Concussions and Head Injuries in Children
Returning to school and sport
After a concussion, your child should reduce both physical and cognitive (thinking) activities for 24 to 48 hours. This is typically called relative rest. After that, they should gradually return to activities of daily living and follow return to sport and return to school strategies.
To help your child return to school and sport, go through the steps below. Your child will be ready to move on to the next step when they can do the activities and handle their symptoms well. Each step in the return to sport and return to school process should take a minimum of 24 hours.
To guide your child’s activities, some steps use the principle that symptoms may get a little bit worse, but this should be mild and brief.
- Mild means that if your child thinks of their symptoms on a scale of 0 to 10, the new activity only makes the symptoms worse by 0 to 2 points. For example, you and your child can picture a scale like the example below to measure symptoms before and after an activity.
- Brief means that your child’s symptoms go back to the level that they were at before the activity within 1 hour.
If your child’s symptoms get worse by more than 2 points on a 0 to 10 scale, or if their symptoms (or worse symptoms) last for more than 1 hour, your child should either:
- do the activity in their current step for less time or at a lower intensity, or
- go back to the previous step
Your child can begin the return to sport steps at the same time they begin the return to school steps.
Give your child support and encouragement through their recovery and as they work through these steps. Make sure your child doesn’t go too quickly and takes rest breaks when they need to. Learning how to pace activity is an important part of concussion recovery.If your child is not gradually improving after 2 to 3 weeks, talk to your healthcare provider about a referral for rehabilitation or further evaluation by a specialist.
Your child’s healthcare provider may refer your child to a physiotherapist to support returning to activity and exercise. Seeing a physiotherapist can be especially helpful if your child has symptoms of dizziness, neck pain, or headaches that are persisting. Seeing an occupational therapist can be helpful with planning return to learning and to help with pacing, concentration, and cognitive challenges.
Some of the other healthcare professionals that your child may be referred to for further evaluation include a pediatrician (a doctor who specializes in children’s health), a sport medicine doctor, a physical medicine and rehabilitation specialist, or a neurologist.
During the return to school steps and the first 3 return to sport steps, symptoms that are mild (increase of 0 to 2 points on a scale of 0 to 10) and brief (last less than 1 hour) are OK. Mild symptoms are perceptible but tolerable and not activity-limiting.
When returning to school and sport, your child should not do any activities with any risk of contact, collision, or fall. Prior to returning to any activities with these risks, all of your child’s concussion-related symptoms should be gone and your child should be cleared by a qualified healthcare professional.
Return to school
Getting your child back to school will help them get back to doing regular activities again. Many children may not have any difficulty with school and returning to learn. In this case, your child may not need a step-by-step return to school strategy. However, if your child has symptoms with any cognitive or learning activities, they may need to follow the return to school strategy. It may take your child only a few days or up to a few weeks to finish the steps of returning to school full time.
Step 1 – Start at-home activities
- After 1 to 2 days of relative rest, your child can start at-home activities before they go back to school.
- Your child should limit screen time and cellphone use to 15 to 20 minutes at a time to start.
- Your child should start doing gentle activities such as walking and light reading.
- Your child can do homework in 2 sessions for 15 to 20 minutes each. Have them take a 15-minute break between sessions.
Step 2 – Returning to school-related activities
- Your child should go to bed at a regular time and get 8 to 10 hours of sleep each night (including weekends).
- Your child can start doing homework, reading, or other cognitive activities outside of the classroom. If they tolerate this well, then consider returning to the classroom.
Step 3 – Returning to school part time
- Your child can start going to school for half days and work up to a full day of classes.
- Your child should go to quieter classes to start (such as art class rather than music class) and avoid those that are harder for them until they feel better. Returning to physical education (gym) classes should follow the return to sport steps below.
- You can talk to your child’s teacher about making some temporary changes to help them adjust to school such as:
- having no exams during the first 2 weeks
- sitting at the front of the class so there are fewer distractions
- having a quiet space in school to relax for 20 to 30 minutes
- changing classes before the bell rings so there is less noise and less congestion in the hallways
- You should try to drive your child to and from school or arrange rides for them so they don’t have to spend as much time walking, taking the bus, and carrying heavy books and other items.
- Aim to start providing regular structured days, like having your child go to bed and wake up at the same time as previously.
- Your child may take only a 30-minute nap a day, if needed.
- Your child can only do 2 homework sessions for 30 minutes each. They should take a 15-minute break between sessions.
