Safety & First Aid Cognitive Rest After a Child's Head Injury By Catherine Holecko facebook Catherine Holecko is an experienced freelance writer and editor who specializes in pregnancy, parenting, health and fitness. Learn about our editorial process Catherine Holecko Reviewed by Reviewed by Alisa Baer, MD on July 31, 2020 facebook twitter linkedin instagram Alisa Baer, MD, is a board-certified pediatrician, nationally certified child passenger safety instructor, and co-founder of The Car Seat Lady. Learn about our Review Board Alisa Baer, MD Updated on February 16, 2021 Print Tom Sperduto / Aurora / Getty Images Table of Contents View All Table of Contents Types of Head Injuries Recovery at Home How Long to Rest Returning to School Emotional Challenges Risks of Not Enough Rest If your child has been diagnosed with a head injury, their doctor will probably recommend a period of both cognitive and physical rest. Each of these elements are critical for your child to make a full recovery. While cognitive rest allows the brain to heal, physical rest is important in the body's recovery process as well. It also ensures that your child is not taking part in physical activities before their coordination, reflexes, and other mental processes are back to normal. Both parents and doctors know that resting is easier said than done—especially for kids and teens who might need to (temporarily) give up their favorite activities. Types of Head Injuries The head injuries most commonly seen in children fall into three categories: ConcussionsContusionsSkull fractures A concussion occurs when a person's head is hit or shaken hard enough for the brain to move inside the skull. This movement causes bruising and stretching of the tissues inside, resulting in damage and chemical changes to brain cells. A brain contusion is a bruise on the brain that may cause swelling and bleeding inside the skull; contusions often have causes and symptoms that are similar to concussions. A skull fracture is a crack or break in the skull, which may or may not include an injury to the brain. Head injuries in children are an unfortunate but common event, with statistics of 1.7 million cases each year among U.S. children under 18 years old.While children can suffer concussions from a variety of causes, the most common causes are contact sports, recreational activities, and falls. Any head injury that involves cognitive symptoms including (but not limited to) headaches, loss of consciousness, confusion, or dizziness will most likely cause your child's doctor to prescribe cognitive rest as part of their recovery process, along with a gradual return to normal activities. Helping Your Child Recover at Home When your child is on complete rest—typically the first two to three days but possibly longer, depending on your doctor's recommendation—they will need to refrain from all physical and cognitive activity. During this time, your child will have to avoid the following activities: DrivingGoing to school (in person or online)Listening to the radio, podcasts, or audiobooksReading, writing, and studyingTaking part in any physical activityUsing any device with a screen (i.e. texting, playing smartphone games, using an e-reader or tablet, etc.)Watching TV or playing video gamesWorking on a computer Pay close attention to your child's symptoms while they are home during the first few days of recovery. Notice how they are acting, how much they are sleeping, and, of course, ask your child how they feel. Use this information to gauge when you think they are ready to begin doing "light cognitive activities" at home, for no more than 30 minutes at a stretch. Some suggestions to begin with are watching TV, drawing, or talking on the phone. If symptoms get worse after the activity, have your child take a 30 minute break before trying again. Slowly work up to longer time periods and activities that require more concentration, such as studying or working on a tablet or computer. For example, a child who likes to read might start by listening to audiobooks. The next day, they can try reading a few pages of a book. If they are still doing well the day after that, they can try reading an entire chapter. The Centers for Disease Control and Prevention (CDC) has a HeadsUp website that covers diagnosis, recovery, and returning to activities after a head injury. If you aren't sure what symptoms to look for or feel unsure about whether your child is ready for the next step, call your doctor. The CDC also offers a printable file of common concussion symptoms and tips for helping your child through their recovery. How Long Is Cognitive Rest Needed? While the exact timeline varies, concussion symptoms usually resolve in 14–21 days, on average. However, it is not necessary to follow a regimen of cognitive and physical rest until symptoms are completely gone. The CDC recommends that children begin to resume normal learning and social activities, also known as "return to learn," after no more than two to three days of rest. By this time, their symptoms should be lessening and most children will be able to handle some classwork, although they may need to skip tests or homework for several more days. This recommendation, which is echoed by the American Academy of Pediatrics (AAP), aims to strike a balance between getting enough cognitive rest but not too much. Avoiding normal social and academic activities for a longer period may result in extra emotional stress for some children. The AAP's guidelines state that children should return to school after a concussion when their symptoms become tolerable for at least 30–45 minutes at a time.They do not need to be completely free of symptoms before going back to