Cognitive Rest After a Child's Head Injury

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.

Refraining from certain physical activities helps prevent a second head injury before the first is healed, especially because the consequences are much greater when two head injuries occur in a short time period. In most cases, a single concussion should not cause permanent damage. However, a second concussion soon after the first one does not have to be very strong for its effects to be permanent.

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. Of course, some physical activities like walking carry a very low risk of head injury whereas sports like football, soccer, and others carry a significantly higher risk of head injury. So, you will need to verify with your doctor what your child can and cannot do.

Types of Head Injuries

The head injuries most commonly seen in children fall into three categories:

• Concussions
• Contusions
• Skull fractures

A concussion is a brain injury that causes temporary loss of normal brain function. It 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 one of the bones of the skull, which may or may not include an injury to the brain.

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 doctor may recommend avoiding the following activities:

• Driving
• Going to school (in person or online)
• Listening to the radio, podcasts, or audiobooks
• Reading, writing, and studying
• Taking part in any physical activity
• Using any device with a screen (i.e. texting, playing smartphone games, using an e-reader or tablet, etc.)
• Watching TV or playing video games
• Working 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. Contact your child's doctor if you notice anything concerning or out of the ordinary such as worsening headaches, slurred speech, seizures, lethargy, or repeated vomiting.

Your doctor will provide guidelines on when your child can begin doing "light cognitive activities" at home such as 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. If these symptoms persist, be sure to let your doctor know.

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.

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 activities
• Dance and other exercise classes
• Physical 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. It is important to emphasize that kids are students first and athletes second. Return to learn happens first, then return to play. 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.

Kids will likely need to take extra rest breaks as needed during the school day. However, many doctors do not advise half days. Instead, they recommend 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 assignments
• Help from a note-taker and/or a tutor
• Postponed 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:

• Anxiety
• Confusion
• Frustration or anger
• Impulsivity
• Irritability
• Sadness

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.

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.

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. What's more, the chances of lasting brain damage increase.

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.

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.