- Gradually progress until:
- Your child is back to full days of school on most or all days of the week.
- Your child goes to all classes, and is carrying their books, and takes the bus or returns to their regular way of getting to and from school.
- Your child takes regular exams, sits in their normal spot in class, and needs fewer rest breaks in a quiet space.
Step 4 – Back to school full-time
- Your child is back to a normal, full workload at school, including taking all exams.
- Your child may also be ready to return to regular sport practices and at-risk activities at school if they are at step 4 of the return to sport steps (below). Talk to your child’s healthcare provider to see if they can have medical clearance to return to full-contact practice and game play.
Return to sport
Your child can begin the return to sport steps at the same time they begin the return to school steps. Spend at least 1 day on each of the steps.
- Steps 1 to 3 are the treatment phase. In steps 1 to 3, your child will be ready to move on to the next step when they are able to do the activities and have only mild and brief symptoms. Mild means that if your child thinks of their symptoms on a scale of 0 to 10, the new activity only makes the symptoms worse by 0 to 2 points. Brief means that your child’s symptoms go back to the level that they were at before the activity within 1 hour. Concussion-related symptoms are only allowed during the treatment phase.
- Steps 4 to 6 are the return to sport phase. Your child should have no concussion-related symptoms during these steps. In this phase, your child should only move on to the next step if they can do the activities and have had no symptoms for the previous 3 steps.
If your child is part of a high-level organized sport, talk to a sports medicine doctor or your child's healthcare provider before they return to regular sports activities.
Step 1 – Start at-home activities
After 1 to 2 days of relative rest, your child can start doing regular day-to-day activities, such as reading, texting, having screen time, and walking, as long as any changes to their symptoms are mild and brief. Your child can start doing 5 to 15 minutes of these activities at a time, and slowly start doing them for more time.
Step 2 – Symptom-tolerated aerobic exercise
- Your child can do light aerobic activities. These activities depend on the age of your child and may include walking, light jogging, or cycling on a stationary bike.
- Your child should do a maximum of 15 to 20 minutes of light aerobic exercise, twice a day. These activities should not include any risk of contact, collision, or fall.
- Symptoms can increase mildly (0 to 2 points on a scale of 0 to 10) and briefly (less than 1 hour). If the symptoms get worse than this or last longer than this, decrease the intensity of the exercise or how long your child is doing the exercise for.
- Your child should not do resistance training or lift weights. Wait until step 3 for resistance training or lifting weights.
- For the first day in step 2, your child should exercise at 55% of their age-predicted maximum heart rate. Use the table below to calculate this heart rate.
- For the second day in step 2, your child should exercise at 70% of their age-predicted maximum heart rate. Use the table below to calculate this heart rate.
Step 3 – Sport-specific training and exercise
- Your child can do a maximum of 20 to 30 minutes of general conditioning exercise, such as running, throwing, or kicking a ball, twice a day.
- Your child should avoid any activities where they could collide (crash into objects or other people) or activities where there is risk of another impact to the head.
- The goal of this step is to reintroduce movement, changing directions, and activities that are specific to the sport to start “retraining” your child’s brain to go back to typical activities.
Before going to Step 4: Your child should get medical clearance from a qualified healthcare professional before starting the next steps, which are called the return to sport phase. In this phase, the risk of contact, collision, and falling are reintroduced. Because of this, your child should no longer have any concussion-related symptoms in steps 4, 5, or 6. Your child’s healthcare professional should not be able to detect any problems that show that your child’s brain is not yet recovered.
Step 4 – Drills with no contact
- Your child can do activities with teammates.
- Your child should avoid contact drills such as checking, heading the ball, tackling, or live scrimmages.
- Your child can start resistance training and working on multiplayer drills for their sport.
- Once your child feels good doing basic skills, they can start to do harder skills for their sport and work up to participating in gym class or a full team practice.
Step 5 – Full-contact practice
- Your child returns to full-contact practice after being able to complete step 4 without any return of symptoms.
Step 6 – Full-contact training and game play
- Your child can start with scrimmages with teammates and work up to regular competitive games.
To see this information online and learn more, visit MyHealth.Alberta.ca/health/pages/conditions.aspx?Hwid=custom.ab_concussion_schoolsport_ac_child.
Related to Concussions and Head Injuries in Children
For 24/7 nurse advice and general health information call Health Link at 811.
Current as of: March 2, 2026
Author: Children's Health, Alberta Health Services
This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.
