CONCUSSION: MORE THAN A BUMP TO THE HEAD
Concussion isn’t always obvious.
A child can “seem fine” at first, keep playing, or only show mild changes that are easy to miss—especially when adrenaline, excitement, or fear is involved.
This article explains what concussion is, what to watch for, what to do early on, and how to support a safe, complete recovery—at home, at school, and in sport.
1. Introduction: concussion can look subtle—and is often missed
Many people picture concussion as a dramatic hit followed by immediate symptoms. In reality, concussion symptoms can start minutes to hours later, and they can be physical, emotional, or behavioural—not just a headache.
Because signs may be subtle (or a child may minimize symptoms to keep playing), concussion can be missed unless you know what to look for and what questions to ask.
A child falls from a bicycle, collides with another player on the sports field, or takes a hard knock during play. They get up, they are talking, and there may be no visible injury. It can be tempting to think, “They seem fine.”
But a concussion does not always look dramatic.
A concussion is a type of mild traumatic brain injury caused by biomechanical forces that temporarily alter how the brain functions. A child does not have to lose consciousness, and there does not necessarily need to be a direct blow to the head. A force transmitted through the body can also cause rapid movement of the head and brain.
Understanding what happens during a concussion helps explain why symptoms can seem so varied, why recovery is different for every child, and why returning to school and sport should be gradual rather than rushed.
IMPORTANT
If you suspect a concussion, treat it seriously and start with safety first. It’s always better to be cautious and get the right medical guidance early.
2. What happens inside the brain?
The brain is soft tissue contained within the skull. During a rapid acceleration, deceleration or rotational movement, the brain is exposed to mechanical forces that can strain brain tissue and nerve fibres.
It is more accurate to think of this as axonal strain and cellular disruption rather than simply saying that the brain has been “bruised” or that axons have been “sheared.”
At a microscopic level, concussion triggers a complex series of chemical and metabolic events known as the neurometabolic cascade of concussion.
Following the injury, neuronal cell membranes become disrupted and there are changes in the normal movement of ions across these membranes. Potassium moves out of cells while calcium can move into them, alongside changes in neurotransmitter activity.
The brain immediately tries to restore its normal cellular balance.
That restoration requires energy.
The sodium-potassium pumps responsible for restoring normal ionic balance require adenosine triphosphate (ATP), the molecule cells use as an immediate source of energy. Energy demand therefore increases at exactly the time that normal cerebral energy metabolism may be impaired. Mitochondrial function can also be affected by calcium accumulation.
This creates what is often described as a temporary energy crisis or energy mismatch.
2.1 Why does this matter?
Concussion affects more than sport. It can impact learning, mood, sleep, balance, vision, and behaviour—things your child needs every day at school and at home.
WHY THIS MATTERS
Early recognition and the right recovery plan reduce the risk of prolonged symptoms and help your child return to school, activities, and sport safely—without setbacks.
3. The neck matters too
Concussion does not necessarily occur in isolation.
The same acceleration, deceleration and rotational forces that move the head can also place considerable load on the cervical spine and surrounding muscles and joints.
This matters because symptoms arising from the neck can overlap with symptoms commonly attributed to concussion.
These may include headache, neck pain or stiffness, dizziness, disturbed balance and discomfort associated with head movement.
For this reason, a comprehensive assessment should consider both the neurological injury and the cervical system, particularly when neck pain, headache, dizziness or balance problems persist.
Current international concussion guidance specifically recommends cervicovestibular rehabilitation when appropriate for persistent dizziness, neck pain and/or headache.
5. What might you notice?
Concussion symptoms can vary from child to child. You might notice one symptom—or a mix that changes over the day, especially with schoolwork, screens, noise, or physical activity.
