Pediatric Concussion: Return to Learn Before Return to Sport

Assessment

• Use age-appropriate symptom assessment, injury history and neurological screening.
• Ask about headache, dizziness, vision, cognition, sleep, mood and school tolerance.
• Consider prior concussion, migraine and learning factors that may influence recovery.

Warning signs

• Worsening severe headache, repeated vomiting, seizure, increasing confusion, slurred speech, weakness, reduced coordination or difficulty waking require urgent medical assessment.

Return to learn

CDC guidance supports return to school for most children within 1–2 days with symptom-based support rather than waiting for complete symptom resolution.

• Use short-term workload, screen/noise or rest-break adjustments when needed.
• Increase cognitive load gradually and coordinate with family and school.

Return to activity and sport

• After 1–2 days of relative rest, introduce light activity that does not significantly worsen symptoms.
• Return to regular non-sport activities before sport progression.
• Use a supervised six-step return-to-sport progression; each stage typically takes at least 24 hours.
• If symptoms recur, stop and return to the previous tolerated stage after recovery and appropriate guidance.

Common mistakes and clinical pearls

• Avoid prolonged complete inactivity.
• Do not clear contact sport based on one symptom alone.
• Clinical pearl: school function is a core recovery outcome.

Summary

Pediatric concussion care combines warning-sign screening, early symptom-limited activity, supported return to school and staged return to sport.