Return to Learn After a Concussion

When can my child return to school?

It will depend on your child. Every child’s injury and recovery is unique and requires careful observation from parents and doctors. You can promote recovery and prevent ongoing symptoms by following a “return to learn” plan like the one below. Your doctor will customize this plan based on your child’s recovery, and your child will move through the plan at his or her own pace.

Return to learn plan

Step 1

Immediately after a concussion, it is beneficial to take a break from cognitive (thinking, processing) activities for up to a few days.

This may mean no school, no homework, no computer, no texting, no video games and maybe no TV if it makes symptoms worse. In general, it is beneficial to minimize screen time.
As symptoms improve, slowly reintroduce light cognitive activity. Initial activities may include watching TV, listening to audio books, drawing and cooking, as long as they do not increase symptoms.

Step 2

Light cognitive activity is resumed once your child has had significant improvement in symptoms at rest.

Your child may do activities that do not cause symptoms to get worse.
Initially, your child may only tolerate five to 15 minutes of work at a time. Stop the activity when moderate symptoms develop.
Your child may increase the length of cognitive activity as long as symptoms do not worsen significantly or as long as symptoms improve within 30 minutes of taking a break.

Step 3

School-specific activity should be increased gradually:

When feeling better, your child should try to do some schoolwork at home, increasing the duration as tolerated.
Your child should continue to participate in this activity in short bursts of time (up to 30 minutes) as tolerated and then work up to longer time periods.

Step 4

Follow these guidelines to determine when your child is ready to return to school:

When your child is able to do one hour of homework at home for one to two days, she may try to return to a modified school schedule. Examples of a modified schedule: A decreased number of classes, adjustments to decrease reading and note taking, and extra time to complete assignments and tests.
If symptoms develop while your child is at school, she should take a break in a quiet, supervised area until symptoms improve. When symptoms improve, she may return to class.
Your child may increase her time in school as tolerated.

Call 911 if your child has any of the following symptoms

Seizures (twitching or jerking movement of parts of the body; may look stiff)
Weakness or tingling in the arms or legs
Cannot recognize people or places
Confused, restless or agitated
Impaired consciousness
Difficult to arouse or unable to awaken
Repeated vomiting
Slurred speech
Bloody or clear fluid from the nose or ears

Q&A About School Re-entry After a Concussion
School Nurse: Why do providers give schools different recommendations for each student?

Matthew Grady, MD: No two concussions are the same. So as a result, the recommendations from a physician regarding school reentry may have to be individualized. As such, some students may be able to transition quickly back to school and may miss little or no time. Other students with more severe concussions may have a prolonged recovery.

The Return-to-Learn plan was developed specifically with the idea that students need to go back to school. The plan is outlined on our website. It's designed to walk someone through step-by-step, gradually increasing their cognitive activity. We hope, if they follow this plan, the recovery will be smooth and faster than if they try to do too much too soon.

Athletic Director: Does a school need to follow the exact recommendations of the physician?

Matthew Grady, MD: I think we should get students back to school as their symptoms allow, and as such, that isn't something that's legislated. Return back to sports is a clearance, and so that's the end of the process. Return back to school is the beginning of the process. So I don't want to delay return back to school due to legal considerations. I would like the schools to be seen as a partner, and so I'm perfectly happy with the schools modifying the plans that I'm giving as long as we're preserving the spirit of the plan. Students and educators are in the school and may be able to come up with more creative or better solutions than a physician in the office can. As such, we would ask our school administrators to help with this process.

School Nurse: Why do some medical providers clear students to return to their sports even though they are still symptomatic in the school setting?

Matthew Grady, MD: Doctors should not be clearing kids to return to play if they're clearly symptomatic. In general, I don't think physicians are intentionally clearing kids to play if they're symptomatic. We know that students may have symptoms in a certain setting but not have symptoms in another setting. And I think, as part of the medical team, we want to make sure that all of the people are working together and we're getting a complete picture for the student athlete. If the communication is not good between the school and the provider and the parents, then a doctor may inappropriately clear a student athlete back to play because they didn't have the correct information. Sometimes in prolonged concussion cases, doctors give partial clearance to return to play. In general, I think of aerobic activity as part of rehabilitation. I will allow athletes to do non-contact activity, such as tennis or swimming or cross-country, because that helps with recovery.