Physical symptoms
Headache or pressure in the head
Nausea or vomiting
Dizziness or feeling “off”
Sensitivity to light or noise
Fatigue or low energy
Feeling worse with activity (physical or mental)
Thinking and concentration
Trouble focusing, reading, or following instructions
Feeling slowed down or “foggy”
Taking longer to answer questions
Forgetfulness (especially around the event)
Vision and balance
Blurred or double vision
Difficulty tracking words on a page
Unsteadiness, clumsiness, or poor balance
Dizziness triggered by busy environments (hallways, stores, sports fields)
Sleep
Sleeping more than usual or difficulty waking
Trouble falling asleep or staying asleep
Feeling unrefreshed despite sleep
Mood and behaviour
Irritability, tearfulness, or mood swings
Anxiety or feeling unusually emotional
Withdrawal from friends/family or loss of interest in usual activities
Behaviour changes that feel “out of character”
Neck-related symptoms
Neck pain or stiffness
Headaches that worsen with neck movement or posture
Dizziness linked to turning the head
Shoulder/upper back tightness
Tip for parents
Ask, “What makes it worse?” and “What makes it better?” Symptoms that reliably worsen with reading, screens, noise, or activity can be a helpful clue—even if the symptom itself seems mild.
6. Red flags: when a concussion may be more than a concussion
Some symptoms suggest a more serious injury and need urgent medical assessment.
7. What should I do if I suspect a concussion?
Stop the activity right away. No same-day return to play.
Keep your child safe and supervised. Avoid risky activities (bike, trampoline, contact play).
Arrange medical assessment, especially if symptoms are significant, new, or worsening.
Document what happened and what you noticed (time, symptoms, triggers). This helps health professionals and schools support recovery.
IMPORTANT
Arrange assessment by appropriately qualified healthcare provider. Seek urgent care if symptoms are worsening or any red flags are present.
7.1 The first 24–48 hours
Focus on calm, supported recovery—not strict bed rest, and not pushing through. Many children do best with relative rest: quiet activities that do not significantly worsen symptoms, with regular breaks. Current recommendations actually support light physical activity such as short walks during the first 1 -2 days, provided it only causes mild/brief symptom aggravation and there is no risk of another head injury.
Helpful early steps may include:
Keeping things low-stimulation (dim lights if needed, reduced noise, short screen time)
Encouraging hydration and regular meals/snacks
Allowing sleep and downtime
Avoiding sport, rough play, and activities with fall risk
If symptoms quickly worsen, or red flags appear, seek urgent medical care.
7.2 Should I keep waking my child?
In many cases, once your child has been assessed (or you have no red flags), sleep is helpful. Waking a child repeatedly through the night is not always necessary and may interrupt recovery.
If a clinician has given you specific instructions (for example, after a higher-risk injury), follow those instructions. If you’re unsure or you notice worsening symptoms, seek medical advice promptly.
7.3 What not to do after a concussion
Don’t let your child “push through” symptoms at school, sport, or activities.
Don’t allow same-day return to play or contact activities.
Don’t assume it’s only a headache—watch for changes in behaviour, sleep, and learning.
Don’t dramatically restrict all activity for long periods without guidance; too much restriction can also slow recovery for some children.
8. How is a concussion treated?
Concussion treatment is usually active and individualized. The goal is to reduce symptom triggers at first, then gradually build tolerance for thinking, movement, and daily life—without causing significant symptom spikes.
Treatment plans may include a combination of:
A step-by-step return to school (return-to-learn) and return to activity
Sleep support and routine building
Guidance on screen time and workload
Targeted rehabilitation (for example, balance/vestibular therapy, vision therapy, neck rehab) when needed
9. What about pain medication?
Pain relief can be appropriate for some children, but medication choices should be guided by a clinician—especially in the early period after injury, or if symptoms are worsening.
Avoid using medication to “mask” symptoms so your child can return to sport or full activity. Pain relief should support comfort and rest, not speed up risky return.
IMPORTANT
If headaches are severe, worsening, or different from your child’s usual headaches, seek medical advice rather than repeatedly increasing medication at home.
10. Returning to school: the brain needs to return to learning too
School is often the biggest “workout” for the recovering brain. Many children need temporary supports to reduce symptoms and prevent setbacks while they heal.
Common short-term school supports include:
Most children should return to school within 1-2 days, often while some symptoms remain, with temporary accommodations. They do not need to be completely symptom-free before returning to learning. Shortened school day or gradual re-entry.
Rest breaks (quiet space)
Reduced workload and postponed tests
Extra time for assignments and exams
Reduced screen-based work when it triggers symptoms
Communication matters: share the plan with the teacher, school office, and any learning support staff so expectations are consistent.
