periods. This does not mean that they have reduced intellectual abilities or reduced physical energy.
    • A child's mental endurance usually improves over time, however fatigue can persist.
    • If your child is experiencing cognitive fatigue contact your local doctor to exclude any other possible causes.
    • As your child's brain injury stabilizes, their cognitive fatigue is likely to reduce.

    For more information


    Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

    Reviewed September 2020.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit



This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.