class. Children are generally advised to refrain from physical activity for a longer period of time. This means that when they are ready to return to school, they still need to avoid activities such as: All P.E. and sports activitiesDance and other exercise classesPhysical play at recess Your child's pediatrician may recommend a second evaluation before clearing them to return to physical activities. Returning to School Once your child can manage cognitive activity at home without an increase in symptoms, they are ready to try going back to school. It is important for children and teens to make a gradual return to full academic and extracurricular activities. Be sure to communicate with your child's teachers and staff upon their return to class; teachers can help monitor your child's symptoms and allow them to slow down or take a break if needed. While doctors at the Cleveland Clinic recommend taking extra rest breaks as needed during the school day, they do not advise half days. Rather, students should go to school in the morning and complete as many classes that day as their symptoms allow. Your child might need additional accommodations at school, such as: Extended deadlines for assignmentsHelp from a note-taker and/or a tutorPostponed or staggered tests, or different ways of showing knowledge (such as a portfolio of past work or an oral exam instead of a written one)Reduced distractions and sensory inputs, such as bright lights and loud noises. This could mean moving a child's seat away from a window or closer to the front of the room. It could also mean avoiding crowded hallways and noisy lunchrooms. Some school districts have written policies for helping children adjust to a full school day following a concussion. Check with your child's teacher or principal to see if this is the case at your school. Emotional Challenges It's important to note that along with the more common symptoms of headaches and fatigue, head injuries in children and teens often cause emotional issues as well. Emotional changes you might notice in your child include: AnxietyConfusionFrustration or angerImpulsivityIrritabilitySadness Add to this the disappointment of having to lie on the couch for several days (or more) without friends, screens, and sports, and you have the perfect recipe for a cranky child. They may also express worry about falling behind in school or extracurricular activities, as well as missing out on socialization at school, with friends, and online. Children often need reassurance that while the recovery period from a concussion can be difficult, it's only temporary. In addition, following the doctor's recommendation for rest will actually speed up their recovery, whereas getting back to activities too soon can set them back. If your child seems especially eager to get back to their regular day-to-day life, you may need to remind them of how serious a head injury is, and that there are consequences of returning to learn or play before they have made a full recovery. 7 Things Your Child With a Concussion Can Do While in Recovery Risks of Not Enough Cognitive Rest Because a head injury makes it harder for children to think, concentrate, and remember information, allowing their brain to rest and heal is critical before returning to school and other activities. The authors of a report in the medical journal Pediatrics note that "using a concussed brain to learn may worsen concussion symptoms and perhaps even prolong recovery." A 2020 review and meta-analysis of studies including over 23,000 children found that children who have had one concussion are four times more likely to sustain another one. Due to these findings, the authors urged increased caution among doctors and sports officials in deciding when children can return to physical activity after a concussion. In addition, the CDC warns that with each successive brain injury, it takes less force to cause another injury and more time to recover from the damage. If not treated correctly, brain injuries can take months or even longer to heal, and may result in permanent neurological changes. Thus, cognitive rest is as important as physical rest in making a full recovery. If your child continues to show symptoms two to three weeks after a head injury, contact your doctor and ask for a referral to a neurologist or other specialist in concussion treatment. It's important to remember that a concussion isn't just a bump on the head—it is damage to the brain itself that can result in irreversible changes if not given the chance to heal properly. 5 Things to Expect During Your Child's Concussion Recovery Was this page helpful? Thanks for your feedback! Get expert tips to help your kids stay healthy and happy. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Cleveland Clinic. Concussion. Updated June 6, 2020. Stanford Children's Health. Head injury in children. Halstead ME, McAvoy K, Devore CD, et al. Returning to learning following a concussion. Pediatrics. 2013;132(5):948-957. doi:10.1542/peds.2013-2867 The Children’s Hospital of Philadelphia (CHOP). Return to learn after a concussion. Updated March 30, 2014. Centers for Disease Control and Prevention. Care of children with concussion (mTBI). Updated January 3, 2020. American Academy of Pediatrics. After a concussion: When to return to school. Updated November 12, 2018. Centers for Disease Control and Prevention. Returning to school after a concussion: A fact sheet for school professionals. January 2021. Van Lerssel J, Osmond M, Hamid J, Sampson M, Zemek R. What is the risk of recurrent concussion in children and adolescents aged 5-18 years? A systematic review and meta-analysis. Br J Sports Med. October 19, 2020. doi:10.1136/bjsports-2020-102967