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Head injury – return to school and sport

  • If your child or adolescent has been diagnosed by a doctor with a mild head injury, such as concussion, they will need time to rest and recover (see our fact sheet Head injury – general advice). This fact sheet provides advice for safely returning your child to school and sport if they have had a mild head injury.

    For moderate or severe head injuries, follow your doctor’s advice for returning your child to their normal activities.

    Signs and symptoms of concussion

    While your child is gradually being returned to school or sport, monitor them for these signs and symptoms of concussion:

    • vomiting
    • headache
    • feeling like they are in a fog
    • just not ‘feeling right’ or ‘feeling down’
    • balance problems or dizziness
    • sleep disturbances or drowsiness
    • being bothered by light or noise
    • confusion, difficulty concentrating or remembering
    • slowed reaction times
    • easily upset or moody.

    Care at home

    The recovery time for children with concussion can vary, as can their symptoms. Children and adolescents with concussion can take up to four weeks to recover, but most concussions will get better on their own over several days. For the first 24 to 48 hours, children should have a period of relative (not strict) rest but should continue with their daily activities and return to light physical activity e.g. walking. Children should have sufficient sleep, a healthy diet, and limited screen time e.g. television, computers and smartphones during this initial period.

    Physical exercise such as walking or stationary cycling, and other activities such as reading or passive screen time (e.g. watching a movie; not gaming or smart phone use), can be introduced gradually as long as your child only experiences mild worsening of symptoms of concussion for a brief period of time (less than one hour).

    Graduated return to school

    Your child can continue to increase activities and move onto the next step if they are not showing any symptoms of concussion, or the symptoms are mild and brief in nature (less than one hour). Leave 24 hours between advancing to each step. If the activity results in more than mild, brief worsening of symptoms, go back to the previous step. If your child cannot advance to the next step without substantially increasing symptoms of concussion, take them to see a doctor.

     Step  Goal

    1. Daily activities at home

    Start your child on typical daily activities, such as reading or gentle walking. Begin with five to 15 minutes at a time and gradually build up.

    A gradual return to typical activities.

    2. School activities at home

    Complete light cognitive activities such as  homework, school reading or other educational activities at home

    To increase tolerance to cognitive work.

    3. Return to school part time

    You should consult with the school and gradually introduce schoolwork and a busy school environment. Your child may need to start with a shorter school day or have increased breaks during the day. Talk to your school about options for quiet break spaces at lunch or break time. School tests may need to be delayed.

    To increase academic activities.

    4. Return to school full time

    Gradually increase school activities until your child can tolerate a full day.

    Return to usual school activities and catch up on missed work.

    Graduated return to sport

    Children and adolescents should not return to sport until they have successfully returned to school. Allow at least 24 hours for each step, and a minimum of one week after the injury before your child returns to normal game play. Only move onto the next step if your child is not showing any symptoms of concussion or the symptoms are mild and brief (less than one hour in duration). Steps 4-6 should only begin when symptoms are resolved. If concussion symptoms are experienced in steps 4-6 return to step 3 until symptoms are resolved including with and after exertion.

     Step  Goal

    1. Symptom-limited activity

    Simple daily activities that do not make symptoms worse, e.g. walking.

    A gradual return to typical activities.

    2A. Light aerobic exercise

    Gradually introduce walking, swimming or stationary cycling at a slow pace. Do not allow resistance training at this stage.

    Then:

    2B. Moderate aerobic exercise

    Gradually introduce walking, swimming or stationary cycling at a medium pace. Do not allow resistance training at this stage.

    To gradually increase heart rate.

    3. Sport-specific exercise

    Your child can begin activities such as running, warm-up drills and practicing ball skills (with a soft ball). Do not allow any activities that involve head contact.

    To add movement.

    4. Non-contact training drills

    Introduce harder, high intensity training drills, such as passing drills. Your child may start progressive training.

    To introduce exercise, coordination and increased thinking.

    5. Full contact practice

    Following medical clearance, e.g.by a GP, participate in normal training activities.

    Restoring confidence, and allowing coaching staff to assess functional skills.

    6. Return to sport

    Your child can now progress to normal game play.

    Resume regular sporting activity.

    Talk to your doctor if you are unsure about your child’s progress at any step.

    Following repeated concussions, your doctor may recommend your child avoid contact sports and any activities with increased risk of head injury for a period of time. This is because after a head injury, your child’s reaction times and thinking may be slower, and this can put them further at risk.

    At-risk sports and activities include:

    • football which involves tackling. 
    • soccer and hockey
    • basketball and netball
    • horse riding
    • riding motorbikes or BMX bikes
    • skiing, snowboarding and surfing
    • riding a bike, scooter, skateboard or skates
    • playing on a trampoline
    • climbing trees or other high structures.

    Make sure your child always wears a helmet when riding a bike, scooter or skateboard.

    When to see a doctor

    Seek urgent medical attention at your local hospital emergency department if during your child’s recovery they have any of the following:

    • unusual or confused behaviour, or irritability
    • severe or persistent headache that is not relieved by paracetamol
    • frequent vomiting
    • bleeding or discharge from the ear or nose
    • a fit or convulsion, or spasm of the face, arms or legs
    • difficulty in waking up
    • difficulty in staying awake
    • they are making you worried for any reason.

    If your child’s symptoms worsen or your child is experiencing new symptoms of concussion, seek urgent medical attention.

    Key points to remember

    • The majority of concussions will get better on their own over several days.
    • Follow the return to school and return to sport steps carefully, ensuring at least 24 hours for each return-to-sport step.
    • Physical and cognitive activities can be increased as long as they do not result in more than brief, mild worsening of symptoms of concussion.
    • Return to Sport Steps 4–6 should only begin when symptoms are fully resolved,
    • Talk to your doctor if you are unsure whether your child is ready for the next stage or if they can fully return to playing sport.
    • Seek urgent medical attention if your child’s symptoms get worse or they develop new symptoms of concussion.
    • Most children recover well after a mild head injury. If your child is still requiring support to return to everyday activities after two weeks following a mild head injury, they should be reviewed by their GP for a medical assessment. Children with ongoing symptoms can be referred to the RCH Victorian Paediatric Rehabilitation Service (VPRS). GPs can make referrals to your local outpatient VPRS services via its website.
    • If you have any questions regarding accessing outpatient VPRS, you can contact the RCH VPRS outpatient coordinator by calling 03 9345 9300 or emailing rehab.services@rch.org.au.

    For more information

    Common questions our doctors are asked

    What happens if my child returns to sport too early?

    If your child returns to sport too soon after a head injury, their reflexes may be dulled, their peripheral vision affected and their response times slightly slower. All of this reduces their ability to protect themselves and avoid collisions or being hit by a ball. This increases their chance of sustaining another head injury. 

    Developed by The Royal Children's Hospital Emergency, Neurosurgery and Neuropsychology departments. We acknowledge the input of RCH consumers and carers.

    Reviewed November 2023

    This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

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


Disclaimer  

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.