Provide patients/caregivers with handouts outlining Return-to-School and Return-to-Activity protocols. Provide written instructions on when to return to ED/primary care provider.
If required, use printable Medical Assessment Letter to document the injury and assessment.
Counsel gentle activities around the house, including social interactions and light walking (if tolerated) for the first 24-48 hours post-injury and physical and cognitive relative rest (if needed). Complete rest for more than 24- 48 hours may negatively impact recovery.²
Recommend that physical and cognitive activity be started 24-48 hours after acute concussion, increasing the intensity gradually as part of the initial treatment. Activities that pose no/low risk of reinjury should be resumed even if mild residual symptoms are present.
Screentime should be minimized in the first 48 hours after injury. After 48 hours, screentime may be gradually resumed and increased according to symptom tolerance as the child/adolescent recovers.¹⁰
Most children recover within 2-4 weeks, although 30% may have persistent symptoms after 1 month.⁹
Recommend medical follow-up 1-2 weeks following the injury or earlier if symptoms worsen. Initiating clinical care early (within 8 days) is associated with improved recovery times.⁷

Medical clearance is not required to return to school. Gradual return to school (Return-to-School Steps) should be encouraged as soon as possible, even if symptoms are still present. Prolonging the return to school may be detrimental to recovery. Complete absence from school for more than one week is not recommended.
Children with concussion should return to school after a short break (24-48 hours at most) and as soon as they can tolerate academic activities with adequate accommodations in place. Any school-related activity that has a risk of reinjury should be avoided until medically cleared.

Resume physical activities by 24-48 hours post-injury (at most). Gradually increase the intensity of aerobic activity as part of the initial treatment for acute concussion using a step-wise Return-to-Activity protocol.
Start with ‘light-intensity’ aerobic exercise, progressing to ‘moderate-intensity’ aerobic exercise, and continue to increase the intensity over time as symptoms are tolerated. Mild exacerbation of symptoms is common; suggest taking a break from the activity if increase in symptoms is more than mild/brief or the symptoms cannot be tolerated.^1,2
Avoid contact sports/activities that risk reinjury until:
1. full return to school without concussion-related academic accommodations AND
2. medical clearance for full-contact sport and high-risk activities
Written determination of medical clearance should be provided before unrestricted return to sport as directed by local laws and/or sporting regulations.
Patients experiencing concussion-related symptoms after medical clearance should return to their health care provider for reassessment with a goal of full resolution of symptoms with exertion before engaging in high-risk activities.