11. Recovery is more than “my headache is gone”
Headache may be the most noticeable symptom—but it’s not the only marker of recovery. A child may feel okay at rest but still struggle with reading, busy environments, or physical exertion.
True recovery means your child can handle school, social life, and physical activity at their usual level without symptoms returning or building across the day.
12. Why is there a return-to-play protocol?
A return-to-play protocol is designed to protect the healing brain. It uses staged increases in activity so symptoms can be monitored and setbacks can be avoided.
This stepwise approach also reduces the risk of a second injury before full recovery, which can be more dangerous than the initial concussion. The protocol is a graded progression under healthcare-provider guidance.
13. What if symptoms return with activity?
Symptoms returning is a signal the brain (or neck/vision/balance systems) isn’t ready for that level of load yet. This doesn’t mean recovery has failed—it means the plan needs adjusting.
In general, step back to the last level that felt manageable, allow symptoms to settle, and progress more gradually. If symptoms repeatedly flare with minimal activity, seek reassessment and targeted support.
14. When recovery takes longer
Some children recover quickly, while others take longer. Longer recovery can happen for many reasons, including symptom burden early on, returning to full school or sport too quickly, co-existing neck injury, migraine tendency, sleep disruption, anxiety, or vestibular/vision challenges.
If recovery is not progressing as expected, it’s worth checking whether there are treatable drivers (sleep, neck, vestibular, vision, mood) that need specific attention—not just more rest.
15. Rehabilitation: treat the child, not just the concussion
A good concussion plan looks at the whole child: symptoms, school demands, stress levels, physical conditioning, and any neck/vestibular/vision issues.
Rehabilitation may involve a team approach, such as a medical provider plus physiotherapy or other therapies when indicated. The aim is to restore confidence and function—step by step—while keeping your child safe.
WHY THIS MATTERS
Persistent symptoms often improve when the specific contributors are identified and treated—rather than waiting for time alone to fix everything.
16. Final thoughts
Concussion can be scary because it’s not always visible—but you’re not powerless. Knowing what to look for, acting early, and following a structured return-to-learn and return-to-play plan can make recovery smoother and safer.
If something doesn’t feel right, trust your instincts and seek professional advice. Most children recover well with the right support.
17. Medical disclaimer
This article is for general education and is not a substitute for medical assessment, diagnosis, or treatment. If you suspect a concussion, seek guidance from a qualified health professional. If red flags are present or symptoms are worsening, seek urgent medical care immediately.
References
Centers for Disease Control and Prevention. (2025). Safety guidelines for pediatric mild TBI. National Center for Injury Prevention and Control.
CDC Pediatric Mild TBI Guidelines
Centers for Disease Control and Prevention. (2025). Signs and symptoms of concussion. HEADS UP.
CDC Concussion Signs, Symptoms and Danger Signs
Centers for Disease Control and Prevention. (2025). Returning to school after a concussion. HEADS UP.
CDC Returning to School After Concussion
Centers for Disease Control and Prevention. (2025). Returning to sports. HEADS UP.
CDC Return-to-Sport Progression
Centers for Disease Control and Prevention. (2025). Responding to a sports-related concussion. HEADS UP.
Davis, G. A., Schneider, K. J., Patricios, J. S., et al. (2024). Pediatric sport-related concussion: Recommendations from the Amsterdam Consensus Statement 2023. Pediatrics, 153(1), e2023063489.
AAP Pediatric Concussion Recommendations
Giza, C. C., & Hovda, D. A. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36(3), 228–235.
Giza, C. C., & Hovda, D. A. (2014). The new neurometabolic cascade of concussion. Neurosurgery, 75(Suppl. 4), S24–S33. https://doi.org/10.1227/NEU.0000000000000505
Patricios, J. S., Schneider, K. J., Dvorak, J., et al. (2023). Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport—Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711.
Amsterdam 2022 Concussion Consensus Statement
Schneider, K. J., Meeuwisse, W. H., Nettel-Aguirre, A., et al. (2014). Cervicovestibular rehabilitation in sport-related concussion: A randomised controlled trial. British Journal of Sports Medicine, 48(17), 1294–1298. https://doi.org/10.1136/bjsports-2